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Clin Med I > Antiviral Drugs > Flashcards

Antiviral Drugs Flashcards

1
Q

RNA Virus: Influenza

A

3 types of influenza virus:

Type A: pandemics & epidemics (e.g. Spanish flu 1918, subtypes based on hemagglutinin & neuraminidase: H1N1, H3N2)

Type B: epidemics

Type C: neither (mild illness)

Large animal reservoirs (e.g. birds, pigs)

Clinical m(x): Uncomplicated influenza, Sinusitis, Ear infections

Complications: Viral pneumonia, 2o bacterial pneumonia, Cardiac complications (e.g. myositis), CNS complications (e.g. transverse myelitis, encephalitis, Reye

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2
Q

Penciclovir adverse events?

A

None

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3
Q

Pandemics and Epidemics are caused by

A

Influenza Type A

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4
Q

Peramivir dosage?

A

600 mg IV 1 dose

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5
Q

NAI’s are useful for patients who…

A
  • Require hospitalization
  • Have complicated/progressive influenza
  • Have high risk of flu like complications
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6
Q

Oseltamivir dosing?

A

75 mg BID 5 days

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7
Q

Acyclovir MOA?

A

Inhibits viral DNA polymerase by competing with Guanosine

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8
Q

Monitoring for Ribavirin?

A
  • CBC
  • INR
  • BUN/SCr
  • Pregnancy
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9
Q

Ribavirin administration route?

A

PO, inhaled, or IV

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10
Q
  • Large animal reservoirs
  • Transmitted via respiratory route
  • Manifests as flu, sinusitis, ear infection
  • Complications include viral and bacterial pneumonia, cardiac complications, CNS complications
A

Influenza (RNA virus)

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11
Q

Palivizumab route of administration?

A

IM (max of 5 doses)

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12
Q

MOA of Foscarnet and Cidofovir?

A

Direct inhibition of viral DNA polymerase (don’t need first phosphorylation, makes them helpful for resistant strains)

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13
Q

Which drugs have antimicrobial activity on CMV?

A

Gangciclovir and Valganciclovir

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14
Q

Ganciclovir adverse effects?

A

Bone marrow suppression (anemia, thrombocytopenia, leukopenia)

Valganciclovir will have same effects

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15
Q

What do Amantadine and Rimantadine treat?

A

Just don’t use them for influenza okay

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16
Q

Famciclovir route of administration?

A

PO

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17
Q

Foscarnet adverse effects?

A

Electrolyte imbalances –> renal impairment (direct), seizures, anemia

T(x): monitor electrolytes at least 2x/week and use replacement therapy when necessary

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18
Q

Valcyclovir metabolism?

A

Metabolized first by viral thymidine kinase then by host enzymes (same as Acyclovir)

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19
Q

Ganciclovir and Valganciclovir adverse events?

A
  • Bone marrow suppression (anemia, platelets, WBC)**
  • Fever
  • Creatine levels; hydrate
  • Neuropathy; D/C
  • Pruitis; D/C
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20
Q

Mild influenza symptoms are caused by?

A

Influenza Type C

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21
Q

Suspect acyclovir resistance if lesions do not improve in ______ days

A

4-5 days

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22
Q

Antigenic Shift

A

Influenza A only

Virus acquires new hemagglutinin (H) and/or neuraminidase (NA) via genetic reassortment

Results in novel influenza virus

No prior immunity

Can potentially cause a pandemic

Occurs less often**

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23
Q

What are the appropriate dosages (all PO) for Acyclovir, Valaciclovir, and Famciclovir for Herpes Zoster (Shingles)?

A

Acyclovir: 800 mg PO 5xdaily x 7 d (800mg PO QID x 5 d for Chicken Pox/Varicella)

Valaciclovir: 1 Gm PO TID x 7 d

Famciclovir: 500mg PO TID x 7 d

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24
Q

Penciclovir treats?

A

HSV and VZV

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25
Q

Ganciclovir MOA?

A

Inhibits CMV DNA polymerase via CMV UL97

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26
Q

Foscarnet adverse events?

