Antivirals Flashcards

Question

Lenecapavir and indication

Answer 1

capsid maturation inhibitor In BHIVA guidelines for "In those with significant resistance, include at least two and preferably three fully active agents with at least one active boosted PI (preferably ritonavir- or cobicistat-boosted darunavir) and one agent with a novel mechanism of action (these may include INSTIs, CCR5 antagonists, molecules targeting glycoprotein 120 [gp120; fostemsavir], monoclonal antibodies targeting CD4 [ibalizumab], capsid inhibitors [lenacapavir], the fusion inhibitor T-20 or other investigational agents). "

Answer 2

5mg/kg (some studies used higher doses)

Answer 3

Induction followed by maintenence Induction: 60mg/kg TDS for two to three weeks (or 90 mg/kg every BD) Maintenance 60 mg/kg daily (same as above but daily rather than TDS), then increased if tolerated to 90–120 mg/kg daily Note for HSV it is 40mg/kg TDS (no maintenance dose)

Answer 4

Anything nephrotoxic Pentamidine- causes calcium problems Note: Women capable of childbearing should use effective contraception methods during Foscavir therapy. Men treated with Foscavir should not father a child during or up to 6 months after therapy

Answer 5

9-carboxymethoxymethylguanine (CMMG)

Answer 6

14 days of valaciclovir (1gm TDS), or aciclovir 800mg 5 times a day - some recommend lifelong treatment Start ASAP but within 5 days

Answer 7

1) Induction* followed by maintenance** *adminisered over two-three weeks, 60mg/kg **60mg/kg daily increase up to 120 if tolerate 2) 40mg/kg TDS induction for indiction- no recommendations for maintenance NOTE: first line therapy is PO valgan 900mg BD for 14-21 days + intravitreal foscarnet 2.4mg

Answer 8

If eye disease, try limiting to topical foscarnet Way up risk vs benefit

Answer 9

Immunosupressants- increased them (see SOLSTICE trial)

Answer 10

Lassa virus and other Arenaviruses (Guanarito, Junin, and Machupo virus) Fusion inhibitor Salvage therapy attempt #193 🤣

Answer 11

Atoltivimab/maftivimab/odesivimab (inmazeb) Ebanga (ansuvimab) Look up palm trial

Answer 12

Prevention of RSV

Answer 13

Prevention of RSV

Answer 14

JC Checkpoint inhibitor Adverse effects: pneumonia, anaemia, thrombocytopenia PeMbriLuzimab

Answer 15

JC virus Checkpoint inhibitor

Answer 16

HSV eye disease MPox kerititis

Answer 17

Inhibitor of VP37 envelope protein BD dosing for 14 days smallpox, monkeypox and cowpox

Answer 18

HIV NRTTI (nucleoside reverse transcriptase translocation inhibitor) Initially concern as it reduced CD4 count but now can be used in lower doses

Answer 19

HIV fusion inhibitor binds to GP41

Answer 20

Capsid inhibtor

Answer 21

Nucleoside analogue, inhibits DNA polymerase

Answer 22

Pyrophosphate analog, inhibits DNA polymerase

Answer 23

Renal failure Leukopenia Anterior uveitis Hypospermia

Answer 24

Measles antiviral. Reduces viraemia, mortality and prevents lymphopenia and immune amnesia in animal model. "Therapeutic mitigation of measles-like immune amnesia and exacerbated disease after prior respiratory virus infections in ferrets" Cox et al 2024, Nature

Answer 25

Inhibits NTCP (Bulevirtide is a sodium-bile acid co-transporter inhibitor) Delta enters hepatocytes via Enters via NTCP, however there is also spread between hepatocytes, which BLV does not block BLV blocks the formation of both covalently closed circular DNA and HDV replicative intermediates and its continuous administration decreases the fraction of infected cells by blocking the HBV-mediated spread of HDV.149, 150, 151 However, during BLV treatment, intrahepatic HDV spreading due to the HBV/NTCP-independent, cell division-mediated mechanism persists, antagonising the eradication of HDV infection

Answer 26

Staging- Uses TIS (Tissue, Immune system, Systemic illness) https://www.cancer.org/cancer/types/kaposi-sarcoma/detection-diagnosis-staging/staging.html Treatment: ART If T1 disease is present, or lesions not regressing with ART, chemotherapy can be considered – Doxorubicin is 1st line

Answer 27

1 COVID predominantly vaccinated population infected with various SARS-CoV-2 variants of concern, showed the efficacy of a single subcutaneous dose of pegylated interferon lambda administered within 7 days after the onset of symptoms (mean, 3 days). This regimen resulted in a greater than 50% reduction in the risk of a primary-outcome event. Our trial findings were consistent across the SARS-CoV-2 variants of concern and across multiple subgroups according to vaccination status. 2) HDV (expand)

Answer 28

helicase primase inhibitor (same as pritelivir) Action against HSV and VZV

Answer 29

Nucleoside analogue Action against CMV ?adeno

Answer 30

viral capsid—function inhibitor Action against picornoviruses

Answer 31

Pleoconaril- capisd function inhibitor (picorno) Baloxavir - cap-dependent endonuclease (influenza) Lenacapavir- HIV, capsid maturation inhibitor

Answer 32

inhibits viral protein p37, encoded by the F13 gene of the variola virus (15). This protein is highly conserved in orthopoxviruses, allowing tecovirimat to have in vitro activity against several orthopoxviruses, including vaccinia, variola, cowpox, and monkeypox viruses (15, 16). The p37 protein is involved in the final steps of maturation of the virus and is required for the intracellular mature virus (IMV) to further envelope without a double membrane layer to form intracellular enveloped virus (IEV). IEV then fuses with the cytoplasmic membrane to release virions to disseminate from the site of infection (15). The p37 protein is specific to the orthopoxvirus family, making tecovirimat highly selective with the inability to inhibit replication of other classes of viruses, including herpesviruses

Answer 33

Tecoviomat: Indications

Answer 34

RSV monoclonal (in phase three)

Answer 35

Inhibits 3C like protease (inhibits Mpro) Needs to be started within 5 days of symptoms onset Trial is EPIC HR