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Pharmacology 2 > Antivirals > Flashcards

Antivirals Flashcards

1
Q

4 classes of RNA viruses?

A

orthomyxovirus
orthocoronavirus
retrovirus
flavivirus

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2
Q

name the 3 orthomyxoviruses?

A

influenza A
influenza B
RSV

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3
Q

name the retroviruses?

A

HIV-1
HIV-2

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4
Q

name the falvivirus?

A

Hep C virus

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5
Q

2 classes of DNA viruses?

A

herpes viruses
hepadnaviruses

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6
Q

name the 4 herpes viruses?

A

HSV-1
HSV-2
varicella-zoster virus
CMV

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7
Q

name the hepadnavirus?

A

hep B virus

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8
Q

what is the challenge for antiviral therapy?

A

have no cell wall or cell membrane

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9
Q

2 synthetic nucleoside analogs that are phosphorylated into nucleotides and taken up by viral DNA polymerase as “false substrates” during the acute phase of infection

A

acyclovir
valacyclovir (prodrug)

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10
Q

3 uses for acyclovir and valacyclovir?

A

HSV-1
HSV-2
VZV

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11
Q

topical ADR of acyclovir and valacyclovir? oral? IV? in patients with impaired renal function?

A

TOPICAL:
burning
stinging
mild pain

ORAL:
headache

IV:
phlebitis

IMPAIRED RENAL FUNCTION:
nephrotoxicity

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12
Q

4 synthetic nucleoside analogs that get phosphorylated into monopotassium phosphate (PO4) by viral thymidine kinase in HSV or VZV-infected cells OR UL97 kinase in CMV-infected cells

A

penciclovir
famciclovir (prodrug)

ganciclovir
valganciclovir (prodrug)

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13
Q

2 uses for penciclovir and famciclovir?

A

HSV
VZV

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14
Q

3 ADR of penciclovir and famciclovir?

A

TOPICAL:
burning/pain

ORAL:
headache

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15
Q

2 uses for ganciclovir and valganciclovir?

A

CMV
CMV retinitis in AIDS

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16
Q

3 ADRs of ganciclovir and valganciclovir?

A

headache
allergic reaction
bone marrow suppression

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17
Q

3 monophosphate nucleoside analogs that do not need the viral kinase to phosphorylate and can overcome viral resistance due to deficient or mutated thymidine kinase or UL 97 kinase

A

cidofovir (IV)
trifluridine (PO, eye)
vidarabine (PO, eye)

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18
Q

2 uses for the monophosphate nucleoside analogs?

A

acyclovir-resistant HSV kerato-conjunctivitis
CMV retinitis

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19
Q

anti-viral that directly inhibits viral DNA polymerase by targeting HIV reverse transcriptase (who converts viral RNA into viral DNA)

A

foscarnet (IV)

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20
Q

2 uses for foscarnet?

A

acyclovir-resistant HSV
ganciclovir-resistant CMV

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21
Q

4 ADRs of foscarnet?

A

“fast cars make me feel imbalanced (electrolytes), nephrotoxicity, hot (fever) and weak (anemia)

nephrotoxicity
electrolyte imbalance
fever
anemia

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22
Q

why is foscarnet hardly used?

A

caused ARDS

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23
Q

unsure MOA, possibly inhibits viral fusion; used OTC and started within 12 hours of symptoms

A

docosanol

(zilactin-B, blistex, erazaban)

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24
Q

use for docosanol?

A

recurrent orolabial herpes

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25
Q

2 ADRs of docosanol?

A

headache
allergic rxn (rare)

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26
Q

target and bind to spike protein of COVID-19, block antigen from binding to cells or “mark” it for processing by immune cells

A

monoclonal antibodies

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27
Q

nucleoside triphosphate analogue that inhibits viral RNA polymerase and stops the inclusion of additional nucleosides

A

remdesivir (IV)

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28
Q

remdesivir use?

A

COVID-19

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29
Q

why does remdesivir have low efficacy, especially on ventilated patients?

A

infection spreads before patient has symptoms

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30
Q

what is the median incubation period of COVID-19? when should remdesivir be started?

A

4 days

8 hours - 2 days of infection

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31
Q

kinase inhibitor that interferes with the main protease enzyme of COVID-19

A

paxlovid (oral)

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32
Q

ADR of paxlovid?

