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Pharmacology > Antivirals > Flashcards

Antivirals Flashcards

1
Q

what are the DNA viruses

A
  • adenovriuses
  • herpesviruses
  • papillonaviruses
  • Varciella-Zoster
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2
Q

what are the RNA viruses

A

-ortho and paramyxoviruses, rubella, viruses and retroviruses

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3
Q

what is used to treat Herpes and Varicella-Zoster Infections

A

Acyclovir

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4
Q

what are the symptoms of Acyclovir toxicity

A
  • nausea, headache, diarrhea and vomiting

- transient renal dysfunction at high doses and when given to dehydrated patients by IV

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5
Q

what is the therapeutic use of Ganciclovir

A
  • treatment of CMV retinitis in immunocompromised pats

- prevention of CMV disease in transplant pts

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6
Q

what is the toxicity of Ganciclovir

A

dose-dependent neutropenia, CNS effects (headache, behavioural changes, convulsions, coma), carcinogenic

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7
Q

patients with Ganciclovir toxicity present with

A
  • blurred vision
  • floaters
  • loss of central or peripheral vision
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8
Q

what is the plasma half life of acyclovir

A

2.5 hrs

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9
Q

what is the plasma half life of Ganciclovir

A

> 24 hrs

Ganciclovir triphosphate [ ] are 10x of acyclovir

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10
Q

what is the therapeutic use of Foscarnet

A
  • IV treatment for CMV retinitis in HIV-infected patients who are resistant to ganciclovir.
  • Herpes patients who are resistant to acyclovir.
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11
Q

Toxicity of Foscarnet

A

Nephrotoxicity, anemia, nausea, fever, hypocalcemia and hypomagnesemia.

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12
Q

what is the therapeutic effect of Trifluridine

A

HSV keratoconjunctivitis and keratitis.

Replaced the drug Idoxuridine

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13
Q

what is the toxicity of Trifluridine

A

Inflammation of the cornea

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14
Q

what is the therapeutic effect of Fomivirsen

A

CMV retinitis in patients who do not respond to other drugs. Do not give to patients who have taken cidofovir in past month-may increase inflammation of the eye.

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15
Q

what is the toxicity of Fomivirsen

A

Iritis, increased intraocular pressure and vision changes.

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16
Q

see mnemonic on slide 13

A

see mnemonic on slide 13

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17
Q

what are the Neuraminidase Inhibitors

A

zanamivir, oseltamivir

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18
Q

what is the therapeutic use of Neuraminidase Inhibitors

A

-shortens the duration and may be used to prevent flu

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19
Q

what is the toxicity of Zanamivir

A

nasal and throat discomfort and headaches

-bronchospasm in asthma patients

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20
Q

what is the toxicity of oseltamivir (TAMIFLU)

A
  • nausea, vomiting and headaches

- when taken with food there is less nausea

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21
Q

what can Zanamivir be used for

A

treatment of H1N1

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22
Q

what is Oseltamivir used for

A

Influenza A and B, H1N1

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23
Q

what are interferons

A

Interferons alpha and beta are made in response to viral infection

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24
Q

what is the MAO of interferons

A

IFNs bind to cellular receptors and activate the JAK-STAT signal transduction pathway
IFNs induce many proteins, including 2’-5’-oligoadenylate synthetase and a kinase, that inhibit protein synthesis.

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25
Q

what is the therapeutic use of interferons

A

genital warts, chronic hepatitis B and C, Kaposi’s sarcoma in HIV-infected patients, multiple melanomas and multiple sclerosis.

