Antivirals

Question 1

What are some antiviral medications?

Answer 1

Ostamivir (Tamiflu), Baloxavir, Acyclovir, Valacyclovir

Question 2

What medications are used for influenza?

Answer 2

Ostamivir (Tamiflu), Baloxavir

Question 3

What medications are used for herpes simplex virus types 1 and 2?

Answer 3

Acyclovir, Valacyclovir

Question 4

Influenza antiviral MOA?

Answer 4

Ostamivir: inhibits influenza viral replication

Question 5

Herpes antiviral MOA?

Answer 5

Acyclovir: nucleoside analog that selectively inhibits the replication of herpes virus

Valacyclovir: prodrug of acyclovir

Question 6

AEs of antivirals for influenza?

Answer 6

Tamiflu: n/v, neuropsychiatric effects (MC older adults), SJS

Baloxavir: generally better tolerated; diarrhea

Acyclovir and valacyclovir: HA, dizziness, n/v, diarrhea

Question 7

When to use antivirals?

Answer 7

Best for use in high risk patients: 3-24 months or >65 years old, pregnancy, chronic conditions (COPD, diabetes), immunocompromised, morbid obesity, Native Americans/Alaska natives

Question 8

What medications are used for the treatment of HIV?

Answer 8

Tenofovir/Emtricitabine
(2 formulations: Truvada and Descovy)

Bictegravir

Question 9

MOA of Truvada and Descovy?

Answer 9

Nucleotide/nucleoside reverse transctiptase inhibitor

Question 10

MOA of Bictegravir?

Answer 10

Integrase strand transfer inhibitor

Question 11

AEs of Tenofovir/Emtricitabine?

Answer 11

Tenofovir: mild GI effects, hepatomegaly, lactic acidosis, renal and bone toxicity with long term use

Emtricitabine: generally well tolerated, ski rash on palms and soles

Question 12

AEs of Bictegravir?

Answer 12

Generally well-tolerated

Question 13

BBW for Tenofovir/Emtricitabine?

Answer 13

YES: posttreatment acute exacerbation of hepatitis B; risk of drug resistance with use for preexposure prophylaxis in pts w/ undetected acute HIV-1 infection – need to confirm HIV-negative status before immediately prior to initiation

Question 14

BBW for Bictegravir?

Answer 14

YES: posttreatment acute exacerbation of hepatitis B

Question 15

Truvada and Descovy pearls

Answer 15

Truvada preferred for PrEP in most patients

Make sure to monitor CD4, HIV RNA plasma levels, kidney function, liver function, bone density, and screen for HBV prior to initiation

Question 16

PrEP dosing with Truvada?

Answer 16

Truvada 300 mg/200 mg: take 1 tab PO QD w/ or w/o food

Question 17

Bictegravir pearls

Answer 17

Approved in 2018 as compnent of Biktarvy
Fewer drug-drug interactions compared to others in class
High barrier to resistance

Make sure to monitor CD4, HIV RNA plasma levels, kidney function, liver function, bone density, and screen for HBV prior to initiation