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Pharmacology Test 2 > AntiVirals > Flashcards

AntiVirals Flashcards

1
Q

all antivirals are nucleoside analogs except

A

foscarnet & docosanol

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2
Q

antivirals work by

A

Most prevent replication of viral nucleic acid

Some inhibit the uncoating of viral nucleic acid or inhibit post translation of viral proteins

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3
Q

inhibit viral replication, does not cure-only reduces the pain, severity & symptoms of the outbreak, shortens its duration and may prevent the overall number of recurrences.

A

Acyclovir (B)

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4
Q

Acyclovir ADRs

A

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

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5
Q

Forms of Acyclovir and their indications

A

PO form – low bioavailability (5 times/day)
IV for serious or systemic infections
Topical – used for genitalis
Available as oral suspension for chickenpox in kids

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6
Q

used for herpes simplex and varicella zoster virus
ADRs: less than acyclovir, N,V, headache
more bioavailability – less frequent dosing
more effective for shingles than acyclovir

A

valacyclovir (B)

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7
Q

used for herpes simplex and varicella zoster virus
ADRs: headache, fatigue, diarrhea
more bioavailability – less frequent dosing
more effective for shingles than acyclovir

A

famciclovir (B)

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8
Q

Active metabolite of famciclovir
Topical for herpes labialis
Potentially used for Epstein-Barr virus
ADRs – mild erythema, headache

A

Penciclovir (B)

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9
Q

First OTC topical for herpes labialis
Limited info available
ADRs – local irritation, headache
NOT a nucleoside analog

A

Docosanol (B)

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10
Q

Indications: Prevention of herpes zoster (shingles) in pts > 50 years old
Live attenuated varicella zoster virus
More potent than chickenpox vaccine
Can reduce shingles cases by 50% and patients who get shingles will get milder cases. Also, in pts who get shingles - 1/3 less likely to develop postherpetic neuralgia.

A

Zostavax SC injection

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11
Q

treatment of ocular HSV
(ophth oint) – blocks vision, use HS
used for keratoconjunctivitis and recurrent epithelial keratitis due to HSV I and II.
ADRs: burning, irritation, lacrimation

A

vidarabine (C) (oint)

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12
Q

treatment of ocular HSV
solution
both used for keratoconjunctivitis and recurrent epithelial keratitis due to HSV I and II.
ADRs: burning, irritation, lacrimation

A

trifluridine (C) (sol)

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13
Q

Used for treatment of CMV retinitis in immunocompromised patients and prevention of CMV diseases in HIV and transplant pts.
PO form has low bioavailability (use for long term suppression of CMV)
ADRs: bone marrow suppression (BMS), H/A, confusion, retinal detachment, liver and renal dysfunction, rash, fever, gi effects
Mutagenic, long term carcinogenic effects

A

ganciclovir (C) (PO, IV, implant)

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14
Q

Used for treatment of CMV retinitis in immunocompromised patients and prevention of CMV diseases in HIV and transplant pts.,
prodrug – can give less frequently

A

valganciclovir (C) (PO)

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15
Q

Used for treatment of CMV retinitis in immunocompromised patients and prevention of CMV
Reserved use for resistant viruses
Higher incidence of more serious adverse effects (nephrotoxicity, neutropenia, metabolic acidosis)

A

cidofovir (C) (IV)

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16
Q

Tx of CMV retinitis in immunocompromised pts when ganciclovir alone has failed. Often given in combo with ganciclovir to reduce toxicity. Also used for acyclovir rst HSV infx and shingles
ADRs: fever, H/A, renal impairment, acute renal failure, N,V,D, hematologic deficiencies, seizures, cardiac arrhythmias, heart failure and pancreatitis

A

foscarnet (C) (IV) (NOT nucleoside)

17
Q

ocular antivirals for CMV

A

Ganciclovir implant – CMV retinitis

Fomiversin (C) inj – CMV retinitis

18
Q

Clinical presentation: Abrupt onset of fever, malaise, sore throat and non-productive cough. Disease peaks b/w December & March
Complications: Pneumonia, myocarditis, Reyes syndrome

A

Influenza

19
Q

People at risk for influenza related complications and severe disease

A

Children aged 6 months up to their 19th birthday
Pregnant women
People 50 years of age and older
People of any age with certain chronic medical conditions
People who live in nursing homes and other long-term care facilities
People who live with or care for those at high risk for complications from flu, including:

20
Q

Influenza virus vaccine (IM) – inactivated (TIV)

A

Provide 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
Do not use in pts allergic to eggs
All flu vaccines 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.

21
Q

Flumist® - intranasal influenza vaccine

A

Live attenuated vaccine (LAIV)
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, fever, cough, vomiting, sore throat
Very expensive

22
Q

MOA: inhibits the replication of the Influenza A virus ONLY by blocking the viral membrane matrix protein (M2)
Has been used for prophylaxis if vaccine cannot be tolerated or for treatment. Not recommended per 2009 guidelines.
Has been used to reduce the symptoms of infection and shortens the course of disease. Not recommended per 2009 guidelines.
ADRs: GI effects, CNS side effects:

A

amantadine (C) PO

rimantadine (C) PO - has lower incidence of ADRs and no dose adjustment in renal dysfunction

23
Q

Indications: Treatment and Prevention of Seasonal Influenza and HIN1
MOA: blocks neuraminidase, an enzyme needed for viral release from infected cell.
ADRs -N, V, D, abdominal pain, dizziness, headache
Effectiveness:
Decreases the onset of symptoms and shortens duration of illness only if taken within 24 - 48 hrs of symptom onset

A

oseltamivir (Tamiflu ®)(C)(PO) (for pts >1 y.o)
zanamivir (Relenza ®)(B)(INH) (for pts> 7 y.o.)
Tablet that must be crushed into a powder

24
Q

Indications: aerosol for severe lower respiratory infections due to Respiratory Syncytial Virus (RSV) in children. It reduces duration of disease, allows children to be removed from ventilator sooner, improves arterial oxygenation
MOA: Prevents mRNA capping and blocks RNA-dependent polymerase
ADRs serious pulmonary and cardiovascular effects – (apnea, pneumothorax, worsening of resp status and cardiac arrest), conjunctivitis, rash.

A

ribavirin (Virazole ®) (Inhalational) (X):

25
Q

Recombinant drug – monoclonal antibody

New drug for prevention of serious lower respiratory tract infections caused by RSV in infants and children

A

palivizumab (IM) (C)

26
Q

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

A

interferons

27
Q

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.

A

Ribaviran (Rebetol ®, Copegus ®)(X) (PO)

28
Q

Lamivudine (Epivir)
Adefovir (Hepsera)
Entecavir (Baraclude)
Telbivudine: (Tyzeka)

A

nucleosides used for Hepatitis B (some used for HIV infection)

29
Q

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

A

HPV IM vaccine (Gardasil)

30
Q

Rotavirus vaccine (RotaTeq)

A

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

31
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

Pharmacology Test 2 (7 decks)

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