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IC Part II > Antiviral and Antifungal Review > Flashcards

Antiviral and Antifungal Review Flashcards

1
Q
  • 5’ monophosphate formed by a CMV viral kinase
  • guanosine analog
  • triphosphate formed by cellular kinases
  • preferentially inhibits DNA polymerase
A

ganciclovir

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2
Q
  • guanosine analogs, monophosphorylated by HSV/VZV thymidine kinase and not in uninfected cells –> few adverse effects
  • preferentially inhibit DNA polymerase by chain termination
A

acyclovir, valacyclovir, famciclovir

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3
Q
  • preferentially inhibits viral DNA polymerase, does not require phosphorylation by viral kinase
  • treats CMV retinitis in immunocompromised patients, acyclovir resistant HSV, long half life
  • nephrotoxicity
A

cidofovir

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4
Q
  • viral DNA/RNA polymerase inhibitor and HIV reverse transcriptase inhibitor
  • binds to pyrophosphate binding site of enzyme
  • treats CMV retinitis when ganciclovir fails, acyclovir resistant HSV
  • nephrotoxic, electrolyte abnormalities, seizures
A

foscarnet

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5
Q

-for primary keratoconjunctivitis and recurrent epithelial keratitis caused by herpes simplex I and II

A

trifluridine

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6
Q

for herpes simplex of face or lips, OTC

A

docosanol

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7
Q
  • thymidine analog, substrate/inhibitor for HIV reverse transcriptase
  • inhibits stable infection of new cells
  • well absorbed, CNS, rapidly metabolized
  • use in 3 or 4 drug cocktail for HIV, resistant due to mutations in reverse transcriptase
  • adverse: bone marrow depression, CNS, toxicity in drugs competing for glucoronidation
A

zidovudine

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8
Q 
zidovudine
zalcitabine
lamivudine
abacavir
tenofovir (nucleotide) 
emtricitabine
A

nucleoside reverse transcriptase inhibitors

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9
Q
  • first gen oral NNRTI
  • non competitive, binds near but not in active site
  • rapid resistance
  • can be active against AZT resistant HIV
  • life threatening skin rash
  • CPY3A4 substrate
A

non-nucleoside reverse transcriptase inhibitors (NNRTI)

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10
Q 
nevirapine
efavirenz
delavirdine
etravirine
rilpivirine
A

NNRTIs

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11
Q
  • prevent viral particle production, prevent maturation of new viruses, pol gene cleaves polypeptide products of mRNA
  • adverse: hyperglycemia, altered fat distribution, hyperlipidemia, insulin resistance
A

HIV protease inhibitors

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12
Q
  • first HIV protease inhibitor
  • well tolerated
  • low oral bioavailability
  • extensive 1st pass
  • DDIs
  • use in combo with RT inhibitors
A

saquinavir

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13
Q

coformulated with protease inhibitors to “boost” levels, inhibitor of CYP3A4

A

ritonavir

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14
Q
  • CCR5 antagonist
  • binds CCR5 on human CD4 cells
  • inhibits gp120 conformational change required for HIV fusion with CD4 cell
A

maraviroc

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15
Q

interferes with entry of HIV-1 into host cells by inhibiting the fusion of virus and cell membranes, binds gp41

A

enfuvirtide

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16
Q

-inhibit catalytic activity of integrase

A

dolutegravir, elvitegravir, raltegravir

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17
Q
  • antimetabolite, blocks GMP formation
  • aerosol for RSV
  • known teratogen, dose dependent myelosuppression
  • treatment of hepatitis
A

ribavirin

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18
Q
  • oral agent effective against all common influenza viruses
  • pro drug
  • NA inhibitor
A

oseltamivir

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19
Q
  • oral inhalation
  • influenza A and B
  • effective in early infection
  • bronchospasm in asthmatics
A

zanamivir

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20
Q
  • treatment of acute, uncomplicated influenza in adults who’ve been symptomatic <2 days
  • 600 mg single dose
A

peramivir

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21
Q
  • block viral uncoating by blocking M2 proton channel
  • given in first 48 hours of contact
  • admin orally, protects only influenza A
A

amantadine, rimantadine

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22
Q

standard of care for treatment of HCV?

A

peginterferon alfa + ribavirin

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23
Q
  • nucleotide analog, inhibits HCV RNA dependent RNA polymerase
  • given in combo with peg interferon and ribavirin
A

sofosbuvir

24
Q

______ have ergosterol in membrane instead of cholesterol

A

fungi

25
Q
  • IV drug that inhibits synthesis of glucan, a major fungal cell wall component
  • use for invase aspergillosis in patients who fail ampho B therapy
A

caspofungin

26
Q

amphotericin B binds ______ in fungal membranes, producing a pore causing leaking of contents

A

ergosterol

27
Q

amphotericin B must be given _____ or ______, widely distributed except CNS, excretion 2 weeks

A

IV, intrathecal

28
Q

-reservoir of amphotericin, has lower affinity for drug than fungal membrane but higher affinity for drug than patient’s membranes

A

liposomal

29
Q

amphotericin B often combined with ________ to delay resistance and use lower doses due to synergism

