Antivirals Flashcards
Acyclovir; Penciclovir
Purine analog (guanosine)
After phosphorylation by VIRAL THYMIDINE KINASE, causes viral DNA chain termination
HSV, VZV (requires higher dose than HSV)
CNS changes and renal dysfunction possible when used at higher doses
Valacyclovir; Famciclovir
Purine analog (guanosine)
Prodrug converted to Acyclovir & Penciclovir, respectively
Ganciclovir
Purine analog (guanine)
After phosphorylation by CMV VIRAL KINASE, causes viral DNA chain termination
Treatment & prophylaxis of CMV infection
Neutropenia, thrombocytopenia Rare GI intolerance
Foscarnet
Pyrophosphate congener
Directly inhibits HSV DNA polymerase or HIV reverse transcriptase
Broad spectrum (HSV/VZV/CMV, and RNA viruses including HIV)
Dose-dependent renal and CNS toxicities, electrolyte & metabolic abnormalities, Myelosuppression
Used for invasive HSV/VZV infections from acyclovir resistant strains; alternative to ganciclovir for CMV
Oseltamivir (Tamiflu); Zanamivir (Relenza); Peramivir (Rapivab)
Neuraminidase inhibitor
Prevent viral release from host cells
Influenza A, influenza B, (treat within 1-2 days of symptoms to speed functional recovery, decrease viral shedding duration)
Neuropsychiatric toxicity has been reported, GI side effects, brochospasm with zanamivir
Prophylaxis considered if in high-risk confined populations (nursing homes) or post-exposure prophylaxis for family members at high risk for severe disease
Zidovudine
NRTIs
Inhibits reverse transcriptase
HIV
Granulocytopenia; N & V; anemia
Lamivudine; Emtricitabine
NRTIs
Inhibits reverse transcriptase
HIV; HBV
Headache; N & V; rash; neutropenia; pancreatitis
Tenofovir
NRTIs
Inhibits reverse transcriptase
HIV; HBV
Nephrotoxicity
Abacavir
NRTIs
Inhibits reverse transcriptase
HIV
Hypersensitivity reaction
Efavirenz; Nevirapine; Rilpivirine; Etravirine
NNRTIs
Inhibit reverse transcriptase through direct enzyme inhibition
HIV
Rash, CNS toxicity, vivid dreams
Teratogenic; pregnancy category D for efavirenz only Affects P450 metabolism
Ritonavir; Fosamprenavir; Atazanavir; Darunavir; Lopinavir
HIV Protease inhibitors
Prevent cleavage of protein chain into functional subunits
HIV
Lipodystrophy syndrome (hyperglycemia, hyperlipidemia, fat distribution); rash Affects CP450 metabolism. Resistance develops slowly
Simeprevir; Bocepravir; Telapravir
-previr
NS3/4A protease inhibitors
Prevent viral maturation through the inhibition of protein synthesis
HCV
Anemia, rash, itching, GI side effects, Affects P450 metabolism
Ledipasvir; daclatasvir; ombitasvir
-asvir
HCV NS5A Inhibitor
Inhibit the viral phosphoprotein, NS5A, that is required for viral replication
HCV
Few side effects; Fatigue, headache possible Affects P450 metabolism
Enfuvitide (Fuzeon); Maraviroc (Selzentry)
Entry inhibitors
Prevent viral cell entry (enfuvitide binds gp41, maraviroc binds CCR5 on Tcells/monocytes inhibiting gp120 interaction)
HIV
Raltegravir; Elvitegravir; Dolutegravir
HIV integrase inhibitor
Binds to HIV integrase to prevent viral DNA strand transfer
HIV
Low side effect profile
Sofosbuvir (Sovaldi); Paritaprevir
RNA Polymerase Inhibitor
Compete with viral nucleotide to cause viral chain termination of HCV RNA
HCV
Few side effects
Ribavirin
Nucleoside analog
Thought to compete with viral nucleotides and cause chain termination
HCV
Hemolytic anemia, teratogenic
Interferon
Induce interferon-stimulating genes to establish antiviral state within cells
HCV; multiple other indications
Flu-like symptoms, cytopenias, depression, fatigue
