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Pharm II > Antivirals > Flashcards

Antivirals Flashcards

1
Q

What are the 3 parts to a virus?

A

o Nucleic acid

o Protein coat
protects genetic mater.

o Envelope
→ Can have receptors to help enter the host

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2
Q

What are the four steps of viral replication?

A
  1. ) Attachment and entrance→ Hemagglutinin (“glu is sticky, that is how it attaches”)
  2. ) Synthesis of proteins
  3. ) Assembly of new virus

4.) Release of new virus particles
→ Lytic or lysis to enter new host cells-Neuraminidase

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3
Q

What is the MOA of anti viral agents?

What type of viruses are the most effective at killing? least effective?

A
  • Virustatic (won’t kill but stop from replicating)
  • Most effective against rapidly replicating virus
    → Not effective against latent virus
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4
Q

Influenza virus causes ?

What are the three types?/Describe influenza A?

A

-Causes acute respiratory illness

3 Types: A, B, and C

o Influenza A

  • Most common/pathogenic→ can cause epidemics

→ M2 protein on coat

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5
Q

What are the different surface antigens of the subtypes for influenza A? Describe them?

A
  • Different subtypes based on surface antigen
  • Hemagglutinin (H)

o Holds sialic acid of host

  • Neuraminidase (N)

o Cuts sialic acid once the cell replicates

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6
Q

Amatadine:

  1. ) Indication?
  2. ) MOA?
A

1.)Treatment and Prophylaxis of Influenza A
→ If started within 48 hrs., duration of symptoms are cut in half

2.) MOA:
→ Blocks viral particle uncoating and nucleic acid release into host cell
→ Inhibits viral replication
→ Works on the M2 proteins

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7
Q

Amatadine:
1.) Monitor:

  1. ) Considerations
  2. ) Additional info
A

1.) -Monitor SCr at baseline

  1. ) Considerations:
    - Avoid in Pregnancy and Breast Feeding

3.) Additional Info:

  • Can be used in PKD
    → Crosses BBB and increases CNS dopaminergic responses (hallucinations psychosis)

-CDC recommends against use in Influenza A in the US due to high level of amantadine resistance among currently circulating strands

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8
Q

Rimantadine:
1.) Indication?

2.) MOA?

A

1.) Treatment and prophylaxis of influenza A
→Within 48 hours of sxs onset

2.)MOA:
-Inhibits viral uncoating and replication
→ Works on M2 proteins

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9
Q

Rimantadine:

  1. ) Monitor
  2. ) Considerations
A

1.) Monitor:
→ Monitor SCr at baseline
→ LFTs

  1. ) Considerations
    - CDC recommends against use in Influenza A in the US due to high level of amantadine resistance among currently circulating strands

-Avoid in Pregnancy and Breast Feeding

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10
Q
  1. ) Influenza Drugs we utilize?/What are their purposes?

2. ) MOA?

A

1.)
-Oseltamivir (Tamiflu)
→ Both tx and ptx of influenzas A and B

-Zanamivir
→ Both tx and ptx of influenzas A and B

-Peramivir
→ Only treatment of influenzas A and B

2.) MOA: Inhibits neuraminidase of influenza A and B
→ Prevents the release of virions from the host cell and prevents entry into the cell

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11
Q

Oseltamivir (Tamiflu)

  1. ) Treatments vs. Prophylaxis
  2. ) Considerations?
A

2.)
Treatment: 75mg po bid x 5 days
Prophylaxis: must be given within 48 hours of exposure- to be effective

3.) Considerations:
-Renal adjustment required
→ Dosed renally (renal dose adjustments required)
→ CrCl < 60 ml/min

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12
Q

Oseltamivir (Tamiflu)

1.) Additional Info:

A

1.) Additional Info:
→ DOC for pregnancy and breast feeding
→ Prodrug, converted to oseltamivir carboxylate

**98% currently circulating influenza virus in US is Oseltamivir-susceptible

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13
Q

Zanamivir

  1. ) Administred via ?
  2. ) Treatment vs. Prophylaxis
A

1.) Administered via Oral Inhalation
→ Co-administered with a bronchodilator (albuterol)

2.)
T: Start within 48 hours of onset (2 puffs Q 12hrs X 5 days)
P: 2 puffs daily

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14
Q

Zanamivir:

1.) Considerations?

A

1.)Considerations:
-Avoid in Milk Allergy
→ Contains milk proteins as vehicles

-Caution with Asthma/COPD

***99% of currently circulating influenza virus in US is Zanamivir-susceptible

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15
Q

Peramiver

  1. ) Administred via ?
  2. ) Monitor?
A

1.) IV = available as IV
→ Administered by healthcare provider
→ Pts unable to take PO

2.) Monitor: → Monitor renal function at baseline

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16
Q

Peramiver
1.) Considerations?

