Antivirals (excluding HIV)

Question 1

What treats/prevents exclusively influenza A?

Answer 1

Amantadine and rimantadine

Question 2

Mechanism of amantidine/ramantidine (tricyclic amines)

Answer 2

Interferes with uncating, orally bioavailable

Question 3

What can neuraminidase inhibitors treat? (i.e. oseltamivir, zanamivir)

Answer 3

Influenza A and B

Question 4

Mechanism of neuramindase inhibitors

Answer 4

inhibit viral neuraminidases (NO SHIT)

Question 5

Side effects of oseltamivir and zanamivir

Answer 5

oseltamivir -> nausea/vomiting

zanamivir -> bronchospasm

Question 6

What does ribavirin treat?

Answer 6

Severe RSV disease in infants; chronic HCV (with IFN)

Question 7

Adverse effects of ribavirin?

Answer 7

Anemia and bronchospasm; teratogenic and mutagenic, so make sure person on this medication doesn’t get pregnant

Question 8

Route of ribavirin?

Answer 8

Aerosol (nebulizer), oral, IV

Question 9

What does acyclovir treat?

Answer 9

Genital, perinatal, and CNS HSV; Varicella and zoster; HSV infections in immunocompromised hosts

Question 10

Mechanism of acyclovir (guanosine analog)

Answer 10

Inhibits viral TK (thymidine kinase?), DNA polymerase; DNA chain termination

Question 11

Adverse effects of acyclovir?

Answer 11

Phlebitis, ehadache, nausea, CNS TOXICITY and crystaluria

Question 12

What do famciclovir and valacyclovir treat?

Answer 12

SHINGLES!

Vala - primary genital HSV
Fam - mucocutaneous HSV infections in immunocompromised hosts

Question 13

Advantages of famciclovir and valacyclovir over acyclovir?

Answer 13

prodrug; oral bioavailability greater than acyclovir

Question 14

Adverse affect of valacyclovir (important)

Answer 14

Valacyclovir has been associated with TTP/HUS in patients with advanced HIV infection and in BMT and renal transplant recipients

Question 15

Acyclovir for normal toddlers and children under 10 yo is efficacious but often not necessary; so who should be treated for varicella?

Answer 15

• immunocompromised and possibly pregannt women
• adolescents and adults
• patients at high risk for complications

Question 16

Can you use acyclovir for CMV?

Answer 16

NOOOOO

Question 17

Drugs to treat CMV?

Answer 17

Ganciclovir, valganciclovir, cidofovir, forscanet

Question 18

Toxicities associated with ganciclovir?

Answer 18

Neutropenia; thrombocytopenia

Question 19

What can interferon alpha treat? (not used too much anymore)

Answer 19

Chronic HBV and HCV, HPV and HHV8 infections

Question 20

Adverse affects of IF-a

Answer 20

flu like symptoms; hematologic, neurologic, hepatic, and renal toxicity

Question 21

Why can’t you use lamivudine alone to treat HBV?

Answer 21

RESISTANCE

Question 22

What are the preferred initial treatment for chronic HBV infection?

Answer 22

Tenofivir and entecavir

Question 23

What genotype is the most common Hep C seen in the US?

Answer 23

Genotype 1