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Pharmacology > Antivirals > Flashcards

Antivirals Flashcards

1
Q

antivirals

A

-Viruses use host cell’s metabolic pathways for reproduction -> limits MOA for antiviral drug action
-Antibacterials & Antifungals have little or no effect on viruses
-Most antivirals are antimetabolites of endogenous nucleosides and prevent replication of viral nucleic acid
-Some antivirals inhibit the uncoating of viral nucleic acid or inhibit post translation of viral proteins

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2
Q

enterovirus- D68

A

-one of more than 100 non-polio enteroviruses

Symptoms:
-Mild - fever, runny nose, sneezing, cough, and body and muscle aches
-Severe: wheezing and difficulty breathing

Prevention:
-Spreads via respiratory secretions
– wash hands, cover sneeze & cough
-Surge – Summer & Fall

Tx: supportive

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3
Q

ebola (aka ebola hemorrhagic fever)

A

Spreads through direct contact:
-can cause disease in humans and nonhuman primates
-broken skin or mucous membranes in, for example, the eyes, nose, or mouth
-Wash with soap & water or use alcohol based cleanser

Treatment:
-No FDA-approved vaccine/antiviral drug available
-Early supportive care

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4
Q

COVID-19

A

-SARS-Cov-2:
-Coronavirus
-Serious Acute Respiratory Syndrome
-Viral respiratory disease

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5
Q

COVID-19 vaccines

A

mRNA:
-Comirnaty® - Pfizer/BioNTech
-Spikevax® - Moderna

Adjuvanted: Novavax

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6
Q

COVID-19 tx inpt vs outpt

A

Inpatient:
-Remdesivir: Antiviral IV tx
-Tocilizumab: IL-6 inhibitor IV tx
-Dexamethasone: IV/PO IN COMBO ^

Outpatient:
- for pts with less than 5 days of sx
-Molnupiravir: Antiviral PO - EUA
-Nirmatrelvir and Ritonavir (Paxlovid): Antiviral PO - EUA
-many DDIs

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7
Q

not recommended or authorized tx for COVID

A

Ivermectin
Doxycycline
Hydroxychloroquine
Colchicine
azithromycin

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8
Q

COVID-19 prevention: preexposure prophylaxis

A

Pemivibart: antiviral
- EUA
- single IV infusion

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9
Q

herpes virus infections

A

Herpes Simplex Virus (HSV):
- herpes labialis: HSV I; cold sores
- herpes genitalis: HSV II
-Herpetic keratoconjunctivitis
-Herpes encephalitis

Varicella-zoster virus: VZV
- chicken pox (varicella)
- shingles (herpes zoster)

Cytomegalovirus (CMV):*
-CMV retinitis
-CMV esophagitis
-CMV colitis
-* most CMV diseases occur in IMMUNOCOMPROMISED pts*

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10
Q

drugs for herpes virus: general description

A

Description:
- all: nucleoside analogs (except facarnet and docosanol)
- most: contain purine/pyrimidine base
- prodrugs: converted to active drugs inside the infective host cell and are selectively toxic + prevent viral RNA synthesis
-Viral resistance develops with all, varies with drug and viral pathogen

-acyclovir
-valacyclovir
-famciclovir
-penciclovir
-docosanol
shingriz SC injection
-vidarabine
-trifluridine
-ganciclovir
-valganciclovir
-cidofovir
-foscarnet
-ganciclovir
-fomiversin

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11
Q

Acyclovir: what does it treat and types of adminstration; ADRs

A

Treatment: of HSV and VZV: PO, IV, topical
-inhibit viral replication
- does not cure!!!!! - reduces pain/severity of sx, shortens duration, and may prevent the overall number of recurrences
-PO form – low bioavailability (5 times/day)- limiting
-IV for serious or systemic infections
-Topical – used for genitalis
-Available as oral suspension for chickenpox in kids

ADRs
- itching, hives
- nephrotoxic
- elevated BUN & creatinine
- N,V,D
- headache
- paresthesias

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12
Q

Valacyclovir and Famciclovir

A

Valacyclovir: PO
-ADRs: less than acyclovir
- n/v
- headache

famciclovir: PO
- ADRs: fatigue, headache, diarrhea

both: acyclovir and famicyiclovir
- increased bioavailability: less frequent dosing
- more effective than acyclovir for shingles

acyclovir ADRs
- itching, hives
- nephrotoxic
- elevated BUN & creatinine
- N,V,D
- headache
- paresthesias

