Antivirals for non-HIV

Question 1

Biosynthesis of a toxin from a non-toxic precursor
Common in nucleoside analogues that must phosphorylated to incorporate into viral DNA

Answer 1

Lethal synthesis

Question 2

MOA of acyclovir and valacyclovir

Answer 2

Inhibit viral DNA synthesis through lethal synthesis
Drugs are monophosphates; host enzymes convert them to inhibitive triphosphates that terminate viral DNA synthesis

Question 3

Acyclovir and valacyclovir lethal synthesis requires these 2 types of enzymes

Answer 3

Viral nucleoside kinase expression to phosphorylate drug (monophosphate)
Host enzymes to convert monophosphate to triphosphate form

Question 4

Valacyclovir is converted to this in a first pass hydrolysis reaction

Answer 4

Acyclovir

Question 5

This is converted to acyclovir in a first pass hydrolysis reaction

Answer 5

Valacyclovir

Question 6

2 indications for acyclovir and valacyclovir

Answer 6

Herpes infections
Cytomegalovirus infections

Question 7

3 main adverse effects of acyclovir and valacyclovir

Answer 7

Reversible renal dysfunction (crystallization of drug in renal tubule and collecting duct)
Neurological and renal toxicity with high dose or IV infusion
Thrombocytopenia purpura-hemolytic uremic syndrome (potentially fatal; most frequent in immunocompromised patients)

Question 8

Reversible renal dysfunction, neurological and renal toxicity with high dose or IV infusion, and thrombocytopenia purpura-hemolytic uremic syndrome are adverse effects of these drugs

Answer 8

Acyclovir and valacyclovir

Question 9

Thrombocytopenic purpura-hemolytic uremic syndrome is a potentially fatal adverse effect of these drugs
Is most frequent in immunocompromised patients

Answer 9

Acyclovir and valacyclovir

Question 10

MOA of cidofovir

Answer 10

Lethal synthesis to activated cidofovir diphosphate (requires only host enzymes)
Cidofovir diphosphate incorporated into DNA slows or stops DNA pol activity

Question 11

Drug that given concurrently reduces cidofovir toxicity

Answer 11

Probenecid
Blocks anion transporter on renal tubular epithelial cells that mediates cidofovir uptake

Question 12

Probenecid given concurrently reduces the toxicity of this drug

Answer 12

Cidofovir

Question 13

Black box warning of Cidofovir

Answer 13

Nephrotoxicity

Question 14

MOA of Foscarnet

Answer 14

Competitive inhibitor of viral DNA polymerase
NO lethal synthesis required

Question 15

2 adverse effects (black box warnings) of Foscarnet

Answer 15

Renal toxicity
CNS disturbances (including seizures)

Question 16

Drug with renal toxicity as an adverse effect; should avoid concurrent use with other nephrotoxic drugs
Electrolyte disturbances in acute overdosage

Answer 16

Foscarnet

Question 17

With foscarnet, concurrent use with these should be avoided

Answer 17

Other nephrotoxic drugs

Question 18

These can occur in acute overdosage of foscarnet

Answer 18

Electrolyte disturbances

Question 19

3 adverse effects of Ganciclovir and Valganciclovir

Answer 19

Acyclovir-like adverse reactions (renal dysfunction, neurological toxicity, thrombocytopenic purpura-hemolytic uremic syndrome)
Bone marrow suppression
Teratogenic, mutagenic, and oncogenic potential

Question 20

4 black box warnings of Ganciclovir and Valganciclovir

Answer 20

Hematological toxicities
Carcinogenic and teratogenic activity
Aspermatogenesis
Appropriate oral and IV use only (ganciclovir only)

Question 21

Hematological toxicities, Carcinogenic and teratogenic activity, Aspermatogenesis, and Appropriate oral and IV use only are black box warnings for these

Answer 21

Ganciclovir and Valganciclovir

Question 22

Bone marrow suppression and teratogenic, mutagenic, and oncogenic potential are characteristic adverse effects of these

Answer 22

Ganciclovir and Valganciclovir

Question 23

Aspermatogenesis is one of the black box warnings for these drugs

Answer 23

Ganciclovir and Valganciclovir

Question 24

Acyclovir, Cidofovir, Foscarnet, Ganciclovir, Penciclovir, Famciclovir, and Trifluridine are drugs used for these infections

Answer 24

Herpes and cytomegaloinfections (DNA viruses)

Question 25

Zanamivir, Oseltamivir, Amantadine, Rimantadine and Ribavirin are drugs used for these infections

Answer 25

Respiratory viral infections (RNA viruses)

Question 26

MOA of Zanamivir and Oseltamivir

Answer 26

Inhibit influenza A and B virus neuraminidase

Question 27

What is the function of viral neuraminidase?

