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Antivirals Flashcards

1
Q

zanamivir mechanism

A

inhibits influenza neuraminidase –> prevents release of progeny virus

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2
Q

oseltamivir mechanism

A

inhibits influenza neuraminidase –> prevents release of progeny virus

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3
Q

clinical use zanamivir

A

influenza A and B

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4
Q

clinical use oseltamivir

A

influenza A and B

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5
Q

ribavirin mechanism

A

inhibits synthesis of guanine nucleotides by competitively inhibiting inosine monophosphate dehydrogenase

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6
Q

clinical use ribavirin

A

RSV, chronic hepatitis C

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7
Q

side effects ribavirin

A
  1. hemolytic anemia

2. severe teratogen

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8
Q

acyclovir, famciclovir, and valacyclovir mechanism

A

monophosphorylated by HSV/VZV thymidine kinase (not in uninfected cells –> few adverse effects)
guanosine analog
triphosphate formed by cellular enzymes
preferentially inhibits viral DNA polymerase by chain termination

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9
Q

clinical use acyclovir, famciclovir, and valacyclovir

A

HSV and VZV (weak activity against EBV)

no effect on latent forms

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10
Q

is acyclovir, famciclovir, valacyclovir useful for CMV?

A

NO!!

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11
Q

which -cyclovir has better oral bioavailability

A

valacyclovir

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12
Q

treatment of herpes zoster

A

famciclovir

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13
Q

side effects acyclovir, famciclovir, and valacyclovir

A

obstructive crystalline nephropathy and acute renal failure

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14
Q

how to prevent renal failure from acyclovir, famciclovir, and valacyclovir

A

hydration!

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15
Q

mechanism of resistance to acyclovir, famciclovir, and valacyclovir

A

mutated viral thymidine kinase

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16
Q

ganciclovir mechanism

A

5’-monophosphate formed by a CMV viral kinase
guanosine analog
triphosphate formed by cellular kinases
perferentially inhibits viral DNA polymerase

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17
Q

clinical use ganciclovir

A

CMV (esp. in immunocompromized)

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18
Q

what ganciclovir has better oral bioavailability

A

valganciclovir

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19
Q

treatment CMV retinitis

A

ganciclovir

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20
Q

side effects ganciclovir

A
  1. leukopenia
  2. neutropenia
  3. thrombocytopenia
  4. renal toxicity
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21
Q

mechanism of resistance to ganciclovir

A

mutated CMV DNA polymerase

lack of viral kinase

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22
Q

mechanism foscarnet

A

viral DNA polymerase inhibitor –> binds pyrophophate-binding site
does not require activation by viral kinase

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23
Q

clinical use foscarnet

A

CMV retinitis in immunocompromised pts when ganciclovir fails
acyclovir-resistant HSV

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24
Q

what to do when ganciclovir fails for CMV retinitis??

A

foscarnet!!

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25
Q

side effect foscarnet

A

nephrotoxicity

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26
Q

mechanism of resistance to foscarnet

A

mutated DNA polymerase

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27
Q

cidofovir mechanism

A

preferentially inhibits viral DNA polymerase

does not require phosphorylation by viral kinase

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28
Q

clinical use cidofovir

A

CMV retinitis in immunocompromised pts
acyclovir-resistant HSV
long half-life

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29
Q

side effects cidofovir

A

nephrotoxicity

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30
Q

how do you reduce the nephrotoxicity associated with cidofovir?

A

coadminister with probenecid and IV saline

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31
Q

what is atazanavir?

A

protease inhibitor

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32
Q

what is darunavir?

A

protease inhibitor

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33
Q

what is fosamprenavir?

A

protease inhibitor

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34
Q

what is indinavir?

A

protease inhibitor

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35
Q

what is lopinavir?

A

protease inhibitor

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36
Q

what is ritonavir?

A

protease inhibitor

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37
Q

what is saquinavir?

A

protease inhibitor

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38
Q

what is abacavir?

A

NRTI

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39
Q

what is didanosine?

A

NRTI

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40
Q

what is emtricitabine?

A

NRTI

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41
Q

what is lamivudine?

A

NRTI

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42
Q

what is stavudine?

A

NRTI

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43
Q

what is tonofovir?

A

NRTI

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44
Q

what is zidovudine?

A

NRTI

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45
Q

what is efavirenz?

A

NNRTI

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46
Q

what is nevirapine?

A

NNRTI

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47
Q

what is delaviridine?

A

NNRTI

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48
Q

what is raltegravir?

