Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pharm- Antibiotics > Antivirals and Disinfectants > Flashcards

Antivirals and Disinfectants Flashcards

1
Q

NRTIs

A 
abacavir (ABC)
• didanosine (ddI)
• emtricitabine (FTC)
• lamivudine (3TC)
• stavudine (d4T)
• tenofovir (TDF)
– nucleotide reverse transcriptase inhibitor
• zidovudine (AZT)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

NNRTIs

non nucleoside transcriptase inhibitors

A 
delavirdine (DLV)
• efavirenz (EFV)
• etravirine (ETV)
• nevirapine (NVP)
• rilpivirine (RPV)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

PIs

Protease Inhibitors

A 
amprenavir (APV)
• atazanavir (ATV)
• fosamprenavir (f-APV)
• indinavir (IDV)
• lopinavir/ritonavir (LPV/r)
• nelfinavir (NFV)
• ritonavir (RTV or r)
• saquinavir (hard gel capsule and tablet formulations) (SQV)
• tipranavir (TPV)
• darunavir (DRV)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Additional Agents for secondary treatment

A 
Fusion inhibitor
– enfuvirtide (T20)
• CCR5 antagonist
– maraviroc (MVC)
• Integrase inhibitor 
– raltegravir
– elvitegravir 
– dolutegravir
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Tenofovir Disoproxil Fumarate (Viread)

A 
• Take without regard to food
• Adverse effects
     - renal insufficiency
• Special considerations
– renal dosing
– use with emtricitabine for pre-exposure prophylaxis (PrEP) and post- exposure prophylaxis (PEP)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Emtricitabine (Emtriva)

A

• Take without regard to food
• Adverse effects
– Hyperpigmentation of the palms
– Skin discoloration

Well tolerated and does not usually have any adverse effects
*looks like secondary syphilis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Zidovudine (Retrovir)

A

• Taken without regard to food
• Adverse effects
– hyperpigmentation of nails and toes (next slide)
– bone marrow suppression
Used as an IV infusion peripartum in women who have viral loads > 400
** drug of choice for pregnant women

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Lamivudine (Epivir)

A 
• Taken without regard to food
• Adverse effects – diarrhea
– malaise, fatigue – headache
• Special considerations
– Epivir HBV! 
• Caution!
– Renal dosing requirements 
**paired with Zidovudine and used for pregnant women
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Combination Products

A

• emtricitabine + tenofovir (Truvada®) – 1 tablet PO daily

emtricitabine + tenofovir + efavirenz (Atripla®) – 1 tablet PO daily

emtricitabine + tenofovir + elvitegravir + cobicistat (Stribild®) – 1 tablet PO daily

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Efaviranz (Sustiva)

A 
• Avoid taking with high-fat foods
– increases serum concentrations by 39-79%
– take on empty stomach
• Adverse effects
– central nervous system (CNS) effects
• 52% of patients in clinical trials
• subside after 2-4 weeks
– rash
– elevated liver function tests (LFTs)
– teratogenic
– false-positive cannabinoid test!
• Drug interactions
– Mixed CYP450 3A4 inducer and inhibitor
    • needs to be taken right before bed
  • *cannot be used for pregnant women
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Rilpivirine (Edurant)

A 
non nucleoside
• Not for use in high viral loads
Drug interactions
– CYP450 inducer
– Avoid use with proton pump inhibitors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Nevirapine (Viramune)

A

• Take without regard to food
Adverse Effects:
– hepatitis, including fatal hepatic necrosis
– higher frequency in women with CD4 > 250, men with CD4 > 400
» avoid initiation in these populations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

PIs Class Issues

A 
– Drug interactions
• Emphasize importance of using same pharmacy for all prescriptions
– Metabolic syndrome
• Insulin resistance/hyperglycemia
• Increased cholesterol and triglycerides • Lipodystrophy/fat redistribution
– Heptatotoxicity
– GI intolerance
– Osteopenia and osteoporosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Ritonavir (Norvir)

A 
pharmacokinetic booster with other protease inhibitors
• 100-400mg/dayin1-2divided doses
• Do NOT refrigerate oral solution
• Adverse effects
– GI upset
– taste perversion
– circumoral tingling
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Atazanavir (Reyataz)

A

• Take with food
• Special considerations
– separate dosing from antacids and H2-blockers – proton pump inhibitors
• when to avoid
• Adverse effects
– indirect hyperbilirubinemia – prolonged PR interval on EKG – nephrolithiasis
– lack of effect on lipids!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Darunavir (Prezista)

A

• Take with food
• Special considerations
– Must take darunavir and ritonavir at the same time – Caution in sulfa-allergic patients
– New 600 mg tablet arrived in late spring 2008
• Adverse effects – Rash

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Lopinavir/ritonavir (Kaletra)

A 
• Take without regard to meals
• Special considerations
– Melt-extrusion technology • No refrigeration needed!!
– Drug of choice in pregnancy
• Adverse effects – asthenia
– as with ritonavir
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Integrase Inhibitor Raltegravir (Isentress)

