Antivirals Flashcards
What are the medications that can be used for treatment of Hepatitis B?
Entecavir, Adefovir, and Interferon Alfa (NRTIs)
What are the medications that can be used to treat Hepatitis C?
Elbasavir/grazoprevir, Ledipasvir/sofosbuvir, Simeprevir, Daclastasvir, Sofosbuvir//velpatasvir, Ombitasvir, Paritaprevir, Ritonavir, Dasabuvir, Ribavirin, and Interferon Alpha
Which medications can be used to treat both Hep B and Hep C?
Interferon Alpha and ribavirin
As a MOA, what does Entecavir inhibit?
nucleoside analogue reverse transcriptase (can’t make DNA)
Entecavir is more potent than what two medications?
Iamivudine and adefovir
Entecavir should not be used for treatment of ___/___ confection when ___ treatment is deferred
HBV/HIV; HIV
Entecavir is generally well tolerated, but can cause adverse drug reactions such as ___, ___, and ___–usually in patients with hepatotoxicity.
HA, NVD, and lactic acidosis
Patients taking Entecavir should take the medication (with/without) food because ____
without, because food decreases bioavailability of the medication
Entecavir has a (high/low) resistance rate in treatment naive patients
low
___ and ___ are two Hep B medications that are only available orally.
Adefovir and Entecavir
Adefovir’s MOA is …
phosphate nucleotide analog
Adefovir is indicated for use in patients who have HBV that is …
resistant to lamivudine, entercavir, HIV, pox, and HSV
Adefovir should not be given to patients who have both ___ and ___
HBV and HIV
Generally, Adefovir is well tolerated, but some ADRs of this medication may include …
HA, diarrhea, abd pain, and asthenia (abnormal physical weakness/lack of energy)
There are some strains of ___ that are resistant to Adefovir
Hep B
Interferon Alfa (is/is not) directly virucidal or virustatic
not
Interferon Alfa induces ___ activity to promote a(n) ___ state
enzymatic; antiviral
Interferon Alfa can be used to treat ___ and ___
Hep B and Hep C
Interferon Alfa is no longer first line, however, it is found naturally in the body and has ___, ___, and ___ effects
antiviral, immunomodulating, and anti proliferative effects
When a patient is taking Interferon Alfa, we as providers have to ensure careful monitoring of ___ and ___ levels, while also watching for ___ concerns.
CBC and TSH; Autoimmune
Some ADRs of Interferon Alfa include …
Flu like syndrome, neuropsychiatric disturbances, sz, and cardiotoxicity
Elbasvir/grazoprevir inhibits ____ ___ replication with HCV protease inhibitor
HCV NS5A
Which medications are indicated for first line treatment of genotype 1 Hep C?
Elbasvir/grazoprevir and Ledipasvir/sofobuvir
A patient should not take Elbasvir/grazoprevir is they have ___ insufficiency or if they are taking medications for ___
hepatic; HIV
Patients who take Elbasvir/grazoprevir may experience ADRs such as ___, ___, and ___
fatigue, HA, nausea
Sofosbuvir will interact with ___ ___ and Ledipasvir will interact with ___
P450 inducers; amiodarone (bradycardia)
Simeprevir should not be used ___ and can treat genotype ___ when taken with ___ or ___
alone/mono therapy; ribavirin or sofosbuvir
If a patient is about to start taking Simeprevir, you as a provider should warn them against possible ___ ___
hepatic insufficiency
Hep C medications that interact with P450 inducers include
Viekira Pak, Ledipasvir/sofosbuvir, Simeprevir, Daclatasvir, and Sofosbuvir/velpatasvir
Which medication for Hep C was the first single tablet regimen for all genotypes?
Sofosbuvir/velpatasvir
The Viekira Pak (Ombitasvir, paritaprevir, ritonavir, dasabuvir, ribavirin) is used for genotype ___ and can cause, most seriously, severe ___ injury in patients with ___
1; liver; cirrhosis
Ribavirin is a purine nucleoside analog that inhibits viral ___ synthesis, is used against ___ and ___ viruses, and can cause ___ in patients taking this medication
RNA; RNA and DNA; Hemolytic anemia
Antivirals used as treatment and prevention of influenza A and B are classified as ___ ___ and include medications such as ___, ___, and ___
Neuroaminidase inhibitors; Oseltamivir, Zanamivir, and Peramivir
A patient should start taking Oseltamivir, Zanamivir, and Peramivir within ___ hours of onset of symptoms
48
When prescribing a patient wither Oseltamivir, Zanamivir, or Peramivir, you should adjust the dose for ___ insufficiency, and ask patients about pregnancy as these medications are pregnancy category ___
renal; C
Taking Oseltamivir, Zanamivir, and Peramivir can cause adverse reactions such as…
NVD, neuropsych, and HA
You should not write a prescription for Zanamivir for patients who have comorbid ___
Asthma/COPD
Acyclovir inhibits ___ synthesis and is the most commonly used antiviral in treatment of ___, ___, and possibly ___
HSV1 and 2, varicella zoster, and possibly EBV
Acyclovir is a pregnancy category ___ as it crosses the BBB and enters the breast milk
B
Acyclovir has a cross resistance to ___ and ___
famicyclovir and valcyclovir
___, ___, and ___ are examples of anti viral pro drugs
Valacyclovir (metabolized to acyclovir), Famiciclovir (converted to penciclovir), and Valganciclovir
Valacyclovir has (more/less) ADRs than acyclovir
less
Famiciclovir has some cross resistance with ___ and has resistance to ___ due to point mutation.
acyclovir; HBV
Ganiciclovir is a competitive inhibitor of DNA polymerases and can be used to treat ___, ___, ___, and ___
CMV, EBV, HSV/VZV, and human herpes virus 6
Valganciclovir is 1st line treatment for ___ and is similar to ____
CMV retinitis; ganiciclovir
Foscarnet is administered as ___ medication only, and can be used to treat various viruses, including ___. However, when taking Foscarnet, patients can develop ___ ___, which can be avoided by doing… and monitoring …
IV; CMV; renal dysfunction; hydration, adjust dosage, avoid nephrotoxic medications, and monitor electrolytes, CBC, renal function weekly
Cidofovir isa rarely used due to ___
nephrotoxicity
Papillomavirus treatment medications include ___, ___, ___, and ___.
Imiquimod, podofilox, Sinecatechins, and Trichloroacetic acid
Which medication is first line treatment for external and perianal genital warts? Which medication is the first line alternative to the previous medication? Why is the first line alternative medication not the first line medication?
Imiquimod; Podofilox–has more ADRs than Imiquimod
Sinecatechins are used for treatment of ___ but can cause ____ in ____ males
anogenital warts; narrowing of foreskin; uncircumcised
Trichloroacetic acid is not approved by FDA because it is a ________
caustic agent