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26
Q

Peg-interferon 2A with Ribavirin is the treatment of choice for

A

chronic hepatitis C

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27
Q

what is the toxicity of interferons

A
  • IM or SC injection may produce flu-like symptoms
  • High dose or chronic therapy may be limited due to bone marrow suppression, fatigue, increased susceptibility to bacterial infections, anorexia, diarrhea and psychiatric syndrome (depression and anxiety)
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28
Q

what is the MOA of Ribavirin

A

inhibits viral mRNA synthesis

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29
Q

what is the therapeutic use of Ribavirin

A
  • Ribavirin with interferon is the standard treatment for hepatitis C
  • Given to treat infants and young children with Respiratory Syncytial Virus infections that cause bronchiolitis and pneumonia.
  • Influenza A and B, Parainfluenza, Paramyxovirus, Arenaviruses and HIV.
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30
Q

what is the toxicity of Ribavirin

A

Aerosol is well tolerated, but systemic doses may cause anemia
Teratogenic therefore do not give to pregnant women.

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31
Q

what does HAART stand for

A

Highly Active Anti-Retroviral Therapy

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32
Q

what are the possible side effects of HAART

A 
liver problems 
diabetes
lipodystrophy syndrome
high cholesterol
increased bleeding hemophiliacs 
decreased bone density
skin rash
33
Q

what is the therapeutic use of Zidovudine (AZT)

A

HIV patients, protects fetuses from becoming infected in HIV-infected pregnant women.

34
Q

Zidovudine resistance

A

Mutated reverse transcriptase that has a lower affinity for the AZT-TP

35
Q

what is the toxicity of Zidovudine

A

Bone marrow (anemia and leukopenia) and headaches

36
Q

what drugs increase the toxicity of Zidovudine

A

Probenecid, Acetaminophen Lorazepam (benzodiazepine), Indomethacin (anti-inflammatory), and Cimetidine (H2-receptor antagonist)

“I am a PAL I Care”

37
Q

what is the therapeutic use of Didanosine (ddI)

A

-patients with AZT-resistant HIV infections

38
Q

what s the toxicity of Didanosine

A
  • Pancreatitis that may be fatal, gastrointestinal disturbances and a dose-limiting peripheral neuropathy
  • toxicity increases when combined with Stavudine
39
Q

what is the therapeutic Zalcitabine (dec)

A

-Given in conjunction with AZT or alone for those who cannot tolerate AZT- treatment

40
Q

what is the toxicity of Zalcitabine

A

Peripheral neuropathy, rash and stomatitis on initial treatments

41
Q

what is the toxicity of Stavudine

A

peripheral neuropathy

42
Q

what is the toxicity of both AZT and Stavudine treatment

A

Potentially fatal lactic acidosis, peripheral lipoatrophy, central fat accumulation and hyperlipidemia

43
Q

what is the therapeutic use of Lamivudine (3CT) and Emtricitabine

A

Patients with HIV in combination with AZT (resistance to AZT develops more slowly when used in combination)
and hepatitis B patients.

44
Q

what is the toxicity of Lamivudine

A

Pancreatitis often develops in pediatric patients

45
Q

what is the therapeutic use of Abacavir

A

: HIV infected adults and children in combination with AZT and Lamivudine or a protease inhibitor

46
Q

what is the toxicity of Abacavir

A

Hypersensitivity resulting in fever, gastrointestinal distress, malaise and rash

47
Q

what is the MOA of Tenofovir

A

Inhibits reverse transcriptase and terminates DNA chain elongation.

48
Q

what is the therapeutic use of Tenofovir

A

HIV infected patients and chronic hepatitis B infections.

49
Q

see slide 32

A

see slide 32

50
Q

what is the toxicity of Tenofovir

A
  • well tolerated except for flatulence, some renal toxicity

- do not give as didanosine, lamivudin or abacavir combo

51
Q

see mnemonic on slide 33

A

see mnemonic on slide 33

52
Q

what is the MOA of Efavirenz

A

alters the conformation of reverse transcriptase

53
Q

what the therapeutic use of Efavirenz

A

Used in combination with AZT and Lamivudine

54
Q

what is the toxicity of Efavirenz

A

Dizziness, headache, insomnia, rash

55
Q

what is the drug interactions of Efavirenz

A

Efavirenz decreases concentration of Phenobarbital, Phenytoin, Carbamazepine, Methadone and Rifabutin.