A 
• Take without regard to food
• Special considerations
– metabolized by glucuronidation
• Adverse effects – headache
– nausea – diarrhea
– increased creatine kinase
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Integrase Inhibitor Stribild®

A 
• Take with food
• Special considerations
• “Quad Pill”
– Drug interactions
– Elevations in serum creatinine
– Increased creatine kinase
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Initial Treatment Considerations

A 
– Results from resistance testing
– Dosing convenience/adherence issues – Adverse effects
– Drug interactions
– Pregnancy potential/CD4 count
– Comorbidities
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Antivirals for HSV and VZV

A

• Treatments are virustatic
– Arrest DNA synthesis by inhibiting viral DNA polymerase
• Must be initiated within 48-72 hours of rash onset

22
Q

Acyclovir (Zovirax)

A

Mechanism of action
– Phosphorylated into the active triphosphate form, where it becomes incorporated into the viral DNA
– Viral replication is inhibited
– Active against HSV-1 and HSV-2 as well as VZV
• Special considerations
– Role for topical therapy, role for IV therapy, patient expectations

23
Q

Valacyclovir (Valtrex)

A

• Mechanism of action
– L-valyl ester prodrug of acyclovir
• Dosing
– Acute infection
– Suppression of recurrent episodes – Reduction of transmission
• Adverse effects
– Thrombotic thrombocytopenic purpura/hemolytic uremic syndrome
• In immunocompromised patients
• Special considerations
– Less frequent dosing than acyclovir
– Higher plasma concentrations than acyclovir

24
Q

Famciclovir (Famvir)

A

Mechanism of action
– Rapidly phosphorylated by viral thymidine kinase to penciclovir monophosphate
• Competitively inhibits viral DNA polymerase and prevents viral replication through inhibition of herpes virus DNA synthesis
• Adverse effects
– Fatigue, GI upset, headache
• Special considerations
– Dose adjustment for renal dysfunction

25
Q

3 Topical Agents

A

• Penciclovir (Denavir)
– 1% cream, for oral herpes lesions
– Apply every 2 hours while awake for 4 days – Headache, local skin reactions
• Docosanol (Abreva)
– 10% cream, available OTC, for oral herpes lesions
– Rub in a thin layer gently but completely 5 times daily until healed
• May apply cosmetics over this product
• Trifluridine (Viroptic)
– 1% ophthalmic solution, for primary keratoconjunctivitis and recurrent epithelial keratitis caused by HSV
– Dose de-escalation procedure

26
Q

CMV

A

– DNA virus
– Typically result from reactivation in immunocompromised patients
• HIV, transplant
– Dissemination results in end-organ disease
• Retinitis, colitis, esophagitis, CNS disease, pneumonitis
• Treatments are virustatic
– Arrest DNA synthesis by inhibiting viral DNA polymerase
• Completely different regimens than used for HSV or VZV
– Increased toxicity

27
Q

Ganciclovir (Cytovene)

A

replaced with valganciclovir
– Converted to ganciclovir triphosphate
• Incorporated into viral DNA
• Inhibits viral DNA polymerase • Terminates viral replication
– Does exhibit activity against HSV, VZV, EBV • Too toxic to be used for those viruses

28
Q

Ganciclovir (Cytovene)

A

• Adverse effects
– Black box warning: bone marrow toxicity
• Special considerations
– Hydrate aggressively
– Monitor renal function and adjust accordingly – Avoid direct contact with skin
• Extremely alkaline solution, teratogenic and carcinogenic

29
Q

Valganciclovir (Valcyte)

A

DRUG OF CHOICE for Tx and Px! (oral)
• Special considerations – PO only
– Look-alike/sound-alike names
• Valganciclovir and valacyclovir

30
Q

Foscarnet (Foscavir)

A

Mechanism of action
– Binds noncompetitively to viral DNA polymerase to form an inactive complex and prevents pyrophosphate cleavage
• Results in termination of viral DNA chain elongation – Broad spectrum of activity
• Covers HSV, VZV
– Reserved for acyclovir-resistant strains
• Covers CMV, influenza, HIV
– Not used for the latter 2
– Used as second-line to valganciclovir for CMV

31
Q

Hepatitis B Virus (HBV) Infection

A
  • Agents utilized – PO
  • Adefovir, lamivudine, entecavir, telbivudine, tenofovir – Subcutaneous
  • Interferon alfa
32
Q

Tenofovir (Viread)

A

1st line treatment
• Special considerations
– Maintains activity against lamivudine- and entecavir-resistant isolates
– Reduced activity against adefovir-resistant isolates – Significantly higher rate of response than adefovir
• Less likely to develop resistance • Fewer adverse effects

33
Q

Entecavir (Baraclude)

