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pharm 2 mod 4: fungals/microbials > Antivirals (incomplete) > Flashcards

Antivirals (incomplete) Flashcards

1
Q

what are the categories of antivirals

A

Respiratory virus infection therapy
anti-herpesviruses
Anti-hepatoviruses
nucleoside analogs
NS5A and plymerase inhibitors

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2
Q

what are respiratory virus infection therapy drugs

A

Oseltamivir
Amantadine

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3
Q

what are anti-herpesviruses medication

A

acyclovir
valacyclovir
famciclovir
foscarnet

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4
Q

what are antihepatoviruse medications

A

interferons

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5
Q

what are nucleoside analogs

A

ribavirin
lamivudine
tenofovir
entecavir

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6
Q

what are NS5A and Polymerase inhibitors

A

ledipasvir
sofosbuvir

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7
Q

what are strategies for controling viral infections

A

avoiding exposure
control of vectors
immunization
other ways to activate host resistance

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8
Q

what are respitoary virus infections

A

influena A and B
SARS-CoV02 antivirals - paxlovid

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9
Q

what are hepatic viral infections

A

hepatitis B and C virus

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10
Q

what are herpes and cytomegalovirus infections

A

HSV
VZV
CMV
- all cause latent infections

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11
Q

what is Paxlovid used for

A

SARS-CoV02 - aka COVID

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12
Q

What is oseltamivir

A

neuraminidase inhibitor used for treating the flu
MOA: inhibitor or neurominadase
AKA tamiflu
used for inflenza A an dB - administered within 24048 hours of symptoms, decreases viral load and used for prophylaxis

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13
Q

what is neurominadase

A

enzyme that is essential for cleaving the virus from the host cell and allowing spread of virus from cell to cell

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14
Q

how is oseltamivir hydrolyzed

A

by the liver in its active form - active orally as a prodrug

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15
Q

what are the pharmacokinetics and ADRs of Oseltamivir

A

PO - dose adjustment in renal impairment
GI side effects: m/c N/V - recommend taking with food

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16
Q

What are influenza treatment recommendations

A

CDC recommends treating patients who are at higher risk for influenza complications:
< 2yo or > 65 yo, comorbidities or immunosuppressed, pregnant or post-partum, morbidly obese and nursing homes/other chronic-care facilities

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17
Q

what drug is currently ineffective in treating influenza because of rate of resistance

A

amantadine

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18
Q

What is Acyclovir

A

antiviral against herpres virus
MOA: guanosine analogs, inhition of transcription- activated by viral thymidine kinase (TK) - activated in infected cells so few adverse effects
acycloGTP inhibits viral DNA polymerase by chain termination

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19
Q

What is the spectrum of activity for acyclovir

A

HSV1 and 2 - not effective against latent virus
VZV - cause of chickenpox, zoster
NO activity against CMV

20
Q

Where is acyclovir metabolised

A

renal metabolism; requires dose adjustment for renal impairment

21
Q

what are the AE of acyclovir

A

generally well tolerated. more SE associated with IV admin.
mild GI symptoms (N/V)
Nephrotoxicity - IV acyclovir can crystallize the renal tubules causing renal dysfunction, minimize risk by hydration and adjusting dose based on GFR
Neurotoxicity - lethargy, confusion, delirium - IV.

22
Q

what is obstructive crystaliline nephropathy

A

crystalization in the renal tubules causing renal dysfunction - SE of IV acyclovir

23
Q

what was created to overcome poor bioavailability of acyclovir

A

valavylovir (prodrug)

24
Q

what is valacylovir

A

aka valtrex
hydrolyzed by first pass enzymes in intestine and liver - 99% converstion rate to acyclovir
5x more expensive
same spectrum of activity and ADRS - HA more common

25
Q

What is Famciclovir

A

used for herpes virus
overcomes poor bioavailability of penvivlovir
metabolized to penciclovir which requires phosphyrlation by viral thymidine kinase in infected cells to become active
it selectively inhbitis viral DNA polymerase by chain termination
same spectrum and ADRs of acyclovir

26
Q

what causes acyclovir resistance

A

mutation or loss of viral thymidine kinase (TK-) which is the first step in phosphylation of acyclovir

