Antiviral Agents Flashcards

1
Q

ANTIVIRAL AGENTS: action

A

Action – Work by interfering with viral replication.

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2
Q

DRUGS FOR NON HIV VIRUSES

Acyclovir [Zovirax

A

Drugs – Acyclovir [Zovirax]*** – used for herpes simplex I & II, varicella-zoster, and herpes zoster. Decreases duration & severity of HSV attacks but does not prevent them.
Routes – PO or IV, topical.
Action – nucleoside analog which mimics one of the substances needed for DNA replication. Virus thus cannot reproduce. SE – local tissue irritation and damage, HA, N/V/D, reversible renal impairment

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3
Q

DRUGS FOR NON HIV VIRUSES

A

Gancyclovir [Cytovene]* - treat CMV, retinitis.
Valacyclovir [Valtrex]* – herpes etc.
Docosanol –[Abreva] – for cold sores. topical – no systemic absorption – OTC
Cidofovir [Vistide] – CMV retinitis in pts with AIDS
Famciclovir [Famvir] – Genital herpes and shingles
Foscarnet [Foscavir] – IV – CMV & herpes

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4
Q

DRUGS FOR NON HIV VIRUSES; Drug interactions

A

Drug interactions – several – including cytotoxic agents (e.g. CA drugs)

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5
Q

DRUGS FOR NON HIV VIRUSES; Interventions

A

Interventions – watch for therapeutic and adverse effects. Advise pt of childbearing age to use contraception during and for at least 3 months after gancyclovir tx because it may cause mutations. Also don’t breast feed while on it.

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6
Q

ANTI-VIRALS FOR FLU

Amantadine [Symmetrel]

A

Amantadine [Symmetrel]*** – used for influenza A virus in high risk groups. Must be given before attack or within 48 hrs. Can be given with flu shot to protect pt while immunity is developing. (also used for Parkinson’s disease – antidyskinetic).

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7
Q

oseltamivir [Tamiflu]

A

oseltamivir [Tamiflu]** – also neuraminidase inhibitor.
Comes as a PO form. Also must be taken within 2 days of sx start. Taken BID x 5 days.
SE: N/V
Effect: Reduces time to Sx relief by about 1.3 days

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8
Q

rimantadine [Flumadine]

A

rimantadine [Flumadine]* – like Symmetrel.

SE: NV, abd pain.

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9
Q

Reverse transcriptase inhibitors

A

Reverse transcriptase is an enzyme needed by virus for DNA synthesis – not found in human cells. Drug mimics the nucleoside and fools the virus → cannot replicate. One of the classes always used in HAART. These are Prodrugs.

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10
Q

Reverse transcriptase inhibitors: SE

A

SE: NVD, HA, fatigue during first few weeks.

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11
Q

Reverse transcriptase inhibitors: SE II

A

Toxic to mitochondria – inhibit gamma-polymerase needed for DNA in mitochondria - can → lactic acidosis & severe hepatomegaly with steatosis syndrome. More common in women and with liver damage to start with. Get increased liver enzymes, fatty liver, maybe failure. SX: N, myalgia, RUQ pain.

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12
Q

Reverse transcriptase inhibitors: SE III

A

Mitochondrial toxicity also → lipodystrophy. Face, arms, legs lose fat. Fat deposited on abdomen, breasts, and base of neck (buffalo hump).

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13
Q

Zidovudine [AZT, Retrovir]

A

Drugs – Zidovudine [AZT, Retrovir]*** – For AIDS. Helps control opportunistic infections like PCP. Current dosing is Q12H.

Interactions: Many! Including ASA and Tylenol.

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14
Q

Reverse transcriptase inhibitors: ADVERSS EFFECTS

A
Adverse effects: N/V/D/A, 
headache, 
fever, 
listlessness, 
skin rashes.  
potentially nephrotoxic.
 Can cause granulocytopenia, and anemia.  Also: dizziness, agitation, restlessness, insomnia, 
n/v/d/a, 
abdominal pain, 
dyspepsia, 
myalgia, 
diaphoresis, 
dyspnea, fever, rash, 
and taste perversion.
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15
Q

Reverse transcriptase inhibitors INTERVENTIONS

A

Interventions: Take around the clock. Does not reduce risk of passing virus to others. Don’t use OTC drugs without checking with nurse first. Resistance develops in 3-6 mo if used alone.

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16
Q

Reverse transcriptase inhibitors DRUGS

A
Drugs – abacavir [Ziagen]*
emtricitabine [Emtriva]*
lamivudine [Epivir]*
stavudine [Zerit]*
tenofovir [Viread]*
17
Q

NonNucleoside Reverse Transcriptase inhibitors [NNRTIs]

A

Action – Inhibit reverse transcriptase by binding close to it and changing its shape.

