Antivirals

Question 1

Agents for HSV and VZV

Answer 1

Oral: Zovirax, Valtrex, Famvir, Topical: Denavir (penciclovir), Abreva (Docosanol)

Question 2

Oral Agent MOA

Answer 2

Nucleoside Analog, Inhibition of viral DNA synthesis

Question 3

Acyclovir

Answer 3

More potent for HSV 1&2, also covers VZV, ONLY ONE AVAILABLE AS IV, Small F, decrease duration of herpes by 2 days, ADE: ND

Question 4

Acyclovir ADE

Answer 4

HA!, Nausea, Diarrhea, generally well tolerated, Note: lots of H2O to stop kidney stone formation

Question 5

Valacyclovir

Answer 5

Much better F, w/ high doses- confusion/hallucinations, More ADE in aids pt’s and transplant pt’s

Question 6

Famciclovir

Answer 6

converted to pencyclovir, EBV(epstein-Barr), Hep-B, HSV and VZV, does not cause chain termination, generally well tolerated, same side effects as Acyclovir

Question 7

Acyclovir vs Valacyclovir

Answer 7

valacyclovir has shorter duration of zoster pain followed by famciclovir then acyclovir

Question 8

Abreva (docosanol)

Penciclovir (Denavir)-metabolite of famciclovir

Answer 8

w/in 12 hours of prodromal symptoms (tingling/numbness) when used 5x’s daily with valacyclovir will shorten cold sores by 18 hours. (abreva- prevents viral entry into cells)

Question 9

Anti-retroviral Agents

Answer 9

NRTI, NNRTI, PI, Integrase Inhibitors, CCR5 receptor antagonists, Fusion Inhibitors

Question 10

ART Standard of Care

Answer 10

Combination of 3-4 antiretroviral agents, viral susceptibility to specific agents varies among pt’s

Question 11

When to Initiate TX

Answer 11

for all HIV infected pt’s

Question 12

Preferred Regimen

Answer 12

2 NRTI (tenofovir/Emtricitabine)!!!!!, then add on another agent or two that are different (Atripla, Truvada…)

Question 13

ATR things to consider

Answer 13

Tolerability, convenience, Adherence, Co-morbid conditions, pregnancy, ADE

Question 14

NRTI

Answer 14

HIV 1&2, inhibits reverse transcriptase (chain termination), BACKBONE OF ART, no food efffect, available in one tab combined (Emtricitabine, Tenofovir, Zidovudine, Abacavir, Lamivudine)

Question 15

Emtriva (emtricitabine) NRTI

Answer 15

Emtricitabine, ADE: HA, ND, Asthenia, Hyperpigmentation of palms, Lots of combo products available, FOR Hep-B, QD DOSING, no drug-drug interactions

Question 16

Viread (tenofovir) NRTI

Answer 16

pro-drug, combo products, GI complaints, HA, asthenia, some RENAL IMPAIRMENT, DECR. BONE MINERAL DENSITY AND TOXICITY

Question 17

Retrovir (zidovudine) NRTI

Answer 17

Zidovudine, GI, Insomia, Lipoatrophy (more when administered w/ other agents, preferred FOR PREGNANT women w/ lamivudine, bid

Question 18

Epivir (lamivudine) NRTI

Answer 18

can be used in women and infant populations

Question 19

Ziagen (abacavir) NRTI

Answer 19

hypersensitivity 3-5% of people w/ HLA-B5701 allele, BID, no food effects, use cautiously in CV risk patients

Question 20

NNRTI

Answer 20

MOA: bind reverse transcriptase (binding site near NRTI site)/(do not require phosphorylation), not effective against HIV-2, base-line genotype testing b/c resistance (2-8%), Disadvant- greater risk of resistance, can have lots of DDI b/c METABOLIZED BY CYP450

Question 21

Sustiva (efavirenz) NNRTI

Answer 21

not in first trimester!!, CNS EFFECTS mostly which dimisnishes w/ continued tx, SKIN RASH (28%), disadvantages: neural tube defects, neuropsychiatric effects (not w/ high fat meal)

Question 22

Edurant (rilpivirine) NNRTI

Answer 22

depressive disorders, rash, hyper-lipidemia, must have acidic pH, NO PPI,

Question 23

Protease Inhibitors

Answer 23

HIV 1&2, prevent processing of viral proteins, LOTS OF METABOLIC COMPLICATIONS (INCREASED TG AND LDL, INSULIN RESISTANCE), fat redistribution worst w/ this group!!, CYP3A4 inhibitors, no phosphorylation needed