A
  • Renal impairment from damage to tubules
  • Electrolyte imbalance
  • Seizures (D/C)
  • Anemia
  • Granulocytopenia

–> Hydrate with 2 L saline prior

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27
Q

Which drugs have antimicrobial activity on HSV and VZV?

A

Acyclovir, Valaciclovir, Penciclovir, and Famiciclovir

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28
Q

Acyclovir adverse effects?

A

Drug can crystallize in renal tubues –> renal impairment/damage

T(x): give fluids to dilute concentration or infuse slower

Valacyclovir will have same effects

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29
Q

Famiciclovir MOA?

A

Prodrug converted to pencyclovir and then inhibits viral DNA polymerase

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30
Q

Which drugs are Adamantanes? Should we use them?

A

Amantadine, Rimantadine

Nah, they really high influenza resistance

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31
Q

Influenza drug of choice and their MOA

A

Neuraminidase Inhibitors (NAIs= Oseltamivir (Tamiflu), Zanamivir, Peramivir)

MOA:

  • Binds to the surface glycoprotein, neuraminidase (NA)
  • Prevents the enzymatic cleavage of sialic acids from cellular receptors on the cell membrane (virions can’t leave the cell to spread infection)
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32
Q

Hepatic impairment with Famiciclovir Tx?

A

In severe hepatic impairment, prodrug conversion may decrease, leading to an increase in Famiciclovir concentrations

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33
Q

Cidofovir + ______ decreases renal absorption and decreases nephrotoxicity?

A

Probenecid and saline prehydration

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34
Q

Oseltamivir adverse events?

A

Nausea
Vomiting
Conjunctivitis
Epistaxis

Take with food

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35
Q

Foscarnet and Cidofovir administration route?

A

IV/Topical

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36
Q

Which antiviral prodrugs turn into which antiviral drugs once metabolized in the body?

A

Valaciclovir –> Acyclovir

Valganciclovir –> Ganciclovir

Famciclovir –> Penciclovir

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37
Q

Penciclovir MOA?

A

inhibits viral DNA polymerase

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38
Q

Foscarnet and Cidofovir treat?

A

ALL 3! HSV, VZV, and CMV

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39
Q

HSV-2

A

Transmitted via direct exposure to genital skin or fluids

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40
Q

Very expensive drug to treat CMV?

A

Valganciclovir

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41
Q

Topical Antivirals for HSV

A

Idoxuridine (HSV-1)

Trifluridine (HSV)

Docosanol (Abreva) –> treats herpes labialis (cold sores), only OTC option

42
Q

Antigenic Drift

A

Influenza A or B

Virus acquires point mutations in surface antigens

  • Hemagglutinin (H)
  • Neuraminidase (NA)

Human antibodies no longer confer immunity to antigenic variants

Results in need for:

  • Annual vaccination
  • Updates in combo of antigenic variants in each annual vaccine

Occurs more frequently**

43
Q

NAI’s MAY be considered for patients who…

A
  • Desires to shorten duration of illness
  • Therapy can be initiated within 48 hr of symptoms
44
Q

Ribavirin

A

Used for: Hep C Virus (in combination), RSV, Influenza

Adverse effect: hemolytic anemia

45
Q

Foscarnet and Cidofovir used most commonly in?

A
  • AIDS patients
  • Patients with resistance to acyclovir MOA
46
Q

Shingles:
Acyc- 800 mg 5X 7 days
Valacyc- 1 g TID 7 days
Famicyc- 500 mg TID 7 days

Chicken Pox:
Acyc- 800 mg QID 5 days

A

VZV Dosing

47
Q

Valcyclovir adverse events?

A
  • Headache
  • GI
  • Phlebitis (inflamed vein)
  • Rash/itching
  • Renal impairment
  • CNS effects; reduce dose or D/C
48
Q

Palivizumab

A

Used for: RSV prophylaxis in pediatric patients

Administration route: IM

49
Q

3 topical for Herpes Viruses?

A

Idoxuridine
Trifluridine
Doconasol (OTC)

50
Q

Penciclovir metabolism?

A

First metabolized by viral thymidine kinase then by host enzymes

** no systemic absorption so no dosage adjustments

51
Q

Which guanosine analogue antiviral drug is preferred for use in pregnant women?