SE – Rash (can be Steven Johnson but rarely); can affect liver

Drugs – Efavirenz [Sustiva]***
Once daily dosage. High fat meals can → absorption 50% which can → toxicity- take on empty stomach.

18
Q

NonNucleoside Reverse Transcriptase inhibitors SIDE EFFECTS

A

SE at beginning – sleep disorders, nightmares, dizziness, decrease ability to concentrate, delusions.These slowly go away in about a month. But about ½ of all pts experience these.
Teratogenic.

19
Q

NonNucleoside Reverse Transcriptase inhibitors DRUGS

A

Delavirdine [Rescriptor]*
Nevirapine [Viramune]*
Etravirine [Intelence]*

20
Q

Protease inhibitors

A

Action – Work by inhibiting protease. Introduced in 1995 and revolutionized HIV.

SE – GI stuff. Lipodystrophy, increased cholesterol, maybe hyperglycemia and diabetes.

21
Q

Protease inhibitors KALETRA

A

Kaletra [lopinavir and ritonavir in combo pill]*** Approved 2000. Ritonavir inhibits the breakdown of lopinavir so much more is available. Much higher blood levels. Take once or twice daily. Drug of choice for first line Tx. Interacts with St. John’s wort → lower antiviral.

22
Q

Protease inhibitors SAQUINAVIR

A

Saquinavir [Invirase]* – First of these new drugs approved by FDA - in only 97 days! Should be used as part of combo tx with AZT, etc.

23
Q

Protease inhibitors

NELFINAVIR

A

Nelfinavir [Viracept]* – approved 1997.

SE: diarrhea (this is severe and most common problem), nausea, flatulence, rash,

24
Q

Protease inhibitors

Ritonavir [Norvir]

A

Ritonavir [Norvir]* – most likely to cause SE and toxicity problems. Used to “boost” blood levels of others – inhibits CYP 450 so others stay at higher levels.
SE: N/V/D/A, HA, fatigue, taste disturbances, circumoral (lip) paresthesia. Diarrhea often severe enough to → noncompliance.

25
Q

Indinavir [Crixivan]

Protease inhibitors

A

Indinavir [Crixivan]** – relatively safe and well tolerated. – give with high fat foods to increase absorption.
SE: Most impt SE is nephrolithiasis. Pts must drink large amts of fluids throughout the day. If stones develop, tx with hydration and analgesics – do not stop indinavir. Q8H dosing.

26
Q

Protease inhibitors

A

Atazanavir [Reyataz] – less effect on lipid levels
Darunavir [Prezista]
Fosamprenavir [Lexiva]
Tipranavir [Aptivus]

27
Q

Fusion Inhibitors

A

Interfere with fusion of viral and cellular membrances → block virus from getting into the host cell

Drugs – Enfuvirtide [Fuzeon]*** – 2003 – given SC BID. Has no effect on liver. Almost always get an injection site reaction at first: pain, pruritus, erythema, cysts, cellulitis.
Also NVD and fatigue and increased risk of pneumonia.

28
Q

Integrase inhibitors

A

2007 – without integrase, HIV can’t insert viral DNA into human chromosome.
Drugs – Raltegravir [Isentress]*** – PO.
SE: HA, GI stuff

29
Q

CCR5 inhibitors

A

CCR5 is one of the receptors HIV has to go through to get into cell. Blocking this reduces viral load.

Maraviroc [Selzentry]*** – po

SE – abd pain, cough, dizziness, fever, rash, URI, musculoskeletal problems. May get liver tox. May increase risk of MI.

30
Q

Gancyclovir [Cytovene]*

A

treats CMV, retinitis

31
Q

Valacyclovir [Valtrex]*

A

for herpes

32
Q

Docosanol –[Abreva]

A

for cold sores

topical – no systemic absorption – OTC

33
Q

Cidofovir [Vistide] – CMV retinitis in pts with AIDS

A

CMV retinitis in pts with AIDS

34
Q

Famciclovir [Famvir] – Genital herpes and shingles

A

Genital herpes and shingles

35
Q

Foscarnet [Foscavir] – IV – CMV & herpes

A

IV only – CMV & herpes

36
Q

ANTI-VIRALS FOR FLU
Amantadine [Symmetrel]
Action

A

Action: not completely clear – may prevent uncoating of virus and thus inhibit replication

37
Q

ANTI-VIRALS FOR FLU
Amantadine [Symmetrel]
Adverse effects

A

Adverse: N/A, nervousness, insomnia, fatigue, depression, anxiety, problems concentrating. Previous psych or abuse disorders can become worse. Seizures in pts with disorder.