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Drugs- Basic High Yield Stuff for Boards > Antiviral > Flashcards

Antiviral Flashcards

1
Q

Oseltamivir, Zanamivir:
MOA
Clinical Use
Administration

A

Inhib Flu Neuraminidase–>decrease release of progeny virus (DOESN’T KILL VIRUS)

  1. Flu A&B treatment/prevention
    * given within 48hrs of Symptoms (F/myalgias)
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2
Q

Acyclovir, famciclovir, valacyclovir (prodrug):
MOA
MOResistance

A

Guanosine Analogs
RXN: Guanine –> Guanine-P –> Guanine-PPP
1. monophosphorylation occurs via HSV/VZV thymidine kinase
2. Triphosphate formed by cellular enzymes
3. preferentially inhib viral DNA polymerase by chain termination

  • phophorylation will only take place in uninfected cells–> few adverse cells

Resistance: Mutated viral thymidine kinase

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3
Q 
Acyclovir, famciclovir, valacyclovir (prodrug):
Clinical use(3)
A

Acute/reactivation HSV, VZV, EBV (weak)

  1. HSV mucocutaneous/genital lesion
  2. HSV encephalitis
  3. Px: immunocompromised patients
  • NOT FOR LATENT FORMS OF HSV/VZV
  • Valacyclovir=prodrug–>better oral bioavailability
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4
Q

Drug used to treat Herpes Zosters

A

famciclovir

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5
Q

Acyclovir, famciclovir, valacyclovir (prodrug):
Adverse
How to avoid adverse?

A
  1. obstructive crystalline nephropathy
  2. Acute Renal Failure
  • Make sure patient stays HYDRATED
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6
Q

Ganciclovir, Valganciclovir (prodrug):
MOA
MOResistance

A

Guanosine analog
Guanosine Analogs
RXN: Guanine –> Guanine-P –> Guanine-PPP
1. monophosphorylation occurs via CMV viral kinase
2. Triphosphate formed by cellular enzymes
3. preferentially inhib viral DNA polymerase by chain termination

Resistance: mutated viral kinase

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7
Q

CMV types of infections in immunocompromised (3)

A
  1. CMV colitis
  2. CMV retinitis
  3. CMV esophagitis
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8
Q

Ganciclovir, Valganciclovir (prodrug):

Clinical Use

A
  1. CMV, esp in immunocompromised patients

2. Valganciclovir=prodrug–> better oral bioavailability

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9
Q

Ganciclovir, Valganciclovir (prodrug):
Adverse
Compare toxicity of ganciclovir w/ acyclovir

A
  1. Bone Marrow Suppression (leukopenia, neutropenia, thrombocytopenia)
  2. Renal tox

toxicity: ganciclovir > acyclovir

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10
Q 
CMV details:
Histo
Latent in which cells
infections
transmission:
A

Histo: owl’s eye inclusions
* latent in mononuclear cells

  1. congenital infection (TORCH)
  2. Mono (monospot -)
  3. pneumonia
  4. retinitis

-congenital, transfusion/transplant, sex, saliva, urine

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11
Q

Foscarnet:
MOA
MOResistance

A

Pyrophosphate analog (“pyro’FOS’phate”)

  • ->binds pyrophosphate-binding site of enzyme
    1. viral DNA/RNA polymerase inhib
    2. HIV reverse transcriptase inhib
  • does not require any kinase activation

Resistance: Mutated DNA polymerase

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12
Q

Foscarnet:

Clinical use

A

2nd line for CMV/ HSV

  1. CMV retinitis in immunocomp. pt. when ganciclovir fails
  2. acyclovir-resistant HSV

*can be used when resistance develops to ganciclovir/acyclovir b/c Foscarnet doesn’t require any kinase activation

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13
Q

Foscarnet:

Adverse

A
  1. Nephrotox –>electrolyte abn (+/- Ca+2, +/- Phosphate, hypokalemia, hypomagnesemia)
  2. seizures (from electrolyte imbalance)
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14
Q

Which B-lactam Abx can cause seizures?

A

Carbapenems

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15
Q

Drugs which induce seizures

A

“With seizures, I BItE my tongue”

  1. Isoniazid (B6 def)
  2. Buproprion
  3. Imipenem/cilastatin
  4. Enflurane
  5. Foscarnet(from nephrotox)
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16
Q

Cidofovir:
MOA
Half-life?

A

inhib viral DNA polymerase
-DOESN’T REQUIRE VIRAL KINASE PHOSPHORYLATION

-long half-life

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17
Q 
Cidofovir:
Clinical use (2)
A
  1. CMV retinits in immunocompromised patients

2. acyclovir-resistant HSV

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18
Q

Cidofovir:
Adverse
How to decrease toxicity?

