Antiviral drugs

Question 1

antivirals requiring first viral kinase and then host cell kinase to function

Answer 1

Acyclovir, Valacyclovir, Famciclovir, Ganciclovir

Question 2

antiviral that blocks viral uncoating

Answer 2

Amantadine

Question 3

antiviral that causes release of dopamine from intact nerve terminals and hence used in Parkinson’s disease

Answer 3

Amantadine

Question 4

Amantadine side effect

Answer 4

ataxia

Question 5

antiviral that inhibits neuraminidase and blocks release of viral progeny

Answer 5

Oseltamvir, Zanamvir

Question 6

antiviral with multifactorial MOA

Answer 6

Ribavirin

Question 7

DOC for RSV bronchiolitis

Answer 7

Ribavirin

Question 8

antiviral that interferes with duplication of viral genetic material

Answer 8

Ribavirin

Question 9

Multifactorial MOAs of Ribavirin

Answer 9

RNA hypermutation; directly inhibits HCV RNA polymerase; Inhibits cellular IMP dehydrogenase–>decreased intracellular GTP; inhibits viral RNA guanylyltranferase and methyltransferase –>defective 5’-cap formation–>ineffective viral translation; immunomodulation- enhances TH1-CMI and inhibits TH2 cytokine production

Question 10

Ribavirin clinical use–

Answer 10

RSV bronchiolitis and Chronic hepatitis C

Question 11

Acyclovir

Answer 11

requires viral kinase for activity

Question 12

A prodrug of Acyclovir which has better bioavailability than acyclovir

Answer 12

Valacyclovir

Question 13

Resistance to acyclovir

Answer 13

lack of viral thymidine kinase

Question 14

Acyclovir side effects

Answer 14

Neurotoxicity (delirium, tremors) and Nephrotoxicity (d/t crystallization–> crystalluria–> renal tubular damage; can be prevented by aggressive IV hydration)

Question 15

DOC for Herpes Zoster

Answer 15

Famciclovir

Question 16

CMV

Answer 16

Ganciclovir

Question 17

Ganciclovir side effects

Answer 17

Neutropenia, anemia, renal toxicity

Question 18

Ganciclovir + AZT risk

Answer 18

can impair hematopoietic cell DNA synthesis–> increase incidence of anemia and neutropenia

Question 19

antiviral that do not need viral kinase phosphorylation for activation

Answer 19

Foscarnet and Cidofovir

Question 20

antiviral drug that is a pyrophosphate analogue

Answer 20

Foscarnet

Question 21

antiviral for CMV retinitis when ganciclovir fails

Answer 21

Foscarnet or Cidofovir

Question 22

antiviral drug for acyclovir-resistant HSV

Answer 22

Foscarnet or Cidofovir

Question 23

antiviral drug that causes electrolyte imbalance- hypokalemia, hypomagnessemia, hypocalcemia and hypophosphatemia–> generalized seizures

Answer 23

Foscarnet

Question 24

Foscarnet side effects

Answer 24

Nephrotoxicity and electrolyte imbalance

Question 25

Cidofovir side effect

Answer 25

Nephrotoxicity (co-administer with probenecid to prevent)

Question 26

Foscarnet and Cidofovir MOA

Answer 26

inhibit viral DNA polymerase independent of activation by viral thymidine kinase

Question 27

All "navirs" are--

Answer 27

Protease inhibitors (PI)

Question 28

Lipodystrophy due to impaired hepatic chylomicron uptake and TG clearance

Answer 28

Protease inhibitors

Question 29

PI that can inhibit P-450 and boost other drug concentrations

Answer 29

Ritonavir

Question 30

PIs: MOA

Answer 30

Prevent assembly and maturation; nonfunctional, noninfectious virions produced

Question 31

PI side effects

Answer 31

Fat redistribution (lipodystrophy), Insulin resistance (hyperglycemia), hypertriglyceridemia

Question 32

HIV +ve patients receiving PI--avoid---->

Answer 32

Rifampin and instead use Rifabutin

Question 33

Must be phosphorylated by thymidine kinase to be active

Answer 33

NRTIs

Question 34

Do not require phosphorylation to be active

Answer 34

NNRTIs

Question 35

NRTIs (TEALZSD)

Answer 35

Tenofovir, Emtricitabine, Abacavir, Lamivudine, Zidovudine, Stavudine, Didanosine

Question 36

anti-HIV drugs that lack 3'-OH, thus inhibit 3'-5' phosphodiester bond formation

Answer 36

NRTIs (e.g. Zidovudine)

Question 37

NRTIs side effect

Answer 37

Bone marrow suppression, peripheral neuropathy, lactic acidosis, megaloblastic anemia (AZT)

Question 38

NRTI that may cause pancreatitis

Answer 38

Didanosine

Question 39

Peripheral neuropathy and Lactic acidosis

Answer 39

Lamivudine

Question 40

NNRTIs (VIR)

Answer 40

NeVIRapine, EfaVIRenz, DelaVIRdine

Question 41

anti-HIV that may cause cutaneous hypersensitivity- Steven-Johnson syndrome and toxic epidermal necrolysis

Answer 41

NNRTIs

Question 42

NNRTIs side effect

Answer 42

Hepatic failure with encephalopathy

Question 43

NNRTIs side effect time profile

Answer 43

first 6 weeks: severe hepatotoxicity. | first 18 weeks: life threatening skin rash

Question 44

Integrase inhibitor

Answer 44

Raltegravir

Question 45

anti-HIV drug that may cause hypercholesterolemia

Answer 45

Raltegravir

Question 46

Interferon-alpha Rx

Answer 46

Chronic hepatitis B & C, Kaposi's sarcoma, Hairy cell leukemia, condyloma acuminata (HPV 6, 11)

Question 47

Interferon-beta Rx

Answer 47

Multiple Sclerosis

Question 48

Interferon-gamma Rx

Answer 48

NADPH oxidase deficiency

Question 49

Interferon side effect

Answer 49

Neutropenia

Question 50

Antibiotic to avoid in pregnancy (Countless SAFe Moms Take Really Good Care)

Answer 50

Clarithromycin (embryotoxic), Sulfonamides (kernicterus), Aminoglycosides (ototoxicity), Fluoroquinolones (cartilage damage), Metronidazole (mutagenesis), Tetracyclines (discolored teeth, inhibition of bone marrow), Ribavirin (teratogenic), Griseofulvin (teratogenic) and Chloramphenicol (gray baby)

Question 51

HIV fusion inhibitor

Answer 51

Enfuvirtide

Question 52

anti-HIV drug that binds to envelope glycoprotein gp-41 and denies the HIV genome entry into uninfected CD4 cells

Answer 52

Enfuvirtide (Fusion inhibitor)

Question 53

pol gene mutations

Answer 53

acquired resistance to PIs and NRTIs/NNRTIs