A

rebound of symptoms after full course and viral clearance

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33
Q

2 paxlovid uses?

A

contain COVID-19 pandemic
decrease hospitalizations and deaths

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34
Q

not yet approved for use but reserved for patients who cannot respond or tolerate paxlovid

A

molnupiravir

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35
Q

used as pre-exposure prophylaxis for COVID-19 infection in patients at risk for the infection and are allergic to the vaccine

A

evusheld (tixagevimab/cilgavimab)

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36
Q

4 ADRs of COVID-19 vaccine?

A

injection site reaction
fatigue
headache
myalgia

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37
Q

what is considered the 1st line treatment for HIV?

A

NRTI’s (nucleoside reverse transcriptase inhibitors)

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38
Q

what is the goal of HIV treatment?

A

slow or reverse the increase in viral RNA load that is associated with disease progression

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39
Q

what is the Highly Active Anti-Retroviral Therapy (HAART) regimen?

A

2 NRTIs + INSTI

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40
Q

what is the HAART alternative #1?

A

2 NRTIs + NNRTI or boosted protease inhibitor

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41
Q

what is the HAART alternative #2?

A

1 NRTI + INSTI

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42
Q

fusion inhibitor that blocks fusion between the virus and target cell membrane extracellularly

A

enfuvirtide (SQ)

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43
Q

-virtide

A

fusion inhibitor

44
Q

enfuvirtide use?

45
Q

2 entry inhibitors known as CXCR4 antagonists and CCR5 antagonists; the CXCR4 and CCR5 receptors help viruses bind

A

maraviroc
ibalizumab

46
Q

maraviroc and ibalizumab use?

47
Q

ADRs of entry inhibitors?

A

hepatotoxicity

48
Q

3 NNRTIs that directly bind to HIV’s reverse transcriptase without needing phosphorylation

A

Rilpivirine
Efavirenz
Nevirapine

49
Q

which NNRTI is used during childbirth to prevent transmission of HIV?

A

nevirapine

“Nevir let the baby get it”

50
Q

ADR specific to efavirenz?

A

vivid dreams

51
Q

2 ADRs of NNRTIs?

A

rash
elevated LFTs

52
Q

NNRTIs have increased effects when used with _____

53
Q

4 NRTIs that need activation/phosphorylation into a “false nucleotide” via intracellular kinases; inhibit conversion of viral RNA into viral DNA

A

Lamivudine
Abacavir
Tenofovir
Emtricitabine

54
Q

which HIV drugs have the least potential for D-D interaction?

55
Q

2 ADRs of NRTIs?

A

lactic acidosis
hepatomegaly

56
Q

ADR of NRTI specific to abacavir?

A

hypersensitivity (esp if + HLA-B5701 gene carrier)

57
Q

what disqualifies a patient from using abacavir?

A

HLA-B5701 gene carrier

58
Q

which NRTI requires testing before considering the use of the drug and should NEVER be re-challenged?

59
Q

which NRTI has few S/E, good bioavailability and is in most HAART regimens?

A

emtricitabine

60
Q

-tegravir

A

integrase inhibitors

61
Q

prevent HIV from getting inserted into the host cell’s DNA, which occurs after reverse transcription of viral RNA to viral DNA has occurred

A

integrase inhibitors

62
Q

ADR of integrase inhibitors?

A

weight gain

63
Q

-navir

A

protease inhibitors

64
Q

stops maturation of viral DNA in HIV

A

protease inhibitors

65
Q

6 ADRs of protease inhibitors?

A

hyperglycemia/insulin resistance
central adiposity
lipodystrophy syndrome
increased LFTs
prolonged QT
hyperlipidemia

66
Q

which protease inhibitor has oral absorption that depends on acidic environment?

A

atazanavir

67
Q

which protease inhibitor has increased D-D interactions since it is a potent CYP3A4 inhibitor?

68
Q

-savir

A

gP120 blocker (attachment inhibitor)

69
Q

inhibits gP120, which would usually stop the drug from entering the viral cell of HIV

A

gP120 blocker (attachment inhibitor)

70
Q

what is a key step needed for entry of HIV-1 into host cell?

A

binding of HIV-1 gP120 to co-receptors CCR5 or CXCR4

71
Q

which 3 drug classes do not have CYP450 interaction?

