Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Miscellaneous > Antivirals lecture > Flashcards

Antivirals lecture Flashcards

1
Q

6 Classes of Antiretrovirals

A

Nucleoside Reverse Transcriptase Inhibitors (NRTIs)
Non-nucleoside reverse transcriptase Inhibitors (NNRTIs)
Protease Inhibitors (PIs)
Fusion Inhibitors
CCR5 Antagonist
Integrase Inhibitor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Initial Treatment for HIV

A
  • Tenofovir/emtricitabine = Dual nucleoside backbone (NRTIs)
  • Efavirenz (NNRTI)
  • Atazanavir/ritonavir OR Darunavir/ritonavir (PIs)
  • Raltegravir (Integrase Inhibitor)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Two major NRTIs

A

Emtricitabine (FTC), Tenofovir (TDF)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Major NNRTI

A

Efavirenz (EFV)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Two major PIs

A

Atazanavir (ATV) Darunavir (DRV)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Major Integrase Inhibitor

A

Raltegravir

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Tenofovir Disoproxil Fumarate

  • Category; use
  • Adverse effects
  • Special considerations
  • Other
A
  • NRTI; dual nucleoside backbone w/ emtricitabine
  • renal insufficiency (increased serum Crt; check every time you see the pt; urinalysis q1yr); lactic acidosis
  • Renal dosing; use with emtricitabine for pre-exposure prophylaxis (PrEP) & post-exposure prophylaxis (PEP)
  • Take w/o regard to food; may cause N/V diarrhea/flatulence
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Emtricitabine

  • Category;use
  • Adverse effects
A
  • NRTI; dual nucleoside backbone w/ tenofovir

- Minimal toxicity; hyperpigmentation of the palms (may mimick 2nd syphilis, dot-like); skin discoloration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Zidovudine

  • Use
  • Adverse effects
A
  • FOR USE IN PREGNANT WOMEN w/ viral loads > 400 + Lamivudine as IV infusion
  • Bone marrow suppression (macrosidic anemia)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Lamivudine

  • Use
  • Adverse effects
A
  • Used for pregnant women w/ viral loads >400 + Zidovudine; 300 mg QD
  • Epivir HBV (occasionally used for HBV tx in a much lower dose (100 mg QD)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Major 3 Combination Products

  • Generic/Brand names
  • Categories
  • Frequency
A
  • Emtricitabine +Tenofovir (Truvada) - 1 tablet PO QD
  • Emtricitabine + Tenofovir + Efavirenz (NNRTI) (Atripla) - 1 tablet PO HS
  • Emtricitabine + Tenofovir + Elvitegravir + Cobicistat (booster + integrase inhibitor) (Stribild) - 1 tablet PO QD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Efaviranz

  • Category; frequency
  • Considerations
  • Adverse effects
  • Other
A
  • NNRTI; 600 mg PO HS
  • Avoid taking w/ high-fat foods – take on empty stomach (food INCREASES the serum [drug])
  • Adverse effects: CNS effects (dizziness, drowsiness, hallucinations/ nightmares) subside w/in 2-4 wks; Rash; Elevated LFTs (MONITOR); TERATOGENIC (okay if she has been on it for a long time; ask about plans for pregnancy); False- + Cannabinoid test
  • Drug Interactions: CYP450
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Rilpivirine

  • Considerations
  • Drug Interactions
A
  • Not for use in high viral loads (>100,000)

- Drug interactions: CYP450 Inducer; AVOID USE WITH PPIs!! (needs acidic environment to be absorbed)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Nevirapine

  • Use
  • Adverse Effects
  • Other
A
  • RTI for Pregnancy
  • Increased LFTs; hepatitis, including fatal hepatic necrosis: higher frequency in women with CD4 >250 (men CD4 > 400) AVOID INITIATION for people with PRESERVED immune systems (may be initiated w/ increased viral load)
  • CYP450 Inducer; counsel pt about mild-moderate rash vs anaphylaxis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Protease Inhibitors: major class issues

  • Drug Interactions
  • Metabolic syndrome
  • Other
A
  • Drug interactions: important to use same pharmacy for all prescriptions
  • Metabolic syndrome: insulin resistance/ hyperglycemia; increased cholesterol & TGs, lipodystrophy/ fat redistribution
  • Hepatotoxicity, osteopoenia/porosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Ritonavir

  • Use
  • Considerations
  • Adverse effects
A
  • Used as a pharmacokinetic BOOSTER with other PIs (works on CYP450 in increase [drug])
  • Refrigerate capsules but NOT PO sol’n
  • Adverse effects: G.I upset, tingling
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Atazanavir