A

Acyclovir

52
Q

Ganciclovir treats?

A

CMV

53
Q

Oseltamivir (Tamiflu)

A

Most commonly used NAI (oral)

Oseltamivir is a prodrug

Preferred treatment in pregnant women

Dose: 75 mg PO BID x 5 days

54
Q

Antiviral drugs that are acyclic guanosine analogues?

A

Acyclovir, Valaciclovir, Penciclovir, Famiciclovir, Ganciclovir, Valganciclovir

55
Q

Zanamivir adverse events?

A
  • Headache
  • Throat and tonsil pain
  • Nasal sxs and cough
56
Q

Ribavirin adverse events?

A
  • Anemia- Needs close monitoring (CBC)
  • Other blood dycrasias
  • Fatigue, headache, insomnia, depression
  • GI
  • Alopecia, rash, itching
  • Hyperbilirubinemia
57
Q

Peramivir adverse events?

A
  • GI problems
  • Neutropenia
  • Hyperglycemia
  • High creatnine
  • High hepatic enzymes
  • Insomnia
  • Hypertension
58
Q

Antivirals with Pregnancy Risk Factor C (do not use these with pregnant women)

A

Ganciclovir, Valganciclovir, & Cidofovir

Use contraception while on these drugs!

59
Q

Ribavirin MOA?

A

Thought to target viral RNA polymerase to inhibit mRNA synthesis

60
Q

Penciclovir administration route?

A

Topical cream

61
Q

Valacyclovir administration route?

A

PO

62
Q

Pregnancy Risk Factor C?

A

Ganciclovir
Valganciclovir
Foscarnet
Cidofovir
Palivizumab
All 3 influenza drugs

63
Q

Acyclovir metabolism

A

Metabolized first by viral thymidine kinase then by host enzymes

64
Q

Ganciclovir administration route?

A

IV

65
Q

Acyclovir administration route?

A

Topical, oral or IV

66
Q

Palivizumab adverse events?

A
  • Fever
  • Rash
  • Antibody development
  • Anaphylaxis
67
Q

Cidofovir adverse events?

A
  • Renal impairment
  • Neutropenia; reduce dose
  • Metabolic acidosis; D/C
  • Ocular complications; D/C
68
Q

Zanamivir dosage?

A

10 mg BID 5 days (inhaled)

69
Q

Ribavirin pregnancy risk factor?

A

Category X- do NOT use with pregnant women or their partners

70
Q

Herpes Simplex Virus (HSV)

A

Human a-herpevirus has 2 types= HSV-1 & HSV-2

140-417 million infected worldwide between 15-49 years ol

Clinical Mx:

  • Herpes labialis or cold sores (mainly HSV-1)
  • Genital herpes (mainly HSV-2)
  • Other: keratitis, encephalitis, disseminated disease
71
Q

Only epidemics are caused by?

A

Influenza Type B

72
Q

Acyc- 200mg 5x 7-10d or 400 mg TID 7-10d
Valacyc- 1 g BID 7-10d
Famicyc- 250 mg TID 7-10d

A

HSV Dosing

73
Q

Acyclovir treats?

A

HSV and VZV

74
Q

The clinical manifestations of herpes include…

A

Cold sores
Genital herpes
Keratitis, encephalitis, disseminated disease

75
Q

Which drugs have antimicrobial activity on all 3- HSV, VZV, and CMV?

A

Foscarnet and Cicofovir

76
Q

Pregnancy Risk Factor B?

A

Acyclovir
Valacyclovir
Famiciclovir
Penciclovir

77
Q

Monitoring for Palivizumab?

A
  • Hypersensitivity rxns
  • CBC (esp with bleeding at injection site)
78
Q

NAIs MOA?

A
  • Prevent viral release from the infected host cell
  • Keeps the varion stuck on the cell membrane
79
Q

Famiciclovir adverse events?

A
  • Headache; reduce dose
  • Drug interaction; reduce dose
80
Q

Valacyclovir MOA?

A

Prodrug converted to acyclovir by enzyme in GI tract and liver; then inhibits viral DNA polymerase

81
Q

Palivizumab treats?

