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Year 3 - Infection > Antivirals > Flashcards

Antivirals Flashcards

1
Q

What are viruses?

A

Obligate intracellular parasites

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2
Q

What do viruses require to replicate?

A

The utilisation of host cell enzymes

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3
Q

What is an example of an adverse effect of an antiviral?

A

Mitochondrial toxicity

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4
Q

What are most antivirals?

A

Nucleoside analogues –> Inhibit nucleic acid synthesis

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5
Q

Which antivirals target receptor binding?

A

Docosonal (Herpes)

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6
Q

Which antivirals target cell entry?

A

Chemokine-receptor blocking agents-(HIV)

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7
Q

Which antivirals target uncoating?

A
  • Amantidine
  • Rimantidine

For Influenza A

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8
Q

Which antivirals target nucleic acid synthesis?

A

1) Nucleoside analogues
- Acyclovir (HSV, VSV)
- Ganciclovir (CMV)

2) Viral DNA polymerase inhibitors:
- Cidofovir (HSV, CMV)
- Foscarnet (HSV, CMV)

3) Guanine nucleotide synthesis:
- Ribvirin (RSV, HCV)

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9
Q

Which antivirals target Reverse transcriptase?

A

1) Non-nucleoside reverse transcriptase inhibitors (HIV):
- Delaviridine
- Efavirenz
- Nevirapine

2) Nucleotide reverse transcriptase inhibitors

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10
Q

Which antivirals target DNA integration?

A

Integrase inhibitors (HIV):

  • Dolutegravir
  • Elvitegravir
  • Raltegravir

“…egravir”

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11
Q

Which antivirals target the release of progeny virus (Influenza A and B)?

A

Neuraminidase inhibitors:

  • Osteltamivir
  • Zanamivir
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12
Q

Which antivirals target proteolytic processing?

A

Protease inhibitors (HIV):

  • Atazanavir
  • Darunavir
  • Indinavir

”..navir”

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13
Q

When may we use antivirals?

A
  • Prophylaxis
  • Pre-emptive therapy
  • Overt disease
  • Suppressive therapy
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14
Q

Why is Prophylaxis used?

A

To prevent infection

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15
Q

Why is Pre-emptive therapy used in viral infection?

A

When evidence of infection is detected, but before symptoms apparent

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16
Q

Why is suppressive therapy used in viral infection?

A

To keep viral replication below the rate that causes tissue damage in asymptomatic infected patient

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17
Q

Examples of Antivirals used in overt disease?

A

Nucleoside analogues:

  • Aciclovir
  • HSV and VSV
  • “…clovir”

Neuraminidase inhibitors:

  • Oseltamivir
  • Influenza A and B
  • “…amivir”
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18
Q

Examples of Antivirals used in pre-emptve viral infection?

A

Protein synthesis:
- Interferon-a = HBV and HCV

Nucleotide analogue:
- Ribavirin = RSV and HCV

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19
Q

Examples of Antivirals used in suppressive viral infection?

A

Antiretroviral (HIV) therapy:

  • Attachment inhibitor (Maraviroc)
  • Penetration inhibitors (Enfuvirtide)
  • NRTI
  • NNRTIs
  • Integrase inhibitors
  • Protease inhibitors
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20
Q

Examples of Antivirals used in prophylaxis?

A

Acyclovir a nucleoside analogue for herpes (HSV)

21
Q

What are antivirals role in latently infected cells e.g. herpes virus?

A

1) They can treat over infection
2) They do not eradicate virus
3) Suppression is then used to reduce risk overt infection

22
Q

Antivirals for herpes viruses, HSV 1 and 2?

A

HSV:
- Nucleoside analogues e.g. acyclovir “…clovir”

  • Viral DNA polymerase inhibitors e.g. Cidofovir or Foscarnet
23
Q

Antivirals for herpes viruses, VZV?

A

Nucleoside analogues e.g. acyclovir “…clovir”

24
Q

Antivirals for herpes viruses, CMV?

A
  • Nucleoside analogues e.g. Ganciclovir “…clovir”

- Viral DNA polymerase inhibitors e.g. Cidofovir or Foscarnet

25
Q

Antivirals for Hepatits B and C?

A
  • Nucleotide reverse transcriptase inhibitors, e.g. Tenofovir
  • Protein synthesis inhibitor, e.g. Interferon-a

Nucleotide analogues, HCV:
Ribavirin

26
Q

Antivirals in influenza?

