Antiviral

Question 1

What are the types of drugs are used for influenza?

Answer 1

• Neuraminidase inhibitors
• M2 Inhibitors

Question 2

Neuraminidase inhibitors MOA, uses, AE

Answer 2

Oseltamivir (oral), Peramivir (IV), Zanamivir (intranasally)

MOA: inhibits neuraminidase which cleaves sialic acid residues from viral proteins and surface proteins > prevents viral release and spread

Uses: Tx Influenza A and B within 48hrs of onset

AE: GI disturbances (Oseltamivir), itching/flu-like (Peramivir), Airway iritation (Zanamivir)

Question 3

M2 Inhibitors MOA, uses, AE

Answer 3

Amantadine, Rimantadine

MOA: inhibits function of membrane M2 protein an acid activated proton channel > prevents uncoating

Uses: tx Influenza A (resistant strains)

AE: GI disturbances, CNS effects (Amantadine)

Question 4

Ribavirin MOA, uses, AE

Answer 4

MOA: prevents viral mRNA capping > inhibition of RNA polymerase

Uses: RSV and Hepatitis C (in combination with Ribavirin)

AE: dose-dependent transient anemia, elevated bilirubin; teratogenic (cat X)

Question 5

Interferon-alpha MOA, uses, AE

Answer 5

MOA: use innate immune response > inhibit DNA/RNA synthesis

Uses: HCV/HBV (in combination with Ribavirin), Kaposi’s carcoma, Hairy cell leukemia, condyloma acuminata

AE: flu-like, fatigue, mental depression

Question 6

Lamivudine, Entecavir MOA, Uses, AE

Answer 6

MOA: nucleotide/nucleoside analog phosphorylated by cellular kinases > inhibit HBV DNA polymerase

Uses: HBV, HIV

AE: well tolerated, HA, dizziness, severe hepatitis after discontinuation

Question 7

Ledipasvir + Sofusbuvir MOA, uses, AE

Answer 7

MOA: inhibit viral replication

Uses: HCV (incombination with IFN-alpha and Ribavirin)

AE: fatigue, HA, weakness, nausea

Question 8

Simeprevir, Telaprevir MOA, Uses, AE

Answer 8

MOA: bind to serine protease and inhibit HCV replication

Uses: HCV (in combination with IFN-alpha and Ribavirin)

AE: itching, rash, photosensitivity, Steven Johnsons

Question 9

Acyclovir (Valacyclovir) MOA, Uses, AE

Answer 9

MOA: synthetic guanosine analog that must be converted to acyclovir-triphosphate > termination of viral replication

Uses: HSV, VZV

AE: renal dysfunction, GI disturbance

Question 10

Cidofovir MOA, Uses, AE

Answer 10

MOA: nucleoside analog phosphorylated by cellular kinases to a diphosphate > stopping DNA synthesis

Uses: CMV retinitis

AE: nephrotoxicity

Question 11

Ganiciclovir (Valganciclovir) MOA, Uses, AE

Answer 11

MOA: acyclic 2’-deoxyguanosine analog that undergoes triphosphorylation to become active and initial monophosphorylation catalyzed by viral UL97 encoded kinase > DNA chain termination

Uses: DOC CMV retinitis, CMV

AE: Myelosuppression, neutropenia

Question 12

Penciclovir MOA, Uses, AE

Answer 12

MOA: acyclic guanine analog which must be phosphorylated > competitive inhibitor of deoxyguanosine triphosphate

Uses: Herpes Simplex Labialis (cold sores)

AE: mild erythema

Question 13

Trifluridine MOA, Uses, AE

Answer 13

MOA: thymidine analog which inhibits thymidylate synthetase and incorporated into viral DNA causing termination

Uses: HSV keratitis / Keratoconjunctivitis (immunocompromised)

AE: eye irritation, light intolerance

Question 14

Foscarnet MOA, uses, AE

Answer 14

MOA: selectively inhibitds viral DNA polymerase without need of phosphorylation

Uses: CMV, CMV retinitis, acyclovir-resistant HSV (immunocompromised)

AE: nephrotoxicity, electorlyte disturbances, anemia, genital ulceration, CNS effects