Answer 27

Allows the virus to break free from the host cell to infect other cells

Question 28

Does this describe Zanamivir or Peramivir: Administered by inhalation or by nasal spray Adverse effects similar to the symptoms of influenza For patients >7 years Can be used for prophylaxis

Answer 28

Zanamivir

Question 29

Does this describe Zanamivir or Peramivir: Administered IV, single dose over 15-30 minutes For patients >2 years Data for influenza B is limited Not for prophylaxis

Answer 29

Peramivir

Question 30

Oseltamivir (Tamiflu) is a prodrug that is activated by these

Answer 30

Esterases in GI tract or liver

Question 31

Oral prodrug for RNA viruses that is activated by esterases in GI tract of liver

Answer 31

Oseltamivir (Tamiflu)

Question 32

Drug with low incidence of self-injury, hallucinations and delirium reports, especially in children Is under consideration for black box warning by FDA

Answer 32

Oseltamivir (Tamiflu)

Question 33

Oseltamivir (Tamiflu) is under consideration for black box warning by FDA for these side effects

Answer 33

Low incidence of self-injury, hallucinations and delirium reports, especially in children

Question 34

MOA of Ribavirin

Answer 34

Converted to monophosphate, diphosphate, and triphosphate forms Monophosphate form inhibits guanosine triphosphate synthesis to block viral mRNA processing and influenza virus RNA pol

Question 35

2 routes of administration of Ribavirin

Answer 35

Oral or IV

Question 36

Drug for RNA viruses whose monophosphate form inhibits guanosine triphosphate synthesis to block viral mRNA processing and influenza virus RNA pol

Answer 36

Ribavirin

Question 37

Hemolytic anemia risk in Ribavirin is increased when used with this

Answer 37

Interferon alfa

Question 38

Ribavirin is contraindicated in these two groups

Answer 38

In pregnant women and male partners of pregnant women (due to mutagenic, teratogenic, and embryotoxic) In patients with sickle cell anemia (high risk of anemia)

Question 39

Dose dependent hemolytic anemia and mutagenic, teratogenic, and embryotoxic describes this drug for RNA viruses

Answer 39

Ribavirin

Question 40

3 black box warnings of Ribavirin

Answer 40

Not recommended for monotherapy Hemolytic anemia Teratogenic and embryocidal (contraindicated in pregnant women, women who might be pregnant, and their male partners; two forms of birth control recommended for up to 6 months following treatment)

Question 41

Hemolytic anemia is a characteristic adverse effect of this drug

Answer 41

Ribavirin

Question 42

Interferon alfa + Ribavirin is used for these infections

Answer 42

Hep C viral infections

Question 43

3 drugs that make the combo drug Vosevi

Answer 43

Sofosbuvir Velpatasvir Voxilaprevir

Question 44

Component of the combo drug Vosevi that Prevents Hep C viral replication by inhibiting NS5B RNA polymerase

Answer 44

Sofosbuvir

Question 45

Sofosbuvir prevents Hep C viral replication by doing this

Answer 45

Inhibiting NS5B RNA polymerase

Question 46

Component of the combo drug Vosevi that Prevents Hep C viral replication by inhibiting NS5A protein essential for viral function

Answer 46

Velpatasvir

Question 47

Component of the combo drug Vosevi that Prevents Hep C viral replication by blocking proteolytic activity of NS3/4A protease, needed for posttranslational processing of viral component proteins

Answer 47

Voxilaprevir

Question 48

Velpatasvir prevents Hep C viral replication by doing this

Answer 48

Inhibiting NS5A protein essential for viral function

Question 49

Voxilaprevir prevents Hep C viral replication by doing this

Answer 49

Blocking proteolytic activity of NS3/4A protease, needed for posttranslational processing of viral component proteins

Question 50

Common adverse effects of Hep C drugs

Answer 50

Headache, fatigue, nausea, and diarrhea

Question 51

Drug where hypertension is a typical sign of emerging nephrotoxicity and should be carefully monitored

Answer 51

Foscarnet