A

RSV in pediatric patients

82
Q

Ganciclovir and Valganciclovir metabolism?

A

metabolized by CMV UL97 phosphotransferase

83
Q

Varicella Zoster Virus (VZV)

A

Infects ~30% of humans in their lifetime

Trasmitted by respiratory route

Clinical manifestations: chickenpox, shingles, neuralgia/cranial nerve palsies, pneumonia, encephalitis

84
Q

Valacyclovir treats?

A

HSV and VZV

*prodrug for Acyclovir*

85
Q

Doconosal MOA?

A

May interfere with binding of viral envelope proteins to cell membrane

86
Q

What are the appropriate dosages for Acyclovir, Valaciclovir, and Famciclovir for 1st episode of genital HSV?

A

Acyclovir: 400 mg PO TID x7-10 d, 200 mg PO 5xdaily x7-10 d

Valaciclovir: 1 Gm PO BID x 7-10 d

Famciclovir: 250 mg PO TID x 7-10 d

87
Q

Very expensive drugs to treat VZV/HSV?

A

Valacyclovir
Penciclovir
Famiciclovir

88
Q

Famciclovir treats?

A

HSV and VZV

89
Q

Acyclovir Resistance?

A

Resistance can emerge due to mutations in viral thymidine kinase or viral DNA polymerase

90
Q

Foscarnet and Cidofovir MOA?

A

Inhibits viral DNA polymerase with no prior phosphorylation needed for binding to the DNA strand

91
Q

Ribavirin treats?

A

Influenza, RSV, Hep C

92
Q

HSV-1

A

Transmitted via contaminated aerosols or droplets

93
Q

Famciclovir metabolism?

A

First metabolized by viral thymidine kinase then host enzymes (just like Penciclovir)

94
Q

Factors that make patients HIGH risk for influenza complications

A
  • Children < 5 yr (especially those < 2 yr)
  • Adults ≥ 65 yr
  • Pregnant women (and those up to 2 wk postpartum)
  • Residents of nursing homes or long-term care facilities
  • American Indians and Alaskan Natives
  • Individuals ≤ 18 yr receiving long-term aspirin therapy (d/t risk of Reye syndrome)
  • Individuals with the following chronic medical conditions: Chronic pulmonary disorders (e.g., asthma), Neurologic or developmental disorders (e.g., stroke, cerebral palsy, epilepsy, spinal cord injury, intellectual disability), Heart disease (e.g., congestive heart failure [excluding hypertension alone]), Blood disorders (e.g., sickle cell disease), Kidney disorders, Liver disorders, Endocrine disorders (e.g., diabetes mellitus), Metabolic disorders (e.g., mitochondrial disorders), Morbid obesity (BMI ≥ 40 kg/m2), Immunocompromising conditions (e.g., HIV/AIDS, chronic corticosteroid use)
95
Q

Guanosine analogue antivirals MOA?

A

Halts viral DNA replication by inhibiting DNA polymerase (compete with dGTP)

Phosphorylated 3 times to be incorporated into DNA replication, second and third phosphorylation is by host

Acyclovir, Valaciclovir, Penciclovir, and Famiciclovir: HSV thymidine kinase for first phosphorylation

Ganciclovir and Valganciclovir: UL97 for first phosphorylation

96
Q

Valganciclovir administration route?

A

PO

97
Q

Palivizumab MOA?

A

Antibody neutralizes glycoprotein F of RSV inhibiting the fusion of RSV to the host cell

98
Q

Acyclovir adverse events?

A
  • Renal impairment (crystallization); hydrate
  • Phlebitis; ensure IV intact
  • GI; reduce does
  • Headache; reduce dose
  • Rash, itching; D/C
99
Q

Cytomegalovirus (CMV)

A

Worldwide prevalence 30-95%

Exclusively human reservoir (transmitted via blood, sexual contact, body fluids)

High morbidity and morality in immunocompromised (transplant patients)

Clinical manifestations: retinitis, esophagitis, colitis, pneumonitis, CNS disease

100
Q

DNA Viruses

A

Herpes Simplex Virus (HSV)

Varicella Zoster Virus ( VZV)

Cytomegalovirus (CMV)

Clin Med I (4 decks)

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