A

Nephrotox

coadmin w/ Probenecid + IV saline

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19
Q

Compare Foscarnet vs. Cidofovir:
MOA
Clinical Use
Adverse

A

Foscarnet: inhib both RNA/DNA pol & HIV RT
Cidofovir: inhib only DNA pol

  • both second line only
  • both cause Nephrotox
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20
Q

What is HAART?
When does it begin
Describe regimen

A

“highly active antiretroviral therapy”

-often initiated at time of HIV diagnosis. Strongest indication for patients presenting with AIDS-defining illness, low CD4+ cell counts (

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21
Q

NRTIs:

Name (7)

A

Nucleoside RT inhib.

  1. Abacavir (ABC)
  2. Didanosine (ddl)
  3. Emtricitibine (FTC)
  4. LamiVUDINE (3TC)
  5. StaVUDINE (d4T)
  6. Tenofovir (TDF)
  7. ZidoVUDINE (ZDV)

“haVE U DINED (VUDINE) with my NUCLEAR (NUCLEOSIDE) family?”

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22
Q

NRTIs:

MOA

A

Competitively inhib Nucleotide binding to RT and terminate the DNA chain (lack 3’OH group)

*Require Phosphorylation to be active!

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23
Q

Unique characteristic of Tenofovir

A

‘T’enofovir is a nucleo’T’ide–> doesn’t require phosphorylation to become active

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24
Q

2 uses Zidovudine

A
  1. general prophylaxis

2. during pregnancy to decrease risk of fetal transmission

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25
Q

Who is Abacavir contraindicated in?

A

pt with HLA-B*5701 mutation

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26
Q

NRTIs:
Adverse
How to decrease/overcome toxicity

A
  1. Bone Marrow suppression (reverse w/ G-CSF or EPO)
  2. peripheral neuropathy
  3. lactic acidosis (nucleosides)
  4. anemia (ZDV)
  5. pancreatitis (didanosine)
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27
Q

NNRTIs:

Name 3

A

Non-nucleoside RT inhib

  1. Delavirdine
  2. Efavirenz
  3. Nevirapine
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28
Q

NNRTIs:

MOA

A

Bind Reverse Transcriptase at different site than NRTI

*don’t require phosphorylation to be active

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29
Q

NNRTIs:

Common adverse for all?

A
  1. Rash

2. Hepatotox (Allman taught not to start this class unless CD4 count was significantly low)

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30
Q

NNRTIs:

Which causes vivid dreams and CNS symptoms?

A

Efaviren’Z’

*efaviren’z’ gives you cra’z’y ‘zzz’s’

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31
Q

NNRTIs:

which are contraindicated in pregnancy? (2)

A
  1. Delavirdine

2. Efavirenz

32
Q

Protease Inhibitors:

Name (7)

A

“-navir” –> “NAVIR (never) TEASE a PROTEASE”

  1. Atazanavir
  2. Darunavir
  3. Fosamprenavir
  4. Indinavir
  5. Lopinavir
  6. Ritonavir
  7. Saquinavir
33
Q

Protease Inhibitors:

MOA

A

Assembly of virons depends on HIV-1 protease (pol gene), which cleaves the polypeptide products of HIV mRNA into their functional parts. –>prevent maturation of new viruses

34
Q

Protease Inhibitors:
which can boost the other drug concentrations?
How?

A

Ritonavir

- inhib P450

35
Q 
Protease Inhibitors:
common Adverse(3)
A
  1. hyperglycemia –>DM
  2. GI intolerance (N/D)
  3. Lipodystrophy –>Cushing-like syndrome
36
Q

Protease Inhibitors:

Which causes Nephropathy/hematuria/ kidney stones?

37
Q

Protease Inhibitors:

DD interaction

A

Rifampin

-potent CYP inducer (which would decrease protease inhib. concentration)

38
Q

Integrase Inhibitors:

Name (3)

A

“-TEGRAvir”

  1. Raltegravir
  2. Elvitegravir
  3. Dolutegravir
39
Q

Integrase Inhibitors:
MOA
Adverse (1)

A

-inhib HIV genome INTEGRATION into host chromosome by reversibly inhib HIV integrate

Adverse: increase creatine kinase

40
Q

Fusion Inhibitors:
Name 2
Adverse

A
  1. Enfuvirtide
  2. Maraviroc

-Skin Rxn at injection site

41
Q

Fusion Inhibitors:

MOA Enfuvirtide

A

binds gp41 –> inhibiting viral entry

“‘E’arly in # for ‘FU’sion”

42
Q

Fusion Inhibitors:

MOA ‘M’araviroc

A

Binds CCR-5 on surface of ‘M’onocytes/Tcells–> inhib interaction with gp120

43
Q

Which antiviral/class?:

screen HLA-B*5701?