2.) Treatment vs. Prophylaxis

A

1.) Considerations:
-Requires renal adjustment if:
→ CrCl < 50 ml/min

2.) Treatment only, no PTX

17
Q

Baloxavir marboxil:
1.) Indication?

  1. ) MOA?
  2. ) Excretion?
A
  1. ) Indication:
    - Txs of influenza A and B

2.) MOA:
-Inhibits viral polymerase acidic protein endonuclease activity
→ Inhibits viral replication

  1. )Excretion:
    - Feces
18
Q

Baloxavir marboxil:
1.) Half-life?

  1. ) Considerations?
  2. )Additional info?
A

1.) Half-Life:
-80 hours!
→ Allows for 1-time (weight based) dose
→ Within 48 hrs. Of sxs

2.) Considerations:
-Weight based dosing
-Separated from dairy products and calcium-fortified beverages
→ Cation interaction

  1. )Additional Info:
    - about $150 (brand name only)
19
Q

Special Populations and Influenza Drugs:

Pregnancy:
-Oseltamivier→ ?

Children:
-Oseltamivir→ Tx vs. Ptx?

  • Zanamivir→ Tx vs. Ptx?
  • Peramivir→ Tx vs. Ptx?
  • Baloxavir→ Tx vs. Ptx?
A

Pregnancy:
o Oseltamivir
→ Treatment is important, high risk of developing pneumonia post—influenza

Children:

o Oseltamivir
 Tx: any age
 Ptx: > 3 m.o.
→ No vaccine until 6 m.o. → look for CNS SEs

o Zanamivir
 Tx: > 7 y.o.
 Ptx: > 5 y.o.

o Peramivir
 Tx: > 2 y.o.

o Baloxavir
 > 12 y.o.

20
Q

Herpesvirus Family:

Large family of DNA viruses → Name each subtype virus (1-8) and describe its correlating disease/manifestation?

A

Large family of DNA viruses:
→ Stay latent

• HHV-1
o Herpes Simplex Virus 1 (HSV-1)
→ Oral lesions

• HHV-2
o Herpes Simplex Virus 2 (HSV-2)
→ Genital lesions

• HHV-3
o Varicella Zoster Virus (VZV)
→ Chicken pox/shingles

• HHV-4
o Epstein-Barr Virus (EBV)
→ Chicken pox/Shingles

• HHV-5
o Cytomegalovirus (CMV)
→ IC patients

• HHV-6a/6b/7
o Roseolavirus

• HHV-8
o Kaposi’s Sarcoma (treat their HIV)
→ AIDs patients

21
Q

What non-specific types of antiviral agents (broad categories) do we have available to treat HHV?

A

• Nucleoside Analogs
-Synthetic analogs of pyrimidines and purines
→ Inhibit viral replication
→Competitive inhibition of DNA polymerase
→Incorporation and termination of viral DNA chain
→Inactivation of viral DNA polymerase

• Miscellaneous Agent
-Won’t cure HHV
→Can prevent if taken early
→Can suppress sxs

22
Q

Trifluridine:

  1. ) What type of drug is it?
  2. ) Indication?
  3. ) Forumulation avaiable?
A

1.) Pyrimidine Analog

2.) Indication: (tri rhymes with eye)
-Ocular HSV
→ HSV keratoconjunctivitis
→Epithelial keratitis

3.)Formulation:
- Opthalmic solution
→Negligible systemic absorption
→Refrigeration required

23
Q

Cidofivir:

  1. ) What type of drug is it?
  2. ) Indication?
  3. ) Caveat of its metabolism?
A

1.) Pyrimidine Analog

2.) Indication
-Tx of CMV retinitis in AIDS patients
→ Not a first line option

3.) Active metabolite → toxic

24
Q

Cidofivir:

  1. )Half-Life?
  2. )Considerations in regards to administering the drug ?
A

2.) Half life:
-Parent drug
→ 3 hours
-Active metabolite
→ 17 hours

3.) Considerations:
-Induction and maintenance dosing
-Patient needs to be hydrated + coadministration of Probenecid
→ Limits renal toxicity
→ Increases bioavailability

25
Q

Cidofivir:
1.)Monitor?

2.)Side Effects?

