Antiviral Therapy

Question 1

Zanamivir, oseltamivir mech

Answer 1

inhibit influenza neuraminidase : decrease the release of progeny virus

Question 2

Zanamivir, oseltamivir clinical use

Answer 2

Treatment and prevention of both influenza A and B

Question 3

Ribavirin Mech

Answer 3

Inhibits synthesis of guanine nucleotides by competitively inhibiting inosine monophosphate DH

Question 4

clinical use of Ribavirin

Answer 4

RSV, Chronic Hep C

Question 5

Ribavirin toxicity/SE

Answer 5

Hemolytic anemia. Severe teratogen.

Question 6

Acyclovir, famciclovir, valacyclovir mech

Answer 6

Monophosphorylated by HSV/VZV thymidine kinase and not phosphorylated in uninfected cells: few adverse effects. Guanosine analog. Triphosphate analog. Triphosphate formed by cellular enzymes. Preferentially inhibits viral DNA polymerase chain termination

Question 7

Acyclovir, famciclovir, valacyclovir clinical use

Answer 7

HSV and VZV; HSV-induced mucocutaneous and genital lesions as well as for encephalitis. Prophylaxis in immunocompromised patients. No effect on latent forms of HSV and VZV.

Question 8

Acyclovir, famciclovir, valacyclovir have weak activity against what virus?

Answer 8

EBV

Question 9

Acyclovir, famciclovir, valacyclovir has NO activity against what virus?

Answer 9

CMV

Question 10

What is a prodrug of acyclovir? what is its advantage?

Answer 10

Valacyclovir; better bioavailability!

Question 11

What is the treatment for herpes zoster?

Answer 11

Famciclovir! (I took this, wasn’t a hug fam of zoster haha)

Question 12

Acyclovir, famciclovir, valacyclovir Toxicity

Answer 12

Obstructive crystalline nephropathy and acute renal failure if not adequately hydreated

Question 13

What is the mech of resistance to acyclovir, famciclovir, valacyclovir?

Answer 13

Mutate viral thymidine kinase

Question 14

Ganciclovir mech

Answer 14

5’-monophosphate formed by a CMV viral kinase. Guanosine analog. Triphosphate formed by cellular kinases. Preferentially inhibits viral DNA polymerase.

Question 15

Ganciclovir Clinical use

Answer 15

CMV, especially in immunocompromised patients. Valganciclovir, a prodrug of ganciclovir, has better oral bioavailability

Question 16

Ganciclovir Toxicity

Answer 16

Leukopenia, neutropenia, thrombocytopenia, renal toxicity. More toxic to host enzymes than acyclovir

Question 17

What is the mech of resistance to Ganciclovir?

Answer 17

Mutated CMV DNA polymerase or lack of viral kinase

Question 18

Foscarnet mech

Answer 18

Viral DNA polymerase inhibitor that binds to the pyrophosphate-binding site of the enzyme. Does not require activation by viral kinase.

Question 19

What is the mneumonic for foscarnet?

Answer 19

Foscarnet = pyrofosphate analog

Question 20

Foscarnet (2) clinical uses?

Answer 20

1) CMV retinitis in immunocompromised patietns when ganciclovir FAILS; 2) acyclovir-resistant HSV

Question 21

Foscarnet toxicity?

Answer 21

Nephrotoxicty

Question 22

What is the mech of resistance to Foscarnet?

Answer 22

Mutated DNA polymerase

Question 23

Cidofovir mech

Answer 23

Preferentially inhibits viral DNA pol. Does not require phosphorylation by viral kinase.

Question 24

What is the clinical use of Cidofovir?

Answer 24

CMV retinitis in immunocompromised patients; acyclovir-resistant HSV.

Question 25

Does Cidofovir have a long or short half life?

Answer 25

long

Question 26

When is HAART initiated?

Answer 26

when patients present with AIDS defining illness, low CD4 counts (

Question 27

What is the HAART regimen?

Answer 27

2 nucleoside reverse transcriptase inhibitors (NRTIs) + 1 non-nucleoside reverse transcriptase inhibitor (NNRTI) OR 1 protease inhibitor or 1 integrase inhibitor

Question 28

What are the Protease inhibitors? stating the suffix is good fucking enough

Answer 28

Atazanavir, Darunavir, Fosamprenavir, Indinavir, Lopinavir, Ritonavir, Saquinavir

Question 29

Mech of protease inhibitors

Answer 29

Assembly of virions depends on HIV-1 protease (pol gene), which cleaves the polypeptide products of HIV mRNA into their functional parts. Thus, protease inhibitors prevent maturation of new viruses.

