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Zey øving > Antiviral 1 > Flashcards

Antiviral 1 Flashcards

1
Q

Nucleoside analogues

A

Acyclovir Famciclovir Valacyclovir Panciclovir Ganciclovir Valganciclovir Cidofovir Trifluridine

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2
Q

Nucleoside analogues - MoA

A

Prodrugs that are converted to monophosphate by virus enzymes, and then to active triphosphate metabolites by host enzymes. Competitive inhibition of viral DNA polymerase.

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3
Q

Acyclovir - Clinical use

A

HSV, VZV Prophylaxis of CMV Chickenpox IV form: most effective treatment for serious herpesvirus infections, including herpetic encephalitis and severe HSV and VZV infections in immunocompromised patients Topical form: herpes genitalis and mild mucocutaneous infections in immunocompromised patients. In cases of herpes genitalis, however, topical form is less effective than oral form

Herpetic encephalitis

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4
Q

Acyclovir - Adverse effects

A

Well tolerated Headache, GI disturbances, rash (General for all the nucleoside analoges) IV: phlebitis + reversible renal dysfunction

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5
Q

Famciclovir - Clinical use

A

HSV VZV

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6
Q

Valacyclovir - Clinical use

A

HSV, VZV Prophylaxis of CMV , such as in bone marrow and organ transplant recipients and in persons with HIV

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7
Q

Panciclovir - Clinical use

A

Herpes labialis

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8
Q

Ganciclovir - Clincal use

A

Prevent CMV diseases, including retinitis, esophagitis, and colitis HSV: keratitis (infection of the corneal epithelium) caused by HSV-1 and HSV-2

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9
Q

Ganciclovir - Adverse effects

A

Leukopeina, thrombocytopenia Retinal detachment, liver and renal dysfunction

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10
Q

Ganciclovir - Interactions

A

Severe myelosupression with zidovudine

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11
Q

Valganciclovir - Clinical use

A

Prevent and treatment of less severe CMV infections, including those occurring in renal and heart transplant patients

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12
Q

Cidofovir - Clinical use

A

Prevent CMV diseases resistant to ganciclovir

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13
Q

Cidofovir - Contraindications

A

Contraindicated in patients taking other nephrotoxic drugs, such as aminoglycosides and amphotericin B.

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14
Q

Cidofovir - Adverse effects

A

Nephrotoxicity, neutropenia, metabolic acidosis.

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15
Q

Trifluridine - Clinical use

A

Ocular herpervirus infections, primarily herpetic epithelial keratitis and keratoconjuctivitis

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16
Q

Pyrophosphate derivative (HSV drug)

A

Foscarnet

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17
Q

Foscarnet - MoA

A

Blocks pyrophosphate-binding sites on viral DNA polymerase and prevents attachment of nucleotide precursor to DNA. Does not need activation by viral/host kinases.

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18
Q

Foscarnet - Clinical use

A

CMV, VZV, HSV CMV retinitis in AIDS patients Acyclovir-resistant HSV infections Shingles Combined with ganciclovir to treat infections resistant to either drug alone because of their synergistic effect on viral DNA polymerase

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19
Q

Foscarnet - Adverse effects

A

Renal impairment and acute renal failure, hematologic deficiencies, cardiac arrhythmias + heart failure, seizures, pancreatitis Renal toxicity can be minimized by administering intravenous fluids to induce diuresis before and during treatment

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20
Q

Nucleoside reverse transcriptase inhibitors (NRTIs)

A

Didanosine Lamivudine Stavudine Emtricitabine Zidovudine (ZDV) Abacivir (ABC) Tenofovir

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21
Q

Nucleoside reverse transcriptase inhibitors (NRTIs) - MoA

A

Triphosphate metabolites of the drug compete with nucleoside triphosphates for incorporation into viral DNA. Cause DNA chain termination. Inhibit host cell DNA polymerase somewhat.

