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BBDA Spring (Exam 7) > Antivirals > Flashcards

Antivirals Flashcards

1
Q

Agents for HSV and VZV

A

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

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2
Q

Oral Agent MOA

A

Nucleoside Analog, Inhibition of viral DNA synthesis

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3
Q

Acyclovir

A

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

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4
Q

Acyclovir ADE

A

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

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5
Q

Valacyclovir

A

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

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6
Q

Famciclovir

A

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

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7
Q

Acyclovir vs Valacyclovir

A

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

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8
Q

Abreva (docosanol)

Penciclovir (Denavir)-metabolite of famciclovir

A

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)

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9
Q

Anti-retroviral Agents

A

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

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10
Q

ART Standard of Care

A

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

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11
Q

When to Initiate TX

A

for all HIV infected pt’s

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12
Q

Preferred Regimen

A

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

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13
Q

ATR things to consider

A

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

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14
Q

NRTI

A

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

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15
Q

Emtriva (emtricitabine) NRTI

A

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

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16
Q

Viread (tenofovir) NRTI

A

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

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17
Q

Retrovir (zidovudine) NRTI

A

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

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18
Q

Epivir (lamivudine) NRTI

A

can be used in women and infant populations

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19
Q

Ziagen (abacavir) NRTI

A

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

20
Q

NNRTI

A

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

21
Q

Sustiva (efavirenz) NNRTI

A

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)

22
Q

Edurant (rilpivirine) NNRTI

A

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

23
Q

Protease Inhibitors

A

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

24
Q

Norvir (ritonavir) PI

A

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

25
Q

Reyataz (atazanavir) PI

A

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)

26
Q

Prezista (darunavir) PI

A

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

27
Q

Kaletra (lopinavir) PI

A

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

28
Q

Integrase Inhibitors

A

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

29
Q

CCR-5

A

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

30
Q

Isentress (raltegravir)

Integrase Inhib.

A

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

31
Q

Stribild (elvitegravir)

Integrase Inhib.

A

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

32
Q

Tivicay (dolutegravir)

Integrase Inhib.

A

avoid antacids, qd-bid dosing

33
Q

Selzentry (maraviroc)

CCR-5

A

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

34
Q

Hep-B

A

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

35
Q

Hep-C

A

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

36
Q

Hep-C

A

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

37
Q

Simeprivir - NS3/4a PI

A

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

38
Q

NS5B PI

A

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

39
Q

NS5A replication complex inhibitors

A

Ledipasvir or ombitasvir,

40
Q

Interferon and Pegylated Alfa

A

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

41
Q

Ribavirin

A

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

42
Q

To treat Influzenza A

A

amantadine, rimantadine, older treatment, not used much

43
Q

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

A

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)

44
Q

Osteltamivir

A

Tamiflu, prodrug, NVD, abdominal pain

45
Q

Zanamivir

A

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

46
Q

ARV
HAART
ART

A

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

47
Q

NS3/4a PI

A

1st gen- Boceprevir/Telaprevir

2nd gen- simveprevir/paritaprevir/asunaprevir)

BBDA Spring (Exam 7) (6 decks)

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