Antivirals and other Antimicrobials Flashcards by Kelsey Robinson

Class: zidovudine

Nucleoside RTI

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Side effect: zidovudine

CNS disturbances: confusion, seizures

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Class: lamivudine

Nucleoside RTI

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Side effect: lamivudine

None. Has activity against hepatitis B

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Class: emtricitabine

Nucleoside RTI

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Side effect: emtricitabine

None. Has activity against hepatitis B

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Class: didanosine

Nucleoside RTI

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Side effect: didanosine

Pancreatitis

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Class: zalcitabine

Nucleoside RTI

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Side effect: zalcitabine

Pancreatitis (uncommon), oral ulcers

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Class: stavudine

Nucleoside RTI

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Side effect: stavudine

Increased hepatic transaminases, lipoatrophy, hyperlipidemia, lactic acidosis

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Class: abacavir

Nucleoside RTI

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Side effect: abacavir

Hypersensitivity reactions in HLA-B5701 (requires screening)

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Class: tenofovir

NucleoTide RTI

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Side effect: tenofovir

Renal impairment with hypophosphotemia. Also has activity against hepatitis B.

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Nonspecific side effects of NRTI class

Peripheral neuropathy, lactic acidosis, fat redistribution (lipodystrophy)

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Class: nevirapine

NNRTI

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Side effect: nevirapine

Rash (SJS), elevated LFTs/liver failure

CYP450 inducer–induces it’s own metabolism!

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Class: delavirdine

NNRTI

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Side effect: delavirdine

Rash, elevated LFTs

CYP450 INHIBITOR–increases levels of drugs metabolized by CYP450. Inhibits it’s own metabolism!

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Class: efavirenz

NNRTI

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Side effect: efavirenz

CNS disturbances (abnormal dreams, impaired concentration, somnolence)
CYP450 inducer

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Class: etravirine

NNRTI–effective in persons with resistance to other NNRTIs

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Side effect: etravirine

Rash (mild) | CYP450 inducer

Class: rilpivirine

NNRTI--effective in persons with resistance to other NNRTIs

Side effect: rilpivirine

Depression, insomnia, headache, rash | CYP450 inducer

Problem with resistance to NNRTI's?

Resistance against one drug of this class confers resistance to the majority of them. Etravirine and rilpivirine remain effective in strains with prior NNRTI resistance.

General side effects of protease inhibitors?

Dyslipidemia, insulin resistance, lipodystrophy

Class: saquinavir

Protease inhibitor

Side effect: saquinavir

Poorly absorbed --> GI effects (diarrhea, nausea, dyspepsia, vomiting) Reformulated as fortovase which has enhanced bioavailability

Class: indinavir

Protease inhibitor

Side effect: indinavir

Kidney stones, GI upset (but absorbed well in fasting state)

Class: ritonavir

Protease inhibitor

Side effect: ritonavir

GI side effects | Potent CYP450 inhibitor (used to "boost" levels of other drugs which allows less frequent dosing)

Class: nelfinavir

Protease inhibitor

Side effect: nelfinavir

Diarrhea

Class: amprenavir/fosamprenavir

Protease inhibitor

Side effect: amprenavir/fosamprenavir

GI upset, rash, paresthesias

Class: lopinavir

Protase inhibitor. Coformulated with ritonavir as combivir.

Side effect: lopinavir/combivir

Mild GI. Well tolerated. | Used during pregnancy.

Class: atazanavir

Protease inhibitor

Side effect: atazanavir

Indirect bilirubinemia without jaundice. Less impact on lipids. Cannot be taken with PPIs.

Class: tipranavir

Protease inhibitor

Side effect: tipranavir

GI upset. Coadministered with ritonavir for boosting.

Class: darunavir

Protease inhibitor--effective in patients with resistance to other PI's

Side effect: darunavir

GI upset. Once daily dosing.

Class: enfuvirtide

Fusion inhibitor (binds p41 of envelope)

Side effect: enfuvirtide

Injection site reactions, neutropenia | "Salvage regimen"

Class: maraviroc

CCR5 inhibitor

Side effect: maraviroc

Well tolerated

Class: raltegravir

Integrase inhibitor

Side effect: raltegravir

Diarrhea, nausea, fatigue

Class: elvitegravir

Integrase inhibitor

Side effect: elvitegravir

Diarrhea, nausea, proteinuria | Administered in combination with emtricitabine, tenofovir, and cobicistat (CYP450 inhibitor), called Stribild

MOA: amantadine, rimantadine

Inhibits viral genome uncoating of influenza A only

Class: oseltamivir, zanamivir, peramivir

Neuraminidase inhibitors

Clinical use of ribavirin?

RSV in infants, Lassa fever (arenaviridae), hantavirus pulmonary syndrome, HCV (in combination with interferon)

Clinical use of interferon?

Treatment of chronic hepatitis B and hepatitis C in combination with ribavirin

MOA: boceprevir/telaprevir

Hepatitis C protease NS3-4A inhibitors. | Used in combination with interferon and ribavirin

Class: acyclovir/famciclovir/valacyclovir

Guanosine analogue, requires phosphorylation by HERPES thymidine kinase

Class: ganciclovir

Guanosine analogue, requires phosphorylation by HUMAN thymidine kinase

Class: cidofovir

Cytosine analogue, requires phosphorylation by HUMAN cellular kinases

Class: foscarnet

Pyrophosphate analogue which inhibit viral DNA polymerase/reverse transcriptase