Antivirals, Disinfectants, Antiseptics, & Sterilants Flashcards
What is the initial preferred treatment of HIV?
- tenofovir/emtricitabine
- ADD efavirenz, atazanavir/ritonavir, raltegravir, darunavir/ritonavir
What is an adverse effect of tenofovir?
- renal insufficiency
check serum creatinine
What is tenofovir’s place in therapy?
- 1/2 of the backbone of preferred HIV tx
Besides direct HIV tx, when can tenofovir be used?
- used with emtricitabine for pre- + pos-exposure prophylaxis
(i. e. needle stick & sexual assault)
What are the ADEs of emtricitabine?
- hyperpigmentation of the palms (mimics 2ndary syphillis)
- skin discoloration
What are the ADEs of zidovudine?
- bone marrow suppression
What is a special consideration for lamivudine?
- lower dose for HBV (Hep B) tx, Epivir
What are the combination HIV products?
- emtricitabine + tenofvir (Truvada)
- e + t + efavirenz (Atripla)
- e + t + elvitegravir + cobicistat (Stribild)
- abacavir + lamivudine + dolutegravir (Trimumeq)
How are the combination HIV products dosed?
- 1 tablet PO BID
What is unique about efaviranz’s dosing?
- HS (take @ bedtime) on an empty stomach
What are the ADEs of efaviranz?
- CNS effects which subside after 2-4w
- rash
- elevated LFTs
- teratogenic
- false (+) cannabinoid test
What viral load is rilpivirine used for?
- NOT high loads (>100,000)
What is rilpivirine’s DI?
- avoid use with PPI (proton pump inhibitor); needs acidic enviornment
What are the ADEs of nevirapine?
- hepatitis, including fatal hepatic necrosis
How is ritonavir dosed?
- booster
- NEVER ALONE
What special considerations must be known with atazanavir?
- separate dosing from antacids/H2 blockers/PPIs
take 12 hrs AFTER omeprazole 20mg qd
What are the ADEs of atazanavir?
- indirect hyperbilirubinemia
- lack of effect on lipids (good! does not cause hyperlipidemia! woohoo!)
What are the special considerations of darunavir?
- caution in sulfa-allergic patients
What are the ADEs of darunavir?
- rash
What is the preferred PI?
- darunavir
What are the special considerations of lopinavir/ritonavir?
(Kaletra)
- drug of choice in pregnancy
What is the ADE of reltegravir?
- increased CK (creatine kinase)
What are the special considerations for dolutegravir?
- increased CK
When must antivirals for HSV and VZV be initiated?
- w/in 48-72h of rash onset
What does acyclovir tx?
- HSV1
- HSV2
- VZV
What are the special considerations of acyclovir?
- topical therapy limited to oral labial herpes, NOT GENITAL
- IV therapy for disseminated zoster
- manage patient expectations that there is no cure
What is valacyclovir’s MOA?
- prodrug of acyclovir
T/F: HSV and VZV treatments are virucidal.
- false, virustatic
T/F CMV treatments are virustatic.
- true
What are the treatments for CMV?
- ganciclovir
- valganciclovir
- foscarnet
- cidofovir
What is the ADE of ganciclovir?
- black box warning: bone marrow toxicity
What are the special considerations of ganciclovir?
- causes nephrotoxicity so hydrate aggressively
- monitor renal fxn, adjust accordingly
- avoid direct contact with skin
What is the drug of choice for tx and prevention of CMV retinitis?
- valganciclovir
How is valganciclovir delivered?
- PO
T/F: Valacyclovir treats CMV.
- False, valganciclovir
BE AWARE OF LOOK-ALIKE/SOUND-ALIKE NAMES
What are the ADE of foscarnet?
- HIGHLY NEPHROTOXIC!!
What are the PO antivirals for HBV?
- adefovir
- *lamivudine (also for HIV)
- *entecavir
- telbivudine
- tenofovir (also for HIV)
What is the subQ antiviral for HBV?
- interferon alfa
What are the special considerations of tenofovir when used for HBV?
- works against lamivudine and entecavir resistant isolates
- does not work against adefovir resistant isolates
- significantly higher rate of response than adevfovir
What are the ADEs of entecavir?
- dizziness
- fatigue
What are the special considerations for lamivudine (Epivir HBV)?
- resistance is common
- lower dose than for HIV
What are the ADEs of interfereon?
- flu-like sx that improve as tx continues
H/A, myalgias, arthralgias, fatigue, malaise, fever, chills
What are the CIs of interferon?
- hepatic decompensation
- autoimmune dz
- hx of arrhythmia
- pregnancy
What type of tx is the standard of care for HCV?
- combo therapy
What are the treatment options for HCV?
- sofosbuvir
- ledipasvir/sofosbuvir
- simeprevir
- ombitasvir/paritaprevir/ritonavir & dasabuvir (Viekira Pak)
- ribavirin
What is the Viekira Pak approved for treating?
- genotype 1 HCV
What is the best method of routine prevention of the flu?
- inactivated influenza vaccine
What are the antivirals for influenza?
- amantadine
- rimantadine
- oseltamivir
- zanamivir
What are the ADEs of amantadine and rimantadine?
- CNS toxicity, increased risk in eldery
rimantadine less than amantadine
What are the special considerations of amantadine?
- no longer recommended for influenza prophylaxis
- used to tx Parkinson and drug-induced EPS
What may happen with disinfectants and antiseptics?
- contaminated with spores or bacteria that transmit infection