A

integrase inhibitor

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49
Q

what is enfuvirtide?

A

fusion inhibitor

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50
Q

what is maraviroc?

A

fusion inhibitor

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51
Q

protease inhibitor mechanism

A

prevent maturation of new viruses (asembly of virions depends on HIV-1 protease [pol gene], which cleaves polypeptide products into functional parts)

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52
Q

which protease inhibitor boosts other drug concentrations by inhibiting cytochrome P-450

A

ritonavir

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53
Q

side effects of protease inhibitors (3)

A
  1. hyperglycemia
  2. lipodystrophy (fat redistribution)
  3. nephropathy
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54
Q

which protease inhibitor causes hematuria?

A

indinavir

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55
Q

which HIV drugs cause fat redistribution?

A

protease inhibitors

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56
Q

which HIV drugs cause hyperglycemia?

A

protease inhibitors

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57
Q

mechanism NRTIs

A

competitively inhibit nucleotide binding to reverse transcriptase and terminate DNA chain (lack a 3’ OH group)

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58
Q

which NRTI is a nucleotide?

A

tenofovir (see the T?)

59
Q

which NRTI is used for prophylaxis and for prevention of mother-to-child transmission?

A

zidovudine

60
Q

side effects NRTIs

A
  1. bone marrow suppression
  2. peripheral neuropathy
  3. lactic acidosis (nucleoside)
  4. rash (non-nucleosides)
61
Q

which NRTI causes anemia

A

zidovudine

62
Q

which NRTI causes pancreatitis

A

didanosine

63
Q

which HIV drugs cause bone marrow suppression?

64
Q

mechanism NNRTIs

A

bind reverse transcriptase (at site different from NRTIs)

do not require phosphorylation to be active

65
Q

side effects NNRTIs

A
  1. rash

2. hepatotoxicity

66
Q

which NNRTI causes CNS symptoms?

67
Q

which NNRTIs are contraindicated in pregnancy?

A

efavirenz

delaviridine

68
Q

mechanism integrase inhibitors

A

inhibits HIV genome integration into host chromosome by reversibly inhibiting HIV integrase

69
Q

side effect integrase inhibitors

A

hypercholesterolemia

70
Q

which HIV drug causes hypercholesterolemia

A

integrase inhibitors (raltegravir)

71
Q

mechanism enfuvirtide

A

binds gp41, inhibiting viral entry

72
Q

mechanism maraviroc

A

binds CCR-5 on surface of T cells/monocytes –> inhibits interaction with gp120

73
Q

mechanism interferons

A

these are glycoproteins normally synthesized by virus-infected cells –> antiviral and antitumoral properties

74
Q

clinical use IFN-alpha

A

(everything else)

  1. hepatitis B and C
  2. Kaposi sarcoma
  3. hairy cell leukemia
  4. condyloma acuminatum
  5. renal cell carcinoma
  6. malignant melanoma
75
Q

clinical use IFN-beta

A

multiple sclerosis

76
Q

clinical use IFN-gamma

A

chronic granulomatous disease

77
Q

side effects interferons

A
  1. neutropenia

2. myopathy

78
Q

what happens if you use sulfonamides in pregnancy?

A

kernicterus

79
Q

what happens if you use aminoglycosides in pregnancy?

A

ototoxicity

80
Q

what happens if you use fluoroquinolones in pregnancy?

A

cartilage damage

81
Q

what happens if you use clarithromycin in pregnancy?

A

embryotoxic

82
Q

what happens if you use tetracyclines in pregnancy?

A

discolored teeth, inhibition of bone growth

83
Q

what happens if you use ribavirin (antiviral) in pregnancy?

A

teratogenic

84
Q

what happens if you use griseofulvin (antifungal) in pregnancy?

A

teratogenic

85
Q

what happens if you use chloramphenicol in pregnancy?

A

gray baby syndrome

86
Q

cidofovir mechanism

A

preferentially inhibits viral DNA polymerase

does not require phosphorylation by viral kinase

87
Q

clinical use cidofovir

A

CMV retinitis in immunocompromised pts
acyclovir-resistant HSV
long half-life

88
Q

side effects cidofovir

A

nephrotoxicity

89
Q

how do you reduce the nephrotoxicity associated with cidofovir?

A

coadminister with probenecid and IV saline

90
Q

what is atazanavir?

A

protease inhibitor

91
Q

what is darunavir?

A

protease inhibitor

92
Q

what is fosamprenavir?