A

Neuraminidase inhibitors:

  • Oseltamivir
  • Zanamivir
27
Q

Antivirals in respiratory syncytial virus, RSV?

A

Nucleotide analogue:

- Ribavirin

28
Q

When are antivirals used in herpes simplex HSV, e.g. Acyclovir, cidofovir or foscarnet?

A
  • Mucocutaneous: Oral, genital, eye, skin
  • Encephalitis
  • Immunocompromised, any site
29
Q

When are antivirals used in chicken pox, VZV?

A

In this at increased risk of complications:

  • Neonate
  • Immunocomprimised
  • Pregnant
30
Q

When are antivirals used in shingles, VZV?

A

Immunocompetent host but only if begun within 72 hours of onset of symptoms

31
Q

How is the nucleoside analogue, acyclovir, administered (HSV, VZV)?

A
  • Oral
  • Intravenous
  • Eye ointment
  • Topical cream
32
Q

How is the nucleoside analogue, valaciclovir, administered (HSV, VZV)?

A

Oral

33
Q

How is the nucleoside analogue, famciclovir, administered (HSV, VZV)?

A

Oral

34
Q

How is the viral DNA polymerase inhibitor, foscarnet, administered (HSV, VZV)?

A

Intravenous

35
Q

What is the mode of action of nucleoside analogues (HSV, VZV, CMV)?

A

1) Acyclovir is monophosphorylated by HSV/VZV thymidine kinase to Acyclovir monophosphate, ACVMP
2) ACVMP is further phosphorylate by hosts kinase enzymes in infected cells to acyclovir triphosphate, ACVTP
3) ACVTP, competitively inhibits and inactivates HSV-specific DNA polymerase
4) Viral DNA synthesis inhibited

36
Q

Why does acyclovir few adverse effect, low cellular toxicity?

A

1) Initial phosphorylation only takes place in viral infected cells
2) Acyclovir triphosphate inhibits viral, not cellular, DNA polymerase

37
Q

Antivirals used in CMV?

A

Nucleoside analogues:

  • Ganciclovir
  • Valganciclovir

Viral DNA polymerase inhibitors:

  • Cidofovir
  • Foscaret
38
Q

How is ganciclovir administered in CMV?

A

Ganciclovir, a nucleoside analogue is administered by:

  • Intravenous
  • Ocular implant
39
Q

How is valganciclovir administered in CMV?

A

Valganciclovir, a nucleoside analogue is administered by:

- Oral route

40
Q

How is cidofovir administered in CMV?

A

Cidofovir, a viral DNA polymerase inhibitor, is administered:
- Intravenously

41
Q

How is foscarnet administered in CMV?

A

Foscarnet, a viral DNA polymerase inhibitor, is administered:
- Intravenously

42
Q

When are antivirals used in CMV?

A

1) In life or sight-threatening CMV infections:
- HIV patients within CMV retinitis or colitis
- Transplant recipients = pneumonitis

2) Neonates with symptomatic congenital CMV infection

43
Q

What is the therapy protocol called in HIV therapy?

A

Combination anti-retroviral therapy, cART

Also known as,

Highly active antiretroviral therapy, HAART

44
Q

Antivirals for chronic hepatitis B?

A

Nucleoside/tide analogues:

  • Tenofovir
  • Adefovir
  • Entecavir
  • Lamivudine
  • Emtricitabine
  • Telbivudine

Interferon-a

45
Q

Antivirals for chronic hepatits C?

A

Often 12-48 weeks

Current:

  • Interferon-a
  • Guanine nucleotide analogue, Ribavirin (Oral)
  • Protease inhibitors, telaprevir or boceprevir

New:

  • Daclatasvir
  • Sofosbuvir
  • Simeprevir
46
Q

How can you test antiviral resistance?

A

1) Phenotypic - Can virus from in presence of the compound e.g. HSV
2) Genotypic - Sequence genome and identify resistance associated mutation e.g. HIV

47
Q

When would you suspect antiviral resistance in herpes in immunocompromised?

A

If there is no response to appropriate antiviral within 7 days

Examples - Acyclovir, cidofovir, foscarnet

48
Q

If HSV or CMV is resistant to acyclovir what is the next therapeutic option usually?

A

Foscarnet, a viral DNA polymerase inhibitor

49
Q

When would trough and peaks need to be monitored in acyclovir therapy?

A

For patients with renal impairment

Year 3 - Infection (16 decks)

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