A

Abacavir (NRTI)

44
Q

Which antiviral/class?:

BM suppression

A

NRTI

Zidovudine also causes anemia

45
Q

Which antiviral/class?:

pancreatitis

A

Didanosine (NRTI)

46
Q

Which antiviral/class?:

Peripheral neuropathy

47
Q

Which antiviral/class?:

rash

48
Q

Which antiviral/class?:

Lactic Acidosis

49
Q

Which antiviral/class?:

Liver tox

50
Q

Which antiviral/class?:

viral booster

51
Q

Which antiviral/class?:

Nephrolithiasis

52
Q

Which antiviral/class?:

Insulin resistance/DM

A

Protease Inhib (‘-navir’)

53
Q

Which antiviral/class?:

injection site rxn

A

Enfuvirtide/ maraviroc

54
Q

Which antiviral/class?:

restricted to CCR5 tropic virus

55
Q

Interferons:
MOA
Adverse (4)

A

Glycoproteins normally synthesized by virus-infected cells, exhibiting a wide range of ANTIVIRAL & ANTITUMOR properties (paracrine signaling)

  1. Flu-like sump
  2. depression
  3. Neutropenia
  4. Myopathy
56
Q 
Interferon-alpha:
Clinical use (6)
A
  1. Hep B/C
  2. Kaposi (HHV8)
  3. Condyloma acuminatum (HPV 6, 11)
  4. Renal cell carcinoma
  5. Hairy cell leukemia
  6. Melanoma
57
Q

Interferon-beta Clinical use

Interferone-gamma clinical use

A

IFN-B: MS
IFN-g: CGD (by increasing phagocyte release of Superoxide species to improve microbicidal properties–>decrease risk by 70% of serious infections)

58
Q

Ribavirin:
MOA
Clinical Uses (2)
Adverse (2)

A

Competitively inhibiting Inosine Monophosphate Dehydrogenase–> inhib synthesis of Guanine Nucleotides

  1. Chronic Hep C 2. RSV(2nd line)

Adverse: 1. hemolytic anemia 2. severe teratogen

59
Q

What is the preferred for treatment for RSV in children?

A

Palivizumab

60
Q

Sofosbuvir:
MOA
Clinical Use (combo of…)
Adverse (3)

A

Inhib HCV RNA-dep-RNA-pol acting as a chain terminator

  1. chronic HCV in combo w/ Ribavirin, +/- Peg IFN-a
    (Never a Monotherapy)

Adverse: 1. Fatigue 2. HA 3. N

61
Q

Simeprevir:
MOA
Clinical Use (combo of…)
Adverse (2)

A

HCV protease inhibitor–> stop viral replication

  1. chronic HCV in combo w/ Ledipasvir (NS5A inhib)
    (Never a Monotherapy)

Adverse: 1. Photosensitivity 2. Rash

62
Q

Infection control techniques:
describe Autoclave
Sporicidal?

A

pressurized steam at >120C

possibly sporicidal

63
Q

Infection control techniques:
describe Alcohols and Chlorhexidine
Sporicidal?

A 
denature proteins and disrupt cell membranes
NOT Sporicidal  (will kill bacteria and viruses)
64
Q

Infection control techniques:
describe Hydrogen peroxide
Sporicidal?

A

Free radical oxidation

SPORICIDAL

65
Q

Infection control techniques:
describe Iodine and Iodophors
Sporicidal?

A

Halogenation of DNA, RNA, and proteins

possibly sporicidal

66
Q

differentiate btw Disinfecting and Sterilizing?

A

Disinfect- decrease pathogens

Sterilizing- destroy living things

67
Q

C.diff is a common cause of hospital infections. What is the best way to eliminate it?

A

C.diff is spore forming

```
#1= hydrogen peroxide
followed by autoclave/ iodine&iodophors
~~~

68
Q

Antimicrobials to Avoid in Pregnancy:

8 drugs

A

“SAFe Children Take Really Good Care”

  1. Sulfonamides
  2. Aminoglycosides
  3. Fluroquinolones
  4. Clarithromycin
  5. Tetracyclines
  6. Ribavirin
  7. Griseofulvin
  8. Chloramphenicol
69
Q

Antimicrobials to Avoid in Pregnancy:

Kernicterus causing

A

sulfonamides

70
Q

Antimicrobials to Avoid in Pregnancy:

ototoxicity causing

A

aminoglycosides

71
Q

Antimicrobials to Avoid in Pregnancy:

cartilage damage

A

fluoroquinolones

72
Q

Antimicrobials to Avoid in Pregnancy:

embryotoxic

A

clarithromycin

73
Q

Antimicrobials to Avoid in Pregnancy:

discolored teeth, inhib of bone growth

A

tetracyclines

74
Q

Antimicrobials to Avoid in Pregnancy:

teratogenic (2)

A
  1. Ribavirin

2. Griseofulvin

75
Q

Antimicrobials to Avoid in Pregnancy:

Gray baby syndrome

A

Chloramphenicol

76
Q

Drugs which inhibit IMP dehydrogenase (2)

A
  1. Ribavirin (used to treat Hep C

2. Mycophenolate (used to prevent organ transplant)

77
Q

What is the triple therapy for Hep C?

A
  1. Ribovirin
  2. Simeprevir
  3. Peg IFN-a

Drugs- Basic High Yield Stuff for Boards (20 decks)

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