A
  1. ) Monitor:
    - SCr
    - Urine protein w/in 48 hours before each dose
    - WBC + diff before each dose

2.) Side Effects:
-*Black Box Warning
→ Renal Impairment resulting in HD
→ Neutropenia
→ Carcinogen/Teratogen

26
Q

Acyclovir:

  1. ) What type of drug is it?
  2. ) Indiction ?
  3. ) When is this drug most effective?
  4. ) This drug is “dependent” on?
A

1.) Purine analog

2.) Indication:
-HSV
-VZV
-Limited benefit
→ CMV
→ EBV
3.)
-Only effective against actively replicating virus
→ Not effective in latent phase

-Kinase Dependent
Must be activated in cell by viral pathways
→ Highly selective to infected cells
→Reduces the toxicity of the drug

27
Q

Acyclovir:
1.) What 3 reasons affect dosing AND frequency?

  1. )Formulations?
  2. ) Monitor?
A

1.) Dosing based on stage of disease
→ Ideal body weight
→ Frequency based on CrCl to prevent accumulation of toxic renal crystals

-Poor bioavailability = Complex Dosing
→ ~ 20%
→ Dosed up to 5x/day

2.) Formulations: Oral and Topical
→ IV – must be hydrated/stable BP
→ Bolus saline first

3.) Monitor:
→ Renal Function (can cause AKI)

28
Q

Valacyclovir:

  1. ) What type of drug is it?
  2. ) Indiction?
  3. ) What is special about this drug?
A

1.)
-Prodrug of Acyclovir
→ Better bioavailability

2.) Indication:
-DOC**
→ HSV
→ VZV

3.) (crosses BBB- option for HSV Encephalitis)

29
Q

Valacyclovir:

  1. ) Monitoring?
  2. ) Formulation available?
  3. )Dosing based on?
A
  1. ) Monitoring:
    - SCr @ baseline

2.) Formulation?
-Oral formulation only
3.) → Dosing based on stage of disease
→ Less frequent than Acyclovir (2x daily)

30
Q

Famciclovir:

  1. ) What type of drug is it?
  2. ) Indication?
A

1.) Prodrug of Penciclovir

2.)Indication:
-TX and Ptx of:
→ HSV
→ VZV

31
Q

Famciclovir:
1.) What is its bioavailability like compared to acyclovir ?

  1. ) Dosed based on?
  2. ) Monitor?
A

2.) Considerations:
-Dosed based on stage
-Better bioavailability than Acyclovir
→Reduced frequency required

  1. ) Monitor:
    - SCr
32
Q

Penciclovir:

  1. )What type of drug is it?
  2. ) Indication?
  3. ) Formulation?
A

1.)Active metabolite of Famciclovir

  1. ) Indication to use drug:
    - Recurrent herpes labialis → think pen as in penis which can give WOMEN herpes because men suck.

3.) Available as topical formulation only “like a pen top”

33
Q

Valganciclovir:

  1. ) What type of drug is it?
  2. ) Indications?
A

1.) Prodrug of Ganciclovir

2.) Indications:
-Tx and Ptx of CMV infections
→ Ptx – transplant patients, IC patients

34
Q

Valganciclovir:

  1. ) What formulations are available?
  2. ) How would you advise you patient to take this drug?
  3. ) Monitor?
A
  1. ) Oral formulation only

2.) Considerations:
→ Administer with food
-Dose varies based on disease

3.)Monitor:
-SCr
-Pregnancy test
-CBC with Diff
→ Bone marrow toxicity

35
Q

Ganciclovir:

  1. ) What type of drug is it?
  2. ) Indication?
A

1.) Acyclovir analog

2.)Indication:
→ Tx and Ptx of CMV infections

36
Q

Ganciclovir:

  1. ) Administration?
  2. ) Monitor?
A

1.) Administration?
-IV administration
→ Administer slowly in a large peripheral or central vein
→ Hydrate pre/post administration

  1. ) Monitor:
    - SCr → Renally Toxic
    - Pregnancy Test
    - CBC/Platelets
37
Q

Miscellaneous Agent
Foscarnet:

  1. ) MOA?
  2. ) Indication?
  3. )Really effective in?
A

1.) MOA:
-Inhibits viral specific DNA polymerases, preventing DNA synthesis
→ Does not require activation by kinases
→ Effective for HSV deficient in kinases

2.) Indications:
-Tx and Ptx of CMV
-Tx of HSV/VZV
→ Not first line

3.)
→ Effective in Acyclovir resistant HSV/VZV

38
Q

Miscellaneous Agent
Foscarnet:

  1. ) Where can this drug accumulate in the body?
  2. )Administration?
A

1.) Accumulate in bone and cartilage

2.) Administration:
-IV only
→ Proper hydration

39
Q

Miscellaneous Agent
Foscarnet:

  1. ) Monitoring?
  2. ) If possible avoid giving this drug to ?
A
  1. ) Monitoring:
    - SCr
    - Electrolytes
    - CBC + diff
    - EKG → avoid giving in cardiac patients if possible

Pharm II (12 decks)

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