  • Use
  • Special considerations
  • Adverse effects
A
  • If used with Atripla, add ritonavir
  • Separate dosing from antacids, H2blockers – PPIs: Omeprazole OTC may be used if 12 hours AFTER Atazanavir (only PRN)
  • Indirect hyperbiliruminemia (check TBili; most effect may be on sclera: jaundice (rarely systemic)); no effect of lipids (ok for high cholesterol)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Darunavir

  • Special considerations
  • Adverse effects
A

-Must take with ritonavir at the same time; CAUTION in sulfa-allergic pts
-Rash (low %)
Hepatotoxicity: primarily with HBV/HCV or with advanced HIV & multiple meds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Lupinavir/ ritonavir

  • Use
  • Other
A

Major drug of choice in pregnancy (with DNRTIS)

-Effects: G.I. upset, tingling, asthenia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Raltegravir

  • Use
  • Category
  • Adverse effects
A
  • Good for people who can’t tolerate NNRTIs or PIs
  • Integrase Inhibitor
  • Increased Creatine Kinase (CPK) MONITOR; HA, nausea, diarrhea
21
Q

Stribild

  • Category
  • Considerations
A
  • Integrase Inhbitor, combo product
  • Elvitegravir is only available in this combo product “Quad Pill”
  • Elevates in serum Creatinine; increased Creatine Kinase
  • Most expensive on the market
22
Q

Considerations with initial treatment

A
  • Results from resistance testing (genotype of virus); “baseline resistance”
  • Dosing convenience/ adherence issues (best opportunity for adherence from the start; missing 1 dose/month can lead to resistance!)
  • Adverse effects & how they relate to pt’s life
  • Drug interactions
  • Pregnancy potential/ CD4 count
  • Comorbidities (i.e. diabetes)
23
Q

HSV and VZV antivirals

  • Action
  • Initiation of tx
  • Duration
  • Examples
A
  • Both DNA viruses; tx is virustatic: stop synthesis by inhibiting viral DNA polymerase
  • MUST BE INITIATED W/IN 48-72 HRS OF RASH ONSET to achieve benefit
  • Duration depends on indication i.e. genital vs oral
  • Aciclovir, Valacyclovir, Famciclovir
24
Q

Acyclovir

  • Uses
  • Dosing
  • Special considerations
A

-Inhibits viral replication; active against HSV-1 AND HSV-2 as well as VZV: initial & recurrent episodes; prophylaxis
-PO, topical, IV
-Role of topicals: oral herpes ONLY
Role of IV: disseminated zoster; systemic ophthalmicus, encephalitis/ meningitis; multiple outbreaks/yr
Patient expectations: NOT curative

25
Q

Valacyclovir

-Dosing, use

A
  • Less frequent dosing than acyclovir w/ higher [plasma]

- Acute infections, suppression of recurrent episodes, reduction of transmission

26
Q

Topicals

  • Examples
  • Indications, dosing,
A
  • Penciclovir: oral herpes; Q2hours while awake x 4 days
  • Docosanol: oral herpes; p.i.d until healed
  • Trifluridine: ophthalmic solution
27
Q

Cytomegalovirus

  • Typical pts
  • Complications
  • Treatment MOA
A
  • Typically result from reactivation in immunocompromised pts (HIV, transplant)
  • Dissemination results in end-organ dz (fatal): retinitis, colitis, esophagitis, CNS dz, pneumonitis
  • Tx is virustatic: non-curative; stop DNA synthesis:ganciclovir, valganciclovir, foscarnet, cidofovir
  • More toxic regiments than for HSV, VZV
28
Q

Ganciclovir

  • Action
  • Dosing
  • Adverse effects
  • Considerations
A
  • Inhibits viral DNA polymerase, stops viral replication
  • Active against HSV, VZV, EBV but TOO TOXIC
  • Dosed according to tx vs prophylaxis; induction vs. maintenance; valganciclovir is favored
  • BLACK BOX WARNING: BONE MARROW TOXICITY (suppresses every cell line); TERATOGENIC
  • Hydrate aggressively; monitor renal function, adjust accordingly
29
Q

Valganciclovir

  • Use
  • Special considerations
A
  • DRUG OF CHOICE FOR TX of CMV retinitis and PROPHYLAXIS for transplants pts
  • PO formulation ONLY; NOT TO BE CONFUSED WITH Valacyclovir (ineffective against CMV)
30
Q

Foscarnet

  • Use
  • Dosing
  • Adverse effects
A
  • Covers HSV, VZV (acyclovir-resistant); CMV (2nd line)
  • For CMV retinitis, IV only (over 1.5-2 hrs)
  • HIGHLY NEPHROTOXIC: acute tubular necrosis; aggressive hydration, monitor BUN & SCr esp w/ other nephrotoxic meds
31
Q

Hepatitis B Virus

  • Patients
  • Chronic infection tx goals
  • Agents utilized: PO, SubQ
A
