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Infectious Disease > Antivirals > Flashcards

Antivirals Flashcards

1
Q

Describe general characteristics of anti-viral drugs?

A

Purine or Pyrimidine analogs.Many are Prodrugs. They must be phosphorylated by viral or cellular enzymes to be active. inhibits active replication so the viral growth resumes after drug removal.

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2
Q

What are the anti-HSV/VZV agents?

A

Acyclovir (Zovirax), Famciclovir (Famvir), Valacyclovir (Valtrex). Inhibit viral DNA-polymerase

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3
Q

What HSV infections is acyclovir (Zovirax) the treatment of choice?

A

HSV Genital infections, HSV encephalitis, HSV infections in immunocompromised and pregnant patient

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4
Q

What is the MOA of acyclovir (Zovirax)?

A

uptake by infected cell. cellular enzymes convert acyclovir to triphosphate. Acyclovir is thus selectively activated in cells infected with herpes virus. Uninfected cells do not phosphorylate acyclovir.

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5
Q

What is the dosing of acyclovir?

A

Varicella (chicken pox)/ zoster (shingles): 800mg PO 4-5x/day x 7days. Genital/mucocutaneous HSV: 1st episode: 400mg PO 3-4x/day x 7-10 days. Recurrence: 400 mg PO TID X 5 days. Suppression: 400mg PO BID

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6
Q

What are adverse effects of acyclovir (Zovirax) and Valacyclovir (Valtrex)?

A

reversible renal toxicity, somnolence, hallucinations, confusion, TTP/HUS (immunocompromised), HA, rash, photosensitivity, anemia, GI

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7
Q

What spectrum does famciclovir (Famvir) cover?

A

oral only. covers HSV 1/2, VZV, to lesser extent EBV, in vitro activity to HBV

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8
Q

How does the MOA of famciclovir compare to acyclovir?

A

converted to penciclovir triphosphate and compared to acyclovir triphosphate, penciclovir triphosphate has a lower affinity for viral DNA polymerase but a longer intracellular half-life.

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9
Q

What is the dosing for famciclovir (Famvir)?

A

Zoster (shingles): 500mg PO tid x 7days. Genital/orolabial HSV: 1st episode: 250mg PO tid x 7-10 days. Recurrence: 1000mg PO bid x 1 day w/in 6hrs of sx onset. Suppression: 250mg PO BID

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10
Q

What are adverse effects of famciclover (Famvir)?

A

neutropenia, thrombocytopenia, somnolence, hallucinations, GI, HA, fatigue, abnormal LFTs

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11
Q

What is the spectrum of coverage of valacyclovir (Valtrex)?

A

is a prodrug of Acyclovir (Rapidly and almost completely converted to acyclovir). Same MOA, spectrum of activity, mechanism of resistance. Better bioavailability

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12
Q

What is the dosing for Valacyclovir (Valtrex)?

A

Zoster (shingles): 1000mg PO tid x 7days. Genital/mucocutaneous HSV: 1st episode: 1000mg PO bid x 7-10 days. Recurrence: 500mg PO bid x 3-5 days. Suppression: 1000mg PO qday

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12
Q

What is the anti-CMV agent?

A

ganciclovir (cytovene)

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13
Q

What is the spectrum of ganciclovir (cytovene)?

A

CMV, EBV, HSV/VZV, HH6. Drug of choice for CMV retinitis in immunocompromised patient. Prevention of CMV disease in transplant patients.

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14
Q

What is the difference btw the ganciclovir MOA and acyclovir MOA?

A

ganciclovir contains a 3’-hydroxyl group, allowing for DNA to continue

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15
Q

What are adverse effects of ganciclovir (Cytovene)?

A

reversible pancytopenia, fever, rash, phlebitis, confusion, renal dsfxn, seizures, psych disturbances

16
Q

What are the influenza agents?

A

Oseltamivir, Zanamivir, Amantadine, Rimantadine

17
Q

What is spectrum of oseltamivr (tamiflu)?

A

works against influenza A/B, avian flu, H5N1. adverse effects include N/V, HA

18
Q

What is the dosing for Oseltamivir (Tamiflu)?

A

Influenza A and B tx: 75 mg PO bid x 5 days w/in 48h of sx onset. Influenza A and B prophylaxis:
75 mg PO qday x 7 days w/in 48h of exposure

19
Q

What is the spectrum of Zanamivir (Relenza)?

A

Uncomplicated influenza A and B, some strains of avian influenza, possibly effective for H5N1
Adverse effects: nasal and throat discomfort, bronchospasm

20
Q

What are Amantadine (Symmetrel) and Rimantadine (Flumadine)?

A

Prevents release of viral nucleic acid. Covers influenza A. Not recommended due to resistance. Adverse effects include seizures, anticholinergic, CNS, edema, blurry vision. Used for parkinsons and tremors

21
Q

What is Ribavirin?

A

Purine nucleoside analog. MOA is inhibition of RNA polymerase.

22
Q

What is ribavirin used to treat?

A

DOC: RSV bronchiolitis and pneumonia in hospitalized children (given by aerosol). Lassa fever. Alternative: Influenza, parainfluenza, measles virus infection in immunocompromised patients. Used in combo with interferons for HCV

23
Q

What are adverse effects of Ribavirin?

A

BBW-Hemolytic anemia*, respiratory deterioration, depression, suicide, bacterial infections, anxiety, fatigue, dizziness

24
Q

What are anti-viral drugs of hepatic viral infections?

A

Interferons. Lamivudine for HBV. Entecavir for HBV lamivudine resistance strains. Ribavirin for Hepatitis C with interferons

Infectious Disease (17 decks)

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