A

protease inhibitor

93
Q

what is indinavir?

A

protease inhibitor

94
Q

what is lopinavir?

A

protease inhibitor

95
Q

what is ritonavir?

A

protease inhibitor

96
Q

what is saquinavir?

A

protease inhibitor

97
Q

what is abacavir?

98
Q

what is didanosine?

99
Q

what is emtricitabine?

100
Q

what is lamivudine?

101
Q

what is stavudine?

102
Q

what is tonofovir?

103
Q

what is zidovudine?

104
Q

what is efavirenz?

105
Q

what is nevirapine?

106
Q

what is delaviridine?

107
Q

what is raltegravir?

A

integrase inhibitor

108
Q

what is enfuvirtide?

A

fusion inhibitor

109
Q

what is maraviroc?

A

fusion inhibitor

110
Q

protease inhibitor mechanism

A

prevent maturation of new viruses (asembly of virions depends on HIV-1 protease [pol gene], which cleaves polypeptide products into functional parts)

111
Q

which protease inhibitor boosts other drug concentrations by inhibiting cytochrome P-450

112
Q

side effects of protease inhibitors (3)

A
  1. hyperglycemia
  2. lipodystrophy (fat redistribution)
  3. nephropathy
113
Q

which protease inhibitor causes hematuria?

114
Q

which HIV drugs cause fat redistribution?

A

protease inhibitors

115
Q

which HIV drugs cause hyperglycemia?

A

protease inhibitors

116
Q

mechanism NRTIs

A

competitively inhibit nucleotide binding to reverse transcriptase and terminate DNA chain (lack a 3’ OH group)

117
Q

which NRTI is a nucleotide?

A

tenofovir (see the T?)

118
Q

which NRTI is used for prophylaxis and for prevention of mother-to-child transmission?

A

zidovudine

119
Q

side effects NRTIs

A
  1. bone marrow suppression
  2. peripheral neuropathy
  3. lactic acidosis (nucleoside)
  4. rash (non-nucleosides)
120
Q

which NRTI causes anemia

A

zidovudine

121
Q

which NRTI causes pancreatitis

A

didanosine

122
Q

which HIV drugs cause bone marrow suppression?

123
Q

mechanism NNRTIs

A

bind reverse transcriptase (at site different from NRTIs)

do not require phosphorylation to be active

124
Q

side effects NNRTIs

A
  1. rash

2. hepatotoxicity

125
Q

which NNRTI causes CNS symptoms?

126
Q

which NNRTIs are contraindicated in pregnancy?

A

efavirenz

delaviridine

127
Q

mechanism integrase inhibitors

A

inhibits HIV genome integration into host chromosome by reversibly inhibiting HIV integrase

128
Q

side effect integrase inhibitors

A

hypercholesterolemia

129
Q

which HIV drug causes hypercholesterolemia

A

integrase inhibitors (raltegravir)

130
Q

mechanism enfuvirtide

A

binds gp41, inhibiting viral entry

131
Q

mechanism maraviroc

A

binds CCR-5 on surface of T cells/monocytes –> inhibits interaction with gp120

132
Q

mechanism interferons

A

these are glycoproteins normally synthesized by virus-infected cells –> antiviral and antitumoral properties

133
Q

clinical use IFN-alpha

A

(everything else)

  1. hepatitis B and C
  2. Kaposi sarcoma
  3. hairy cell leukemia
  4. condyloma acuminatum
  5. renal cell carcinoma
  6. malignant melanoma
134
Q

clinical use IFN-beta

A

multiple sclerosis

135
Q

clinical use IFN-gamma

A

chronic granulomatous disease

136
Q

side effects interferons

A
  1. neutropenia

2. myopathy

137
Q

what happens if you use sulfonamides in pregnancy?

A

kernicterus

138
Q

what happens if you use aminoglycosides in pregnancy?

A

ototoxicity

139
Q

what happens if you use fluoroquinolones in pregnancy?

A

cartilage damage

140
Q

what happens if you use clarithromycin in pregnancy?

A

embryotoxic

141
Q

what happens if you use tetracyclines in pregnancy?

A

discolored teeth, inhibition of bone growth

142
Q

what happens if you use ribavirin (antiviral) in pregnancy?

A

teratogenic

143
Q

what happens if you use griseofulvin (antifungal) in pregnancy?

A

teratogenic

144
Q

what happens if you use chloramphenicol in pregnancy?

A

gray baby syndrome

Pharmacology (8 decks)

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