22
Q

Nucleoside reverse transcriptase inhibitors (NRTIs) - Clinical use

A

HIV Some are active for Epstein-Barr virus and hepatitis B virus

23
Q

Nucleoside reverse transcriptase inhibitors (NRTIs) - Special considerations

A

Included in almost all HIV treatment regimens. Often more effective with multiple NRTIs (antimetabolites of different bases of DNA). Cross BBB. Careful with renal impairment

24
Q

Nucleoside reverse transcriptase inhibitors (NRTIs) - Adverse effects

A

Lactic acidosis, hepatic steatosis, lipodystrophy

25
Q

First line HIV drugs

A

Abacivir (ABC) Tenofovir Emtricitabine Lamivudine

26
Q

Alternative for 1st line drugs for HIV

A

Stavudine Didanosine

27
Q

ucleoside reverse transcriptase inhibitors (NRTIs) - For treatment of hepatitis B

A

Lamivudine Tenofovir

28
Q

Which NRTI is used to treat HIV in pregnant women?

A

Zidovudine (ZDV)

29
Q

Which NRTIs are not used together and why?

A

Zidovudine and stavudine because they appear to be antagonistic

30
Q

Abacavir - Adverse effects

A

Hypersensitivity reactions

31
Q

Which NRTIs cause Pancreatitis and Peripheral neuropathy

A

Didanosine and Stavudine

32
Q

Tenofovir - Adverse effect (the most important)

A

Renal impairment

33
Q

Zidovudine - Adverse effect (the most important)

A

Bone marrow suppression

34
Q

Nonnucleoside reverse transcriptase inhibitors (NNRTIs)

A

Efavirenz Nevirapine Delavirdine

35
Q

Nonnucleoside reverse transcriptase inhibitors (NNRTIs) - MoA

A

Direct inhibition of reverse transcriptase

36
Q

Nonnucleoside reverse transcriptase inhibitors (NNRTIs) - Clinical use

A

HIV

37
Q

Nonnucleoside reverse transcriptase inhibitors (NNRTIs) - Special considerations

A

Cross BBB Act synergistically with NRTIs and PIs against HIV. Never used alone for HIV

38
Q

Nonnucleoside reverse transcriptase inhibitors (NNRTIs) - Contraindications

A

Contraindicated for hepatic impairment

39
Q

Nonnucleoside reverse transcriptase inhibitors (NNRTIs) - Adverse effects

A

Moderately well tolerated Rash (can progress to Stevens-Johnson syndrome) Hepatotoxicity Drug interactions

40
Q

Which is the most potent NNRTI?

A

Efavirenz

41
Q

Efavirenz - Contraindications

A

Contraindicated during pregnancy

42
Q

Efavirenz - Adverse effects

A

Teratogenic Neuropsychiatric reactions

43
Q

Nevirapine - Interactions

A

Induces CYP3A4 + CYP2B6: Increases metabolism of certain drugs Increases metabolism of PIs, contraceptive steroids, other drugs

44
Q

Nevirapine - Adverse effects

A

Hepatotoxicity, rash (+Stevens-Johnson syndrome)

45
Q

Delavirdine - Special consideration

A

Usually not recommended for HIV (less potent)

46
Q

Protease inhibitors (PIs) (Most important)

A

Ritonavir Atazanavir Darunavir

47
Q

Protease inhibitors (PIs) - MoA

A

Bind HIV protease and inhibits proteolytic activity. Production of immature, noninfectious viral particles.

48
Q

Protease inhibitors (PIs) - Clinical use

A

HIV

49
Q

Protease inhibitors (PIs) - Adverse effects

A

Lipodystrophy, hyperlipidemia, insulin resistance and DM, liver dysfunction, hepatitis.

50
Q

Protease inhibitors (PIs) - Interactions

A

Inhibits metabolism of other drugs: PIs, antiarrhythmic agents, opioids, tricyclic antidepressants Nevirapine: Increase PI metabolism.

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