Antiviral Agents: Non-HIV Infections

Question 1

Acyclovir (zaltrex) valacyclovir (valtrex)-HSV
Famciclovir (famur), penciclovir (denavir)- HSV/VZV
Ganciclovir (cutuene), valganciclovir (valcyte)- CMV
* cidofovir (vistide): nephrotoxicity, neutropenia, ocular effects
*foscarnet (fosavir): nephrotoxicity
* use is restricted to severe CMV if resistant to other CMV drugs, caution with renal failure

Answer 1

Nucleoside/nucleotide analogs

Question 2

Nucleoside/nucleotide analogs

-Rx for HSV, CMV, VZV

Answer 2

MOA: designed to Look like purines and pyrimidines to fool the cell- when added to RNA/mRNA in DNA and inhibits the enzyme
(Inhibit viral DNA polymerase)
*require activation by phosphorylation
Infected cell: enzymes P the drug and activate it and healthy cells don’t
* caution in PTs with renal failure
Renal elim (unchanged)- low drug inx risk
Generally well tolerated

Question 3

Nucleoside reverse transcriptase inhibitors (NRTIs)

*Rx for Hepatitis

Answer 3

Activation required-P
Renally eliminated
Well tolerated

Question 4

Aclefovir (hepsera): nephrotoxicity 
Tenofovir (viread)*
Entecovir (boraclade)*
Telbuvidine (tyzeka)*: fatigue, cough, N/V/D, HA 
Lamividine (epiur- HBV)* 
* also used to treat HIV

Answer 4

NRTIs

Question 5

Interferons (cytokines)

*Rx for hepatitis

Answer 5

MOA: very complex, many mechanisms
-combo with other antivirus, never used alone
AE: severe flu like syndrome (X10)
*depression
* suicide risk with pre-existing depression

Question 6

Ribavirin (rebetol, copegus)

-Rx for hepatitis

Answer 6

MOA: unclear 
* only used in combo with interferons 
AE: hemolytic anemia (monitor WBC) 
* pregnancy category X 
Women take with caution- no babies!!!!
Male partners can be affected

Question 7

HCV protease inhibitors

Rx for hepatitis C

Answer 7

MOA: Inhibit viral protease that process vital polypeptides
* protiens don’t get converted to active forms
Hepatic elimination
* major drug inx risk

Question 8

HCV RNA polymerase inhibitors-2

Rx for hepatitis C

Answer 8

MOA: inhibits viral RNA polymerase
Newest
AE: fatigue, headache

Question 9

Sofosbuvir (solvadi): used with ribavirin and PEG- INF, very expensive

Dasabuvir

Answer 9

HCV RNA polymerase inhibitors

Question 10

HCV NS5A inhibitors

-Rx for hepatitis C

Answer 10

MOA: inhibits non structural protien 5A
Used with HCV RNA polymerase inhibitors
New drug

Question 11

Ledipasvir
Ombitasvir
Daclatasvir (dakinza)

Answer 11

HCV NS5A inhibitors

Question 12

Neuramindase inhibitors

Rx for influenza A and B

Answer 12

MOA: inhibits budding of new viral Particles, traps new viruses inside infected cells= no spreading 
-starting at onset of flu is jet 
Renal elim 
Caution with renal dysfunction 
AE: N/V ( give with food)

Question 13

Oseltamivir (tamaflu)-PO
Zanamivir (relenza)- inhaled
Peramivir (not fda approved)- IV

Answer 13

Neuramindase inhibitors

Question 14

Adamantanes

Rx for influenza A

Answer 14

MOA: many mechanism 
Resistance is major concern 
Don't really work 
AE: CNS effects (dizzy, insomnia, low concentration) 
Orthostatic hypotension 
Edema

Question 15

Amantadine (symmetryl): also used for Parkinson’s disease, lots of AE, livedo reticularis rash

Rimantadine (flumadine)- low AE

Answer 15

Adamantanes

Question 16

Boceprevir (victrelis)
Telaprevir (incivek)
Simeprevir (olysio)
Paritaprevir

Answer 16

HCV protease inhibitors