Antiviral Drugs Flashcards
Zanamivir, Oseltamivir
Influenza drugs
Ribavirin
RSV, Hep C
Acyclovir
Herpes viruses
Ganciclovir, Foscarnet, Cidofivir
CMV drugs
Interferon Tx
Viral infections
Zanamivir/Osteltamivir (Tami-flu)
Neuraminidase inhibitors
Neuraminidase is
enzyme that cleaves sialic acid from glycoproteins
-require for exit from cells
Zanamivir/Osteltamivir (Tami-flu) must be administered w/n what time frame to be effective?
48 hours
DNA/RNA polymerases work by
splits off two phosphates from nucleotriphosphates
uses remaining phosphate to form backbone
What is a mechanism of resistance towards RNA/DNA polymerase inhibitors?
Viral kinase mutation
Ribavirin mimics
Guanosine
-Has a different base attached
Ribavirin is triphosphorylated by
Cellular kinases within infected cell
Ribavirin inhibits
RNA polymerase
What other enzyme besides RNA polymerase does Ribavirin inhibit?
Inhibits IMP dehydrogenase
- ribavirin mimics inosine monophosphate (biochemical intermediate that gets converted to guanosine nucleotides)
- decreases guanosine nucleotides available
What are the two main uses of Ribavirin?
Severe RSV Tx
Combined with interferon to treat Hep C
What is key S/E of Ribavirin?
Hemolytic Anemia
-Drug accumulates in RBCs and depletes phosphate pool, causing ATP deficiency
Can you give Ribavirin to pregnant women?
No
Acyclovir
Inhibits herpes DNA polymerase
Mimics guanosine
Acyclovir does not have a ribose sugar (O instead of OH)
Acyclovir has a targeted effect (only works in effective cells) b/c
Acyclovir must be phosphorylated by herpes virus thymidine kinase
Cell enzymes converted acyclovir monophosphate into triphosphate.
Acyclovir mimics what to inhibit viral DNA polymerase?
deoxyguanosine triphosphate (dGTP)
Viruses develop resistance to Acyclovir by
decreasing viral thymidine kinase
altering viral thymidine kinase
altering viral DNA polymerase
Famciclovir
Similar MOA to Acyclovir
Has a longer half-life so lower dose can be used
Valacyclovir
Pro-drug converted to acyclovir
-Increased bioavailability so lower dose can be used
Acyclovir administered by IV can cause
Nephrotoxicity
- Crystallizes in urine
- Administer with IV fluids
HSV-1, HSV-2, and VZV tx
Acyclovir
Acyclovir is not effective for CMV and EBV (also herpes viruses) because
They have a different viral kinase that cannot phosphorylate Acyclovir
Tx for genital herpes, oral herpes, herpes encephalitis, herpes zoster
Acyclovir
CMV infections are a big problem in
immunocompromised patients
Ganciclovir, Foscarnet, Cidofivir
CMV drugs
-Inhibit CMV DNA Polymerase
Ganciclovir
Similar MOA to Acyclovir
-mimics guanosine
Major toxicity of Ganciclovir
Bone marrow suppression, especially leukopenia
Also inhibits bone marrow DNA polymerase
Valganciclovir
Pro-drug that is converted to Ganciclovir
Better bioavailability
Ganciclovir is administered by IV due to
Poor bioavailability
If Ganciclovir must be administered orally for CMV infection,
Pt is given its pro-drug, Ganciclovir
Foscarnet
Pyrophosphate Analog
- Mimics phosphate group
- DNA cannot cleave phosphate groups off nucleotide
- Results in chain termination
When is Foscarnet used?
CMV Tx when Ganciclovir fails
HSV/VSV Tx when there is resistance to Acyclovir
Main limiting S/E of Foscarnet
nephrotoxicity
Pts on Foscarnet must have electrolytes monitored b/c
Foscarnet chelates calcium
- Causes hypocalcemia
- Renal wasting of magnesium induced (hypomagnesaemia)
- Resulting seizures
Cidofovir
CMV drug
Cytidine analog
Viral DNA polymerase inhibitor
Cidofovir undergoes phosphorylation by
Cellular kinase (not viral kinase)
What is main use of Cidofovir?
CMV retinitis
What is the main toxicity due to Cidofovir?
Renal Failure
- Cidofovir is bound by anion transporter in proximal tubule, resulting in high concentrations in the renal cortex
- Co-administer with saline to flush kidneys
- Use probenecid (gout drug) to block Cidofovir accumulation in tubular cells
Interferons
Used for anti-viral therapy
Cytokines
Glycoproteins synthesized by infected cells and lymphocytes
Numerous immunomodulatory effects
Interferon alpha primes cells to fight against
Hep B & C
HHV-8 (causes Kaposi’s sarcoma)