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13
Q

Penciclovir

A

HSV and VZV tx: topical
-Active metabolite of famciclovir

Indications:
- herpes labialis
-Potentially use: Epstein-Barr virus

ADRs:
- mild erythema
- headache

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14
Q

Docosanol

A

HSV and VZV tx:
- first OTC topical for herpes labialis
-Limited info available

ADRs
– local irritation, headache
-NOT a nucleoside analog*

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15
Q

varicella-zoster vaccine:

A

Shingrix SC injection
-Zoster Vaccine Recombinant, Adjuvanted
- More potent than chickenpox vaccine
-Can reduce shingles cases by 50%
- pts who get shingles: have MILDER cases +
1/3 less likely to develop postherpetic neuralgia

Indications:
- Prevention of herpes zoster (shingles) in pts > 50 years old or 18 yrs+ with increased risk of shingles due to immunodeficiency or immunosuppression (not on test)

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16
Q

TX of HSV: ocular infections

A

Indications:
- keratoconjunctivitis
- recurrent epithelial keratitis due to HSV I and II

Vidarabine:
- ophth ointment
- blocks vision temporarily: use at night (HS)

Trifluridine
-ophth solution

ADRs: burning, irritation, lacrimation

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17
Q

CMV: ganciclovir

A

CMV tx: PO, IV, implant
- TREATMENT of CMV retinitis in immunocompromised pts
- PREVENTION of CMV diseases in HIV and transplant pts
-PO form: low bioavailability (use for long term suppression of CMV)

ADRs:
- bone marrow suppression: dose limiting
- H/A
- confusion
- retinal detachment
- liver and renal dysfunction
- rash
- fever
- gi effects
-Mutagenic: long term carcinogenic effects*

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18
Q

CMV treatment drug names

A
  • Ganciclovir
  • Valganciclovir: prodrug
  • Cidofovir: more resistant viruses
  • Foscarnet: not nucleoside*

Ganciclovir:
- CMV, retinitis
- prevention and prophylaxis of CMV ds in HIV/transplant pts

Valganciclovir:
- prodrug: can give less frequently
- same indications as ganciclovir

Cidofovir:
- same indications as ganciclovir
- use for RESISTANT viruses
- higher incidence of ADRs: nephrotoxicity, neutropenia, metabolic acidosis

Foscarnet:
- NOT nucleoside
- tx for CMV retinitis in immunocompromised pts when ganciclovir alone failed
- give in combo with ganciclovir to decrease toxicity
- tx for acyclovir resistant HSV infx and shingles

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19
Q

CMV: valganciclovir: indications

A

-PO
-Same indication as ganciclovir, prodrug – can give less frequently

  • TREATMENT of CMV retinitis in immunocompromised pts
  • PREVENTION of CMV diseases in HIV and transplant pts
    -PO form: low
20
Q

CMV: cidofovir: indications, ADRs

A

-IV
-Same indications as ganciclovir
-Reserved use for resistant viruses

ADRs:
-Higher incidence of more serious adverse effects (nephrotoxicity, neutropenia, metabolic acidosis)

  • TREATMENT of CMV retinitis in immunocompromised pts
  • PREVENTION of CMV diseases in HIV and transplant pts
    -PO form: low
21
Q

CMV: foscarnet tx indications

A

-IV
-NOT nucleoside*

Indications:
-Tx: CMV retinitis in immunocompromised pts when ganciclovir alone has failed!!
-Often given in combo with ganciclovir to reduce toxicity
-IV hydration before to prevent renal toxicity
-Acyclovir resistant HSV infx and shingles

22
Q

CMV: foscarnet tx ADRs

A

hematologic deficiencies *
seizures *
cardiac arrhythmias *
heart failure *
pancreatitis *
acute renal failure *
fever
H/A
renal impairment
N,V,D,

23
Q

ocular antivirals for CMV

A

Ganciclovir implant: CMV retinitis

Fomiversin inj: CMV retinitis

24
Q

influenza statistics (dont need to know)