27
Q

What is foscarnet

A

used for herpesviruses
inorganic pyrophosphate analog
directly inhibits DNA. plymerase (does NOT require activation of viral kinase)

28
Q

what is foscarnet used for

A

treatement of immunocompromised patients with cytomegalovirus (CMV) retinitis and mucocutaneous acyclovir-resistant HSV and VZV infections
IV only

29
Q

what are the foscarnet toxicities

A

renal dose adjustment
GI effects: N/V/D
may cause ELECTROLYTE ABNORMALITIES: hypokalemia, hypocalcemia, hypomagnesemia, hypophosphatemia
Nephrotoxicity (reversible)

30
Q

what is Haptatis B

A

can be found in all body fluids and is transmitted by percutaneous or mucosal contact with infectious body fluids.

31
Q

what are high risk transmission sources for HBV

A

sex with infected parner
IVDU - sharing needles
birth to an infected mother
contact with blood or open sores of an infected person
needle stick or sharp instrument exposure
sharing items such as razors, toothbrush with infected person

32
Q

what are the three types of chronic HBV

A

latent
chronic liver disease
cirrhosis

33
Q

what is the serologic responses to acute HBV infection

A

+HBsAg and IgM anti-HBc

34
Q

what is the serologic responses to chronic HBV infection

A

+HBsAg and IgG anti-HBc

35
Q

What are interferons

A

HBV and HCV treatment
MOA: IFN alpha2b and alpha2a: host cytokines (proteins) with complex viral, immuno-modulatory and antiproliferative activites
thoughts to induce gene transcription of host cell enzymes that inhibit viral RNA; increases phargocytic activity of macrophages; increase cytotoxicity of lymphocytes for target cells

36
Q

what are the AE of interferons

A

flu-like symptoms shortly after admin (IV/SQ)
mood disorders, depression, somnolence, confusion, profound fatigue, weight loss, seizure, myelosuppression, rash, cough, myalgia, alopecia, tinnitus, reversible hearing loss, retinopathy, pneumonitis, cardiotoxicity, autoimmune reaction
discontinued in US

37
Q

What are the goals of HBV antiviral therapy

A

suppression of HBV DNA levels
seroconversion of HBeAg- positive to HBeAg-negative
loss of HBsAg detection
decrease risk of liver damage

38
Q

What is Lamivudine

A

antiviral against chronic hep B
cytosine analog works to inhibit viral DNA synthesis by inhibiting HBV DNA polymerase (also works against HIV reverse transcriptase)
HIV testing prior to treatment initiation
growing resistance

39
Q

what are the pharmacokinetics of Lamivudine

A

good Po absoprtion
dose-adjustment in renal impairement (if CrCl <50)

40
Q

what are the AE of Lamivudine

A

generally well tolerated
HA and dizziness may occur
may cause pancreatitis
-rare: lactic acidosis and severe hepatomegaoly

41
Q

what is entecavir

A

phosphorylated to guanosine triphosphate and competes as substrate for HBV DNA polymerase thereby inhbiting the enzyme
not preferreed to lamivudine -resistant strains (tenofovir preferred)
weakly active against HIV

42
Q

what is the pharmacokinetics and ADR to entecavir

A

dose- adjustment in renal impairment (if CrCl<50)
AE: may vause increase ALT levels, mild GI upset, mild hyperglycemia, HA
RARE: lactic acidosis and severe hepatomegaly

43
Q

What is the MOA of tenofovir

A

inhibit replication of HBV by inhibiting HBV DNA plymerase (also works against HIV reverse transcriptase)
HIV testing prior to treatment initiation
may be used in patients who had prior treatment of developed drug resistance - preferred if lamivudine- resistance

44
Q

what is the medication of choice for lamivudine resistance

A

tanofovir

45
Q

what are pharmacokinetics for tenofovir

A

2 formulations available: tenofovir disoproxil fumarate and tenofovir alafenamide (associated with less renal and bone toxicity)
dose adjustment in renal impairment (if CrCl<50)

46
Q

what are the AE of tenofovir

A

Gi effects
rash
hypercholesterolemia
decreased bone mineral density

47
Q

what is the box warning for HBV infection medcations

A

post-treatment exacerbation of hepatitis

pharm 2 mod 4: fungals/microbials (3 decks)

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