Antivirals

Question 1

What are the two classes of antivirals for influenza?

Answer 1

Adamantanes and Neurominidase Inhibitors

Question 2

Name two adamantanes and the influenza virus(es) they are active against.

Answer 2

Amantadine and Rimantadine. ONLY Influenza A.

Question 3

Name two Neurominidase Inhibitors and the influenza virus(es) they are active against.

Answer 3

Oseltamivir and Zanamivir. Have activity against influenza A and B.

Question 4

What is the MOA of Neurominidase Inhibitors, Oseltamivir and Zanamivir?

Answer 4

• Block active site of neuraminidase
• Reduce the amount of viral particles released from infected cells

Result in decreased shedding of influenza A and B viruses

Question 5

Neuromindase Inhibitors main tx efficacy:

Answer 5

– Reduces duration of uncomplicated influenza A and B illness
– Reduction in viral shedding, fever, illness
– May reduce complications, death and shorten duration of hospitalizations
– Shortens symptoms by 1 or 2 days

Question 6

Adverse effects of Oseltamivir?

Answer 6

– Nausea, vomiting (9-10%)
– Transient neuropsychiatric events (self-injury or delirium – majority in Japan
– Limited data in children

Question 7

T or F: Oseltamivir is preferred in pregnancy

Answer 7

True

Question 8

T or F: Oseltamivir is preferred in pregnancy

Answer 8

True

Question 9

Route of administratin of Zanamivir (for influenza A, B)

Answer 9

Orally inhaled powder

Question 10

Adverse effects of Zanamivir:

Answer 10

– Nausea, diarrhea
– Headache
– Cough
– BRONCHOSPASM in persons with pulmonary disease (not recommended in this population)

Question 11

What are the antivirals used for HSV?

Answer 11

• Acyclovir/ Zovirax
• Famciclovir/ Famvir
• Valacyclovir/Valtrex

Question 12

Which antiviral is converted to acyclovir after oral administration?

Answer 12

Valacyclovir/Valtrex - it has better bioavailability

Question 13

Which antiviral is converted to acyclovir after oral administration?

Answer 13

Valacyclovir/Valtrex - it has better bioavailability

Question 14

MOA of Acyclovir?

Answer 14

Acyclovir is a guanosine analog that is incorporated into the virus DNA and inhibits further viral synthesis.

Question 15

T or F: Acyclovir only works against viruses that are actively replicating and is ineffective against latent virus.

Answer 15

True

Question 16

Which antiviral can actively cross the blood barrier and can thus be used to treat herpes meningitis and encephalitis?

Answer 16

Acyclovir/Zovirax

Question 17

Indications for Acyclovir/Zovirax?

Answer 17

– Genital Herpes (shortens sx by 2 days) – Herpes labialis (modestly beneficial)
– Varicella (HIGHER DOSES REQ)

Question 18

Adverse effects of Acyclovir/Zovirax?

Answer 18

– Oral: Headache, nausea and vomiting
– IV: Renal Toxicity (need proper hydration),
CNS side effects
– Topical: skin irritation

Question 19

Two treatments for Hep B?

Answer 19

1. Immunomodulatory therapy (finite therapy)

2. Anti-viral agents acting on Hep B DNA polymerase (treatment may be indefinite)

Question 20

What is the immunomodulatory therapy and what is its duration and goal?

Answer 20

Pegylated interferon for 48 weeks

Goal: sustained suppression of viral replication after completion of treatment

Question 21

MOA of Peg-interferon alfa (Pegasys®)?

Answer 21

CYTOKINE that induces specific & nonspecific immune responses

Question 22

What is the only effective tx of Hep B with Hep D coinfection?

Answer 22

Peg-interferon alfa (Pegasys®)

Question 23

Adverse effect/toxicity of Peg-interferon alfa (Pegasys®)?

Answer 23

– fatigue 
– flu-like rxn 
– anemia 
– panctyopenia 
– depression
– mood disturbances (20-30% of patients)

Question 24

Contraindications of Peg-interferon alfa (Pegasys®)?

Answer 24

– autoimmune disease
– uncontrolled psychiatric disease
– decompensated cirrhosis
– uncontrolled seizures

Question 25

What monitoring do you need to do with patients on Peg-interferon alfa (Pegasys®) and how often?

Answer 25

CBC TSH Every 3 months

Question 26

Ideal (necessary?) patient picture for treatment with Peg-interferon alfa (Pegasys®)?

Answer 26

– low HBV DNA levels – high levels of ALT – lack of advanced liver disease

Question 27

What are the 5 nucleoside or nucleotide analogs (anti-virals for Hep B)?

Answer 27

``` – lamivudine – adefovir – telbivudine – ENTECAVIR – TENOFOVIR ```

Question 28

Duration of nucleoside or nucleotide analogs therapy is variable and influenced by (3 things):

Answer 28

– HBeAg status – duration of HBV DNA suppression – presence of cirrhosis/decompensations

Question 29

Which two nucleoside or nucleotide analogs are the only first line antivirals for treatment naïve patients with HBV?

Answer 29

– ENTECAVIR | – TENOFOVIR

Question 30

What is the class and MOA of Tenofovir (Viread®)?

Answer 30

NucleoTIDE analog Inhibits hepatitis B REVERSE TRANSCRIPTASE (NRTI)

Question 31

Which nucleotide analog is the referred 1st line treatment for HBV and also recommended for lamivudine- resistance HBV infection?

Answer 31

Tenofovir (Viread®)

Question 32

Adverse reactions/side effects of Tenofovir (Viread®)?

Answer 32

``` – asthenia (abnormal physical weakness or lack of energy) – fatigue – lactic acidosis – acute renal failure – hypophosphatemia – osteoporosis ```

Question 33

What monitoring is needed for someone on Tenofovir (Viread®)?

Answer 33

``` – ALT/AST – total bilirubin – BMP (basic metabolic) – CrCl – CBC with differential ```

Question 34

Class/MOA of Entecavir (Baraclude®)?

Answer 34

NucleoSIDE analog Inhibits hepatitis B POLYMERASE.

Question 35

Which nucleoside analog is NOT recommended with previous Lamiduvine resistance?

Answer 35

Entecavir (Baraclude®)

Question 36

Which nucleoside analog is approved for children 2 years and older?

Answer 36

Entecavir (Baraclude®)

Question 37

Adverse/side effects of Entecavir (Baraclude®) ?

Answer 37

``` – nausea – dizziness – ALT elevations – lactic acidosis – anaphylaxis ```

Question 38

Monitoring of patients on Entecavir (Baraclude®), and timeline?

Answer 38

– ALT/AST – renal function – hepatitis B virus DNA During treatment and several months after completion

Question 39

Why is Entecavir (Baraclude®) not recommended in HIV/HBV co-infected patients not treated with highly active antiretroviral therapy?

Answer 39

The potential for the development of resistance