A

1st line treatment
• Mechanism of action
– Carbocyclic analog of guanosine – Phosphorylated to its active form
• Then inhibits viral polymerase and halts HBV DNA synthesis
– Effective for lamivudine-resistant HBV
Adverse effects
– Black box warning: severe acute exacerbations of hepatitis upon discontinuation
– Dizziness, fatigue, headache, nausea

34
Q

Lamivudine (Epivir HBV)

A 
Special considerations for HBV
– Dosing is 100 mg PO daily
• Epivir HBV dosage form
– Very rapid and potent HBV suppression
• HOWEVER, resistance is quite common
35
Q

HCV Infection goals of therapy

A

Goals of therapy
– Eradicate the virus
– Achieve sustained virologic response (SVR)
• Undetectable viral load for 6 months after completion of therapy
– Improve liver histology
– Reduce risk of hepatocellular carcinoma

36
Q

Interferons for HCV Infection

A 
Products available – Pegasys
– Peg-Intron
• Adverse effects
Interferons for HCV Infection
– Flu-like syndrome
• Headache, myalgias, arthralgias, fatigue. malaise, fever, chills 
• Improves as treatment continues
• Special considerations
– Contraindications to therapy
• Hepatic decompensation • Autoimmune disease
• History of arrhythmia
• Pregnancy
37
Q

Ribavirin (Rebetol, Copegus)

A

• Adverse effects
– Hemolytic anemia (must monitor CBC q4 weeks)
– GI upset
– Depression
– Teratogenic!!
• Special considerations
– Handling capsules, pregnancy precautions

38
Q

Sofosbuvir (Sovaldi)

A 
• Special considerations
– $1000 per tablet!!
– Pan-genotypic activity
– Makes it possible to treat some patients without interferon! 
Polymerase inhibitor
39
Q

Simeprevir (Olysio)

A 
• Dosing
– 150 mg PO daily with food
• Adverse effects – Rash
– Itching
– Nausea
• Special considerations
– Assessment of Q80K mutation 
– Drug interactions!!
40
Q

Influenza virus

A 
Single stranded RNA virus
• Influenza A and Influenza B
• Influenza A
– Two surface antigens:
– hemagglutinin (H1 to H16) and neuraminidase (N1 to N9)
41
Q

Complications of Influenza

A

Viral Pneumonia
Complications of Influenza
• Secondary bacterial pneumonia, sinusitis, otitis
• Exacerbates other medical conditions – Especially cardiac/pulmonary disease
• Also uncommonly associated with: – encephalopathy, transverse myelitis
– myositis, myocarditis, pericarditis
– Reye’s syndrome

42
Q

Antiviral Therapy treating with 48 hrs if?

A

Treat if high risk group within 48 hrs
children younger than 2 years old
adults 65 years and older
pregnant women and women up to 2 weeks postpartum
persons with certain chronic medical or immunosuppressive conditions

43
Q

Antiviral Prophylaxis

A

Chemoprophylaxis if
– persons at higher risk for influenza-related complications have significant contact with flu.
– Early treatment is alternative to chemoprophylaxis after a suspected exposure.
• If clinical signs or symptoms develop, then treat
• Best method of routine prevention: inactivated influenza vaccine!!

44
Q

Amantadine (Symmetrel)

A

• Adverse effects
– Dry mouth, nausea, anorexia
– CNS toxicity (increased risk in elderly)

Mechanism of action
– Inhibits viral replication by interfering with viral attachment and uncoating

• Special considerations
– No longer recommended for influenza prophylaxis
– Role in treatment in 2012
– Teratogenic
– Used to treat Parkinson Disease and drug-induced EPS

45
Q

Rimantadine (Flumadine)

A

• Adverse effects
– As with amantadine
• Less CNS adverse effects

MOA is same as amantadine

46
Q

Oseltamivir (Tamiflu)

A

• Mechanism of action
– Neuraminidase inhibitor
– Active against both influenza A and B

• Adverse effects
– Nausea, vomiting, abdominal pain
– CNS adverse effects

– Approved for use in ages 1 and over – Dose adjust for renal insufficiency

47
Q

Zanamivir (Relenza)

A

• Adverse effects
– Cough, bronchospasm
– Reversible decrease in pulmonary function – Transient nasal and throat discomfort
• Special considerations
– Avoid use in patients with asthma and COPD
– Puncture Rotadisk only when ready to use
– FDA alert 10/9/2009!

48
Q

Disinfectants

A

– Chemicals that inhibit or kill microorganisms (not spores)
• Used on inanimate surfaces
– Regulated by EPA
Disinfectants and Antiseptics can become contaminated with spores and bacteria

49
Q

Antiseptics

A

– Disinfecting agents that can be applied to skin, mucus membranes, wounds due to low toxicity to host cells
• To prevent infection
– Regulated by FDA

50
Q

Sterilants

A

– Kill both cells and spores when applied for certain duration of time/temperature
– Regulated by EPA

Pharm- Antibiotics (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions