Antivirals and HIV drugs Flashcards
What drugs are neuraminidase inhibitors?
Zanamivir (in), oseltamivir (po), peramivir (po)
What is the MOA and indications of neuraminidase inhibitors?
MOA: inhibits viral neuraminidase (less removal of sialic acid) and interferes w release of progeny influenza virus from infected cells
Uses: influenza
What are adverse effects and CIs of zanamivir?
AEs: cough and headache
CIs: milk production hypersensitivity, COPD, and asthma
What are adverse effects of oseltamivir?
Headache and N/V
What are adverse effects of peramivir?
Diarrhea
What is the MOA, indications, and AEs of amantadine?
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
What drugs are NRTIs?
Didanosine, zidovudine, lamivudine, abacavir, tenofovir, and emtricitabine
- end in “dine” or “bine”
- Tenofovir and emtricitabine have one day dosing
What is the MOA of NRTIs and indication?
MOA: competitively inhibit nucleotide binding to reverse transcriptase which terminates DNA chain
Indication: HIV
What are class adverse effects of NRTIs?
Causes mitochondrial toxicity
- Pancreatitis
- Lactic acidosis
- Anemia
- Neuropathy
Notes: didanosine and zidovudine have the highest toxicity for this compared to “LATE” drugs
What is a specific adverse effect for abacavir?
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
What are specific toxicities seen with tenofovir?
Renal and bone toxicities but new formulation have less
What is are adverse effects of zidovudine?
Lipoatrophy, hepatotoxicity (BBW), and lactic acidosis (BBW)
What indication does lamivudine, tenofovir, and emtricitabine share in common and what can it cause?
Indication: can also have activity against Hep B
Caution: Can cause hepatic flare with acute removal so BBW for potential exacerbation
What are adverse effects of didanosine?
Pancreatitis (BBW), hepatotoxicity (BBW), and lactic acidosis (BBW)
What drugs are NNRTIs and what are they used for?
Efavirenz, nevirapine, etravirine, and rilpivirine
- “vir” in the middle
- used for HIV
What is the MOA, AEs, and interactions with NNRTIs?
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
What are counseling tips for NNRTIs?
- 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
What are special AEs seen with efavirenz?
CNS symptoms (vivid nightmares, stoned) and teratogenic
What drugs are INSTIs and what are they used for?
Raltegravir, elvitegravir, dolutegravir, and bictegravir
- have “tegravir” in the name
- used for HIV
What is the MOA and AEs for INSTIs?
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
What drugs are PIs and what are they used for?
Atazanavir, darunavir, ritonavir (used only as booster), nelfinavir, and indinavir
- end in “navir”
- used in HIV
What is the MOA, AEs, and interactions of PIs?
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
What are treatment regimens in HIV therapy?
- 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)
What is the MOA, indication, AEs, and DDI for maraviroc (entry inhibitor)?
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
What is the MOA, indication and AEs for enfuvirtide (entry inhibitor)?
MOA: binds to gp41 which blocks fusion and viral entry into cell
Indication: HIV
AEs: injection site rxs
Note: SQ formulation
What is the MOA, indication and AEs for ibalizumab (entry inhibitor)?
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