Question 30

Which protease effects metabolism of other drugs? how?

Answer 30

Ritonavir can boost other drug concentrations by inhibiting CYP-450.

Question 31

Navir tease a protease

Answer 31

haha

Question 32

Protease inhibitor Toxicity

Answer 32

Hyperglycemia, GI intolerance (nausea, diarrhea), lipodystrophy. Nephropathy.

Question 33

What protease can cause hematuria?

Answer 33

Indinavir

Question 34

What are the Nucleoside Reverse transcription inhibitors?

Answer 34

Abacavir, Didanosine, Emtricitabine, Lamivudine, Stavudine, Tenofovir, Zidovudine (ZDV, formerly AZT)

Question 35

What is the mech of NRTIs?

Answer 35

Competively inhibit nucleotide binding to reverse transcriptae and terminate the DNA chain (lack a 3'OH group). The nucleosides need to be phosphorylated to be active

Question 36

Which NRTI is actually a nucleotide?

Answer 36

Tenofovir

Question 37

Which NRTI is used for general prophylaxis and during pregnancy to decrease the risk of fetal transmission?

Answer 37

ZDV

Question 38

Toxicity of NRTI's

Answer 38

Bone marrow suppression (can be reversed with granulocyte colony-stimulating factor and erythropoietin, peripheral neuropathy, lactic acidosis (nucleosides), rash (non-nucleosides), anemia (ZDV), pancreatitis (didanosine).

Question 39

NNRTIs

Answer 39

Efavirenz, Nevirapine, Delavirdine

Question 40

Efavirenz, Nevirapine, Delavirdine mech

Answer 40

Bind to reverse transcriptae at site different from NRTIs. Do no require phosphorylation to be active or compete with nucleotides.

Question 41

Efavirenz Nevirapine, Delavirdine SE/Toxicity profile

Answer 41

Rash and hepatotoxicty are common to all NNRTIs. Vivid dreams and CNS symptoms are common with efavirenz. Delavirdine and efavirenz are contraindicated in pregnancy

Question 42

What is the integrase inhibitor?

Answer 42

Raltegravir

Question 43

Raltegravir mech

Answer 43

Inhibits HIv genome integration into host cell chromosome by reversibly inhibiting HIV integrae

Question 44

Raltegravir SE/toxicity

Answer 44

Hypercholestrolemia

Question 45

What are the fusion inhibitors?

Answer 45

Enfuvirtide, Marviroc

Question 46

Enfuvirtide mech

Answer 46

binds gp41, inhibiting viral entry

Question 47

Maraviroc mech

Answer 47

Binds CCR-5 on surface of T cells/monocytes, inhibiting interaction with gp120

Question 48

Skin reaction at injection site is a SE of which drug?

Answer 48

Enfuvirtide

Question 49

What are interferons?

Answer 49

Glycoproteins normally synthesize by virus-infected cells

Question 50

What is the mech of interferons?

Answer 50

antivrial and antitumoral properties

Question 51

IFN-alpha clinical usage?

Answer 51

Chronic Hep B & Hep C, Kaposi Sarcoma, Hairy cell leukemia, condyloma acuminatum, renal cell carcinoma, malignant melanoma

Question 52

IFN-beta

Answer 52

multiple sclerosis

Question 53

IFN-gamma

Answer 53

Chronic granulomatous disease

Question 54

Interferon toxicity

Answer 54

Neutropenia, myopathy

Question 55

Antibiotics to avoid in pregnancy + adverse effect?

Answer 55

The following are examples.....

Question 56

Sulfonamides

Answer 56

Kernicterus

Question 57

Aminoglycosides

Answer 57

Ototoxicty

Question 58

Fluoroquinolones

Answer 58

Cartilage damage

Question 59

Clarithromycin

Answer 59

Embryotoxic

Question 60

Tetracyclines

Answer 60

Discolored teeth, inhibition of bone growth

Question 61

ribavirin

Answer 61

Teratogenic

Question 62

Griseofulvin

Answer 62

Teratogenic

Question 63

Chloramphenicol

Answer 63

Gray Baby