A

NNRTI
fusion inhibitor
integrase inhibitor (INSTI)

72
Q

which 2 drug classes are metabolized by CYP3A4?

A

protease inhibitor
entry inhibitors

73
Q

which 2 HIV drugs have acid-dependent oral absorption and will thus be affected by PPIs and other drugs that decrease acidity?

A

atazanavir
rilpivirine

74
Q

during which 2 trimesters have the highest transmission rate of HIV?

75
Q

what can be given to pregnant patients with HIV who are and are not already being treated?

76
Q

which PrEP drug has the highest risk of hepatotoxicity with CD4 > 250?

A

nevirapine

77
Q

available for HIV negative patients; take a once daily combination of 2 NRTIs before coming into contact with HIV to decrease infection risk. which 2 drugs can be used?

A

“PrEPare for ET”

PrEP

emtricitabine
tenofovir

78
Q

used for suppress local viral replication of HIV prior to dissemination to abort infection

79
Q

when should PEP be started?

A

within 1-2 hours of exposure

80
Q

what is the PEP regimen for a patient in low risk, with asymptomatic HIV, low HIV-RNA titer, and a high CD4 count?

A

zidovudine + lamivudine

81
Q

what is the PEP regimen for a patient in high risk, with symptomatic HIV, high HIV-RNA titer, and a low CD4 count?

A

zidovudine + lamivudine + indinavir (protease inhibitor)

82
Q

which protease inhibitor has no antiviral activity but it used to boost the systemic exposure of the active components being used to attack HIV?

83
Q

-mivir

A

viral neuraminidase inhibitors

84
Q

use of viral neuraminidase inhibitors?

A

influenza A
influenza B

85
Q

when should viral neuraminidase inhibitors be taken?

A

within 24-48 hours of symptom onset

86
Q

ADRs of viral neuraminidase inhibitors (mivir)?

A

N/V
nasal discomfort
bronchospasms

87
Q

in which medical condition should viral neuraminidase inhibitors be avoided?

88
Q

inhibitor of CAP endonuclease (an essential subdomain of viral RNA polymerase within influenza A and B)

A

“CAP” associated with Bal…”

baloxavir

89
Q

baloxavir has a synergistic effect with which other antiviral?

A

oseltamivir

90
Q

what should NOT be administered in any case of influenza infection d/t the risk of Reye syndrome (brain/liver damage)?

A

aspirin (pepto)

91
Q

2 drugs that inhibit the 1st step in viral replication of influenza A and rubella viruses? are now used as anti-parkinsonism agents

A

amantadine
rimantadine

92
Q

2 previous uses for amantadine and rimantadine?

A

influenza A prophylaxis
decreased symptom duration if taken within 48 hours of contact

93
Q

antiviral that inhibits viral RNA polymerase

94
Q

use of ribavirin? previous use?

A

severe RSV infection

previously HCV

95
Q

ADR of ribavirin?

A

human teratogen (CI in pregnancy!!!)

96
Q

drug that stimulates synthesis of antiviral proteins that mimic host interferon; inhibiting viral life cycle at multiple steps

A

interferon alpha (IFN-alpha)

97
Q

use for INF-alpha?

A

Hep B
Hep C

98
Q

4 ADRs of IFN-alpha?

A

flu-like symptoms
confusion
emotional disturbance
dose-limiting bone marrow suppression

99
Q

added to increase the activity IFN-alpha for Hep B and Hep C

A

polyethylene glycol

100
Q

the drug combination of IFN-alpha OR polyethylene glycol IFN-alpha + ribavirin, requires what d/t being a teratogen?

A

pregnancy test and contraception

101
Q

what is the current standard of care for chronic HCV?

A

oral direct-acting antivirals (DAA)

102
Q

what is the length of treatment with DAA?

103
Q

what drugs do DAAs have a high D-D interaction potential with?

A

anticoagulants:

apixaban
edoxaban
rivaroxaban
dabigatran

104
Q

-previr

A

DAA protease inhibitors

105
Q

-asvir

A

DAA NS5A inhibitors

106
Q

-buvir

A

DAA nucleoside and non-nucleoside inhibitors

107
Q

what is chronic HCV treatment dependent on?

A

genotype testing

Pharmacology 2 (22 decks)

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