A

flucytosine

30
Q

infusion related reactions, fever, chills, muscle spasms, vomiting, headache, hypotension

  • pretreat w/ antipyretics, antihistamines, aanalgesics, coticosteroids
  • nephrotoxicity
A

amphotericin B

31
Q

flucytosine activated by fungal ________ and converted to 5-flurouracil, blocks DNA and RNA synthesis

A

cytosine deaminase

32
Q
  • CNS, excreted in urine
  • low toxicity to patient
  • narrow spectrum, rapid resistance so only use with ampho B
A

flucytosine

33
Q
  • inhibit ergosterol synthesis
  • oral antifungal for systemic
  • inhibit CYPs, extensive DDI
  • severe hepatotoxicity, gynecomastia, interactions w/ cyclosporines and antihistamines
A

ketoconazole

34
Q

broader spectrum, less adverse than ketoconazole

A

itraconazole

35
Q

-effective against aspergillosis, fluconazole susceptible and resistant candida, and cryptococcus neoformans

A

voriconazole

36
Q
  • water soluble azole
  • good CSF delivery
  • more selective for fungal P450s
A

fluconazole

37
Q

newer and broad spectrum member of azole family, good for candida and aspergillus
-oral only

A

posaconazole

38
Q
  • inhibits synthesis of B(1,3)D-glucan, an essential component of fungal cell wall
  • treats invase aspergillus
  • candida: intra abdominal abscess, esophagitis, peritonitis, febrile neutropenic patients
  • hypotension, tachycardia, fever, chills, rash, anemia, hypokalemia
A

caspofungin

39
Q

-topical antifungal, too toxic for systemic use

A

nystatin

40
Q

griseofulvin concentrates in _______ tissue, treats ringworm athlete’s foot, disrupts mitotic spindle in fungal cells, hepatitis and DDIs with warfarin and phenobarbital

A

keratinized

41
Q
  • topic or systemic
  • concentrates in keratinized tissue
  • inhibits squalene epoxidase
A

terbinafine

42
Q

only ______ affects tissue schizonts

A

primaquine

43
Q
  • alters metabolism of hemoglobin by parasite, blocks nucleic acid synthesis
  • highly effective blood schizonticide
  • clears parasite from all 4 plasmodia (used w/ primaquine for vivax and ovale)
  • prophylactic, preferred when resistance not a problem
A

chloroquine

44
Q
  • visual impairment with long term therapy
  • widespread resistance
  • p glycoprotein efflux mechanism (block with verapamil)
A

chloroquine

45
Q
  • destruction of asexual bloods forms of malarial pathogens falciparum and vivax
  • oral only, metabolized in liver
  • CNS psychotropic effects
  • use for chloroquine resistant malaria
A

mefloquine

46
Q
  • anti folate drug combo effects on protozoa
  • effective blood schizonticide for p falciparum, slow acting
  • multi drug resistance common
A

fansidar (pyrimethamine-sulfadoxine)

47
Q
  • selectively inhibits parasite mitochondrial electron transport
  • inhibits DHFR
  • prevent or treat acute uncomplicated p falciparum malaria
  • increased transaminase, headaches, dizziness
A

atovaquone plus proguanil

48
Q
  • treat chloroquine resistant p falciparum
  • interferes with oxygen uptake and carb metabolism, intercalates into DNA
  • cinchonisms: flushed, tinnitus, blurred vision, confusion
A

quinine, quinidine

49
Q
  • chinese herbal medicine
  • activated by oxidative metabolism
  • rapidly acting blood schizonticide, useful for MDR p falciparum
A

artemesinin

50
Q

standard prophlactic drug for SE Asia with high rates of resistance to mefloquine

A

doxycycline

51
Q

-derived from artemesinin, treats MDR p falciparum

A

artemether, lumefantrine

52
Q
  • tissue shizonticide
  • metabolites are intracellular oxidants
  • use in combo with chloroquine for prophylaxis/cure of p vivax, p ovale
  • withheld until G6PD status is known
  • hemolytic anemia, GI distress
A

primaquine

53
Q
  • tissue amebicide activated by electron donation
  • used for urogenital trichomonas, giardia, aspiration pneumonia, anaerobics
  • disulfiram effect
A

metronidazole and nitazoxanide

54
Q
  • concentrates in liver, spleen, kidney
  • doesn’t enter CNS
  • pneumocystic prophylaxis in sulfonamide intolerant pts
  • resp stimulation then depression
A

pentamidine

55
Q

diloxanide furoate, iodoquinol, paromomycin treat?

A

aymptomatic amebiasis intestinal infections

56
Q
  • depolarizing neuromuscular blocking agent on nicotinic receptor
  • increases release of acetylcholine and inhibits cholinesterase in the worm
  • use: ascariasis, pinworm, hookworm, whipworm
  • n/v/d/anorexia
A

pyrantel pamoate

57
Q
  • increases chloride permeability, polarizing cells leading to paralysis
  • use for strongyloidiasis, onchocerciasis
A

ivermectin

IC Part II (29 decks)

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