Co-administration of Rifampin will reduce levels of Efavirenz

56
Q

what is the MOA of Nevirapine

A

alters the conformation of reverse transcriptase

57
Q

what is the therapeutic use of Nevirapine

A

used in combo with Didanosine or Stavudine

58
Q

what is the toxicity of Nevirapine

A

Rash, fever, nausea, severe dermatologic effects and fatal hepatotoxicity

59
Q

what are the drug interactions of Nevirapine

A

Must warn patients not to take St. John’s Wort which lowers the concentration of Nevirapine.

Nevirapine induces CYP3A4 and therefore it may lower the concentration of drugs metabolized by this enzyme.

Nevirapine lowers plasma concentrations of Ethinyl estradiol and therefore patients should be given alternate methods of birth control

60
Q

what is the MOA of Delavirdine

A

binds and inhibits reverse transcriptase

61
Q

what is the therapeutic effect of Delavirdine

A

Used in combination with Zidovudine and Didanosine, least potent NNRTI

62
Q

what are the drug interactions of Delavirdine

A

Delavirdine inhibits CYP3A4 and may thus alter the metabolism of Rifampin, Rifabutin, Ergot derivatives, Triazolam, Midazolam and Cisapride.

Delavirdine also inhibits CYP2C9.

Drugs that induce CYP3A4, such as Carbamazepine, Penobarbital, Phenytoin, Rifabutin and Rifampin, may decrease Delavirdine levels.

63
Q

see mnemonic on slide 37

A

see mnemonic on slide 37

64
Q

what are the protease inhibitors

A 
Atazanavir
Indinavir
Ritonavir
Lopinavir
Nelfinavir
Amprenavir
Saquinavir
65
Q

see mnemonic on slide 39

A

see mnemonic on slide 39

66
Q

what is the therapeutic use of protease inhibitors

A

HIV patients must take the drugs continuously in combination with AZT and Lamivudine or other nucleoside reverse transcriptase inhibitors.

67
Q

what is the toxicity of protease inhibitors

A

Well tolerated

Sometime- nausea, vomiting, diarrhea, lipodystrophy and hyperglycemia

68
Q

what is the resistance of protease inhibitors

A

Cross-resistance often occurs among the protease inhibitors, but the HIV strains may still be susceptible to Amprenavir.

69
Q

what are the pharmacokinetics of Lopinavir/Ritonavir

A

is metabolized by CYP3A. Ritonavir is an inhibitor of CYP3A4 activity and, therefore, raises the Lopinavir plasma levels

70
Q

what is the therapeutic use of Lopinavir/Ritonavir

A

The combination of drugs is used to treat HIV strains that are resistant to multiple protease inhibitors

71
Q

what is the toxicity of Lopinavir/Ritonavir

A

Well tolerated.

Diarrhea, nausea, fatigue, headache, hyperlipidemia, hyperglycemia, and altered body fat

72
Q

what are the drug interactions of Lopinavir/Ritonavir

A

Inhibit the activity of CYP3A4 and CYP2D6 and therefore may increase or prolong the therapeutic or adverse effects of drugs metabolized by these pathways

73
Q

what the Fusion Inhibitor

A

Enfuvirtide

Macaviroc

74
Q

what is the therapeutic use of Enfuvirtide

A

Injected twice daily in HIV patients. Used with other drugs

75
Q

what is the toxicity of Enfuvirtide

A

Pain, redness, nodules and cysts formation at the site of injection

76
Q

what is the therapeutic use of Maraviroc

A

HIV patients

77
Q

what is the MOA of Maraviroc

A

The drug blocks the CCR5 chemokine receptor. HIV uses CCR5 as a co-receptor to bind and enter macrophages

78
Q

what is the toxicity of Maraviroc

A
  • most common are cough, fever, dizziness, headache, lowered blood pressure, nausea, and bladder irritation
  • May cause liver problems and cardiac events, an increased risk for some infections, and a slight increase in cholesterol levels
79
Q

see slide 47

A

see slide 47

Pharmacology (23 decks)

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