Question 24

Norvir (ritonavir) PI

Answer 24

will increase plasma levels of other PI’s, ADE: GI disturbances, recommended when possible w/ all PI’s

Question 25

Reyataz (atazanavir) PI

Answer 25

Atazanavir, NO EFFECTS ON LIPIDS, FAT REDISTRIBUTION OR METABOLIC SYNDROME, absorption depends low gastric pH and some food, NO MI OR STROKE RISK, PPI contraindicated!!, to be boosted w/ ritonavir, disad: (HYPEBILIRUBINEMIA)

Question 26

Prezista (darunavir) PI

Answer 26

Darunavir, dyslipidemia, liver toxicity, boosted w/ ritonavir, CAN BE GIVEN W/ PPI !!!!, MANY DDI, skin rash, food requirements, watch pt's w/ sulfa allergy

Question 27

Kaletra (lopinavir) PI

Answer 27

Lopinavir, SHORT TERM USE IN PREGNANCY, elevated TG and cholesterol, BID ideal, High risk of MI

Question 28

Integrase Inhibitors

Answer 28

block enzyme responsible for replication of HIV 1&2, Raltegravir, elvitegravir, dolutegravir

Question 29

CCR-5

Answer 29

bind chemokine co-receptor on CD4 cells, prevent HIV entry, Maraviroc

Question 30

Isentress (raltegravir) | Integrase Inhib.

Answer 30

less DDI than PI's or NNRTI regimens!!, BID, no food effect, increased CPK = increased rhabdomyolysis

Question 31

Stribild (elvitegravir) | Integrase Inhib.

Answer 31

CrCl>70ml/min, cobicistat to boost elvitegravir, new onset or worsening renal impairment, food requirement, proximal renal tubulopathy

Question 32

Tivicay (dolutegravir) | Integrase Inhib.

Answer 32

avoid antacids, qd-bid dosing

Question 33

Selzentry (maraviroc) | CCR-5

Answer 33

used for R5-HIV, test w/ tropism assay before tx, compared to efavirenz it has less ADE, DDI

Question 34

Hep-B

Answer 34

we can only suppress NOT treat, 1st line tx: Pegylated interferon alpha-2a, entecavir, tenofovir (KNOW ALL 3!)

Question 35

Hep-C

Answer 35

most common chronic blood-borne infection in US, 5x's more common than HIV,

Question 36

Hep-C

Answer 36

most common chronic blood-borne infection in US, 5x's more common than HIV

Question 37

Simeprivir - NS3/4a PI

Answer 37

two forms of birth control for men and women, SUN SENSITIVITY, not for use w/ sulfa aller.

Question 38

NS5B PI

Answer 38

Sovaldi (sofosbuvir)- two forms of BC to be on, life threatening bradycardia

Question 39

NS5A replication complex inhibitors

Answer 39

Ledipasvir or ombitasvir,

Question 40

Interferon and Pegylated Alfa

Answer 40

moa: inhibits viral penetration, translation, and transcription, (pegylated means we give it less often), long half life (up to 160 hrs), ADE: flu like symptoms (30%), Black Box Warnings

Question 41

Ribavirin

Answer 41

inhibits replication of DNA and RNA viruses, DON'T USE in pregnancy, large spectrum of activity (HIV, RSV, Influenza A and B)

Question 42

To treat Influzenza A

Answer 42

amantadine, rimantadine, older treatment, not used much

Question 43

Oseltamivir (tamiflu) and Zanamivir (ralenza)- as an inhaler

Answer 43

neuraminadase inhibitor, for influenza A and B, inhibit release of progeny to new host cells when administerd 36-48 hours after onset of sx, (decrease sx and will decrease overall conditions by 1-2 days)

Question 44

Osteltamivir

Answer 44

Tamiflu, prodrug, NVD, abdominal pain

Question 45

Zanamivir

Answer 45

Relenza, ADE: cough bronchospasm, deceased pulmonary function, nasal throat discomfort

Question 46

ARV HAART ART

Answer 46

Anti-retroviral, Highly active anti-retroviral therapy, Anti-retroviral therapy

Question 47

NS3/4a PI

Answer 47

1st gen- Boceprevir/Telaprevir | 2nd gen- simveprevir/paritaprevir/asunaprevir)