A

U.S. Epidemiology:
-Annual Infections: 25-50 million
-Annual Hospitalizations: 226,000
-Annual Mortality: 19,000 -36,000

25
Q

influenza type a vs B and clinical presentation and complications

A

Types A & B
-Type A: moderate/severe illness -> from 0 to 100
-Type B: milder - primarily affects children

Clinical presentation:
- Abrupt onset of fever, malaise, sore throat and non-productive cough
- disease peaks: December & March

Complications:
- Pneumonia
- myocarditis
- Reyes syndrome

26
Q

flu vaccine guidlines

A

-Vaccination now recommended for ALL persons > 6 months old
-All children 6 months – 8 years old being vaccinated for first time should receive 2 doses (4 weeks apart) - DONT NEED TO KNOW THIS PART

27
Q

flu vaccination during vaccine shortage DONT NEED TO KNOW

A

-Children aged 6 months through 4 years (59 months);
-People aged 50 years and older;*
-People with chronic pulmonary (including asthma), cardiovascular (except hypertension), renal, hepatic, neurologic, hematologic, or metabolic disorders (including diabetes mellitus);
-People who are immunosuppressed (including immunosuppression caused by medications or by Human Immunodeficiency Virus);
-Women who are or will be pregnant during the influenza season and women up to two weeks after delivery;
-People who are aged 6 months through 18 years and receiving long-term aspirin therapy and who therefore might be at risk for experiencing Reye syndrome after influenza virus infection;
-People who are residents of nursing homes and other chronic-care facilities;
-American Indians/Alaska Natives;
-People with extreme obesity (body-mass index [BMI] is 40 or greater);
-Health care personnel;
-Household contacts and caregivers of children younger than 5 years and adults aged 50 years and older, with particular emphasis on vaccinating contacts of children aged younger than 6 months; and
-Household contacts and caregivers of people with medical conditions that put them at higher risk for severe complications from influenza

28
Q

influenza vaccine: IM

A

Influenza virus vaccine (IM): inactivated -> DOES NOT CAUSE THE FLU
-Provides active immunity to influenza virus strains in the vaccine
-New vaccine formulated each year, standardized by U.S. Public Health Service
-This years vaccine contains an H1N1 strain

CI:
- pts allergic to eggs:
contain small amounts of egg protein
-Pts who can tolerate eggs in baked goods can usually tolerate vaccine
-Try using vaccine w/ less egg (Agriflu or Fluarix)

ADRs: Local reactions, fever/malaise, allergic reactions

-THE INACTIVATED FLU VACCINE DOES NOT CAUSE THE FLU !!!

29
Q

influenza vaccine: intranasal

A

Flumist: intranasal influenza vaccine
-LIVE attenuated vaccine -> You become a flu CARRIER
-About as effective as IM vaccine
-2010 guidelines: can be used in healthy patients aged 2-49 years old.
-NOT approved in pts > 50 y.o or pts with chronic illness

ADRs:
- runny nose, nasal congestion, cough, vomiting, sore throat, fever
-Very expensive

30
Q

influenza A drug tx

A

Amantadine PO
Rimantadine PO

MOA:
- inhibits the replication of the Influenza A virus ONLY!!
- Blocks the viral membrane matrix protein (M2)

Old use in prophylaxis and treatment: NOT recommended per 2009 guidelines
- to reduce the sx and shortens the course
-Prophylaxis if vaccine cannot be tolerated
- prophylaxis for treatment

31
Q

amantadine and rimantadine ADRs

A

Drugs for influenza A

ADRs:
- GI effects
- CNS side effects:
- Rimantadine: less incidence of ADRs +
no dose adjustment in renal dysfunction (good drug but not first choice)

32
Q

influenza A and B drugs

A

Indications:
- Tx and Prevention of Seasonal Influenza
- HIN1
- decreases the onset of sx and shortens duration of illness if taken within 24-48h of sx onset

MOA:
- blocks NEURAMINADASE: enzyme needed for viral release from infected cell

drugs:
- Oseltamivir: > 1 yr
- Zanamivir: > 7 yrs, tablets crushed into powder

33
Q

Oseltamivir and Zanamivir ADRs and drug names

A

Drugs for influenza A and B

ADRs
-N, V, D
- abdominal pain
- dizziness
- headache
-Effectiveness:

Drugs:
-oseltamivir (Tamiflu) (PO): for pts >1 yrs
-zanamivir (INH): for pts> 7 yrs; Tablet that must be crushed into a powder
-first choice, tx can be worse than the flu
-good for if a whole family got sick

34
Q

RSV: ribavirin (inhalation): indication and MOA

A

aka VIRAZOLE *

Indications:
- aerosol for severe RSV lower respiratory infections in children
- reduces duration of disease -> allows children to be removed from ventilator sooner, improves arterial oxygenation

MOA:
- Prevents mRNA capping and blocks RNA-dependent polymerase

35
Q
A
35
Q

ribavirin (VIRAZOLE): ADRs

A

Serious pulmonary and cardiovascular effects:
- apnea
- pneumothorax
- worsening of resp status
- cardiac arrest

Conjunctivitis
Rash

RSV inhalation drug for severe lower respiratory infections -> decreases duration of ds

36
Q

palivizumab (synagis): adrs

A
  • nervousness
  • fever
  • fungal dermatitis
  • eczema
  • N/V/D
  • anemia
  • otitis media
  • cough
  • wheezing

RSV IM drug for prevention of serious lower respiratory tract infections in infants + kids < 2yrs

37
Q

RSV drug names

A

Ribavirin (VIRAZOLE): inhalation
- severe lower respiratory infections in children

Palivizumab (SYNAGIS): IM
- prevention of serious lower respiratory infections in infants + kids < 2 yrs

38
Q

RSV: palivizumab

A

-SYNAGIS
-IM
-Recombinant drug: monoclonal antibody

Indication:
-New drug for PREVENTION of serious lower respiratory tract infections caused by RSV in infants and children < 2 yrs

39
Q

interferons

A

Definition: Recombinant DNA technology drug with immunomodulating and antiproliferative effects
-Forms – alfa 2a, alfa 2b, pegylated alfa 2a
-Can be used in Tx of hepatitis B & C (all forms)
-Can also be used in Tx of certain cancers (all forms) and in Tx of anogenital warts (alfa 2a) and
-ADRs: hematological toxicity, cardiac arrhythmias, changes in BP, CNS dysfunction, gi distress, chills, fatigue, H/A, myalgia, alopecia

40
Q

hepatitis: ribaviran

A

-PO
-Given in combo with interferon alpha 2b for the treatment of chronic hepatitis C in pts with compensated liver disease
-ADRs: CNS side effects (dizziness, H/A, fatigue), alopecia, rash, pruritis, gi effects, bone marrow suppression (all observed when given w/ interferon alfa 2b)
-Non FDA Tx – various viruses including west nile, hemorrhagic fever viruses, etc.

41
Q

hepatitis B: nucleotides

A

-some may also be used for HIV infection
-Lamivudine (Epivir)
-Adefovir (Hepsera)
-Entecavir (Baraclude)
-Telbivudine: (Tyzeka)

42
Q

hepatitis B tx

A

DONT NEED TO KNOW
-drugs we use for B overlap with C

43
Q

HPV IM vaccine

A

-gardasil
-Indicated to prevent diseases caused by HPV virus types 6,11,16 and 18 (cervical cancer & genital warts) in women b/w 9-26 years old.
-Given in 3 doses at 0, 2 and 6 months.
-ADRs – local reactions, fever
-New issues regarding safety of this vaccine reported by VAERS

44
Q

rotavirus vaccine

A

-RotaTeq
-LIVE oral vaccine for rotavirus
-Rotavirus most common cause of severe diarrhea and vomiting in young children
-Given to infants at age 2, 4 and 6 months
-Have been reports of intrasussception with this vaccine

45
Q

avian flu vaccine (H5N1)

A

-Not available commercially
-Being reserved for distribution in the event of an outbreak
-MAY provide early limited protection in the event of a pandemic until a vaccine is developed & produced against the specific pandemic strain of the virus

46
Q

A 34 year-old female with no significant past medical history presents to your office with cold sores on her lips. She asks for a recommendation for a topical OTC product. Which of the following would you recommend for this patient?

A

acyclovir
ganciclovir
penciclovir
docosanol***

Pharmacology (18 decks)

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