Antivirals and HIV drugs

Question 1

What drugs are neuraminidase inhibitors?

Answer 1

Zanamivir (in), oseltamivir (po), peramivir (po)

Question 2

What is the MOA and indications of neuraminidase inhibitors?

Answer 2

MOA: inhibits viral neuraminidase (less removal of sialic acid) and interferes w release of progeny influenza virus from infected cells
Uses: influenza

Question 3

What are adverse effects and CIs of zanamivir?

Answer 3

AEs: cough and headache
CIs: milk production hypersensitivity, COPD, and asthma

Question 4

What are adverse effects of oseltamivir?

Answer 4

Headache and N/V

Question 5

What are adverse effects of peramivir?

Answer 5

Diarrhea

Question 6

What is the MOA, indications, and AEs of amantadine?

Answer 6

MOA: interferes w M2 protein on influenza A virus which inhibits acid-mediated dissociation of ribonuclein-protein complex
Indications: influenza
AEs: CNS (insomnia, nervousness, light-headed) and GI effects

Question 7

What drugs are NRTIs?

Answer 7

Didanosine, zidovudine, lamivudine, abacavir, tenofovir, and emtricitabine
- end in “dine” or “bine”
- Tenofovir and emtricitabine have one day dosing

Question 8

What is the MOA of NRTIs and indication?

Answer 8

MOA: competitively inhibit nucleotide binding to reverse transcriptase which terminates DNA chain
Indication: HIV

Question 9

What are class adverse effects of NRTIs?

Answer 9

Causes mitochondrial toxicity
- Pancreatitis
- Lactic acidosis
- Anemia
- Neuropathy
Notes: didanosine and zidovudine have the highest toxicity for this compared to “LATE” drugs

Question 10

What is a specific adverse effect for abacavir?

Answer 10

Hypersensitivity reactions HLA-B5701 which can cause a rash, fever, and fatigue (BBW) d/t CD8 T ells attacking skin and GI cells
Note: need HLAB-5701 testing before starting

Question 11

What are specific toxicities seen with tenofovir?

Answer 11

Renal and bone toxicities but new formulation have less

Question 12

What is are adverse effects of zidovudine?

Answer 12

Lipoatrophy, hepatotoxicity (BBW), and lactic acidosis (BBW)

Question 13

What indication does lamivudine, tenofovir, and emtricitabine share in common and what can it cause?

Answer 13

Indication: can also have activity against Hep B
Caution: Can cause hepatic flare with acute removal so BBW for potential exacerbation

Question 14

What are adverse effects of didanosine?

Answer 14

Pancreatitis (BBW), hepatotoxicity (BBW), and lactic acidosis (BBW)

Question 15

What drugs are NNRTIs and what are they used for?

Answer 15

Efavirenz, nevirapine, etravirine, and rilpivirine
- “vir” in the middle
- used for HIV

Question 16

What is the MOA, AEs, and interactions with NNRTIs?

Answer 16

MOA: Binds to RT and causes a conformational change and disrupts catalytic center of the RT
AEs: rash and hepatotoxic
Class interactions: cyp interactions except rilpivirine

Question 17

What are counseling tips for NNRTIs?

Answer 17

• Efavirenz needs to be given on empty stomach to decrease side effects
• Etravirine and rilpivirine need to me taken with food to increase absorption
• Nevirapine can be taken whenever

Question 18

What are special AEs seen with efavirenz?

Answer 18

CNS symptoms (vivid nightmares, stoned) and teratogenic

Question 19

What drugs are INSTIs and what are they used for?

Answer 19

Raltegravir, elvitegravir, dolutegravir, and bictegravir
- have “tegravir” in the name
- used for HIV

Question 20

What is the MOA and AEs for INSTIs?

Answer 20

MOA: interfere w integration of viral DNA into host DNA
AEs: GI but well tolerated
- Note raltegravir is metabolzied via 3A4 so use booster with it like cobicistat

Question 21

What drugs are PIs and what are they used for?

Answer 21

Atazanavir, darunavir, ritonavir (used only as booster), nelfinavir, and indinavir
- end in “navir”
- used in HIV

Question 22

What is the MOA, AEs, and interactions of PIs?

Answer 22

MOA: block proteolytic cleavage of protein precursors that are needed for production of infectious particles
AEs: metabolic abnormalities like hyperlipidemia, hyperglycemia, and fat redistribution aka protease pouch + hepatotoxicity (note that atazonavir can cause hyperbilirubinemia)
Interactions: Cyp interactions
Note: nelfinavir is only PI that does not require boosting w ritonavir

Question 23

What are treatment regimens in HIV therapy?

Answer 23

• 2 NRTIs + 1 INSTI: recommended for most pts and this is biktarvy
• 2 NRTIs + 1NNRTI
• 2 NRTIs + 1 PI
  Note: can use Triumeq (dolutegravir/abacavir/lamivudine) if pt is HLAB5701 negative + in selected pts 2 drug regimen is possibly like Dovatu (dolutegravir/lamivudine)

Question 24

What is the MOA, indication, AEs, and DDI for maraviroc (entry inhibitor)?

Answer 24

MOA: CCR5-R antagonist aka blocks fusion and viral entry into cell so must do tropism test before starting
Indication: HIV
AEs: increased risk of infections
DDI: 3A4 inhibitors/inducers
Note: PO forumulation

Question 25

What is the MOA, indication and AEs for enfuvirtide (entry inhibitor)?

Answer 25

MOA: binds to gp41 which blocks fusion and viral entry into cell
Indication: HIV
AEs: injection site rxs
Note: SQ formulation

Question 26

What is the MOA, indication and AEs for ibalizumab (entry inhibitor)?

Answer 26

MOA: mab against CD4 and inhibits HIV from entering cells
Indication: multi-drug resistant HIV
AEs: diarrhea, dizziness, immune reconstitution inflammatory disease (IRIS) which can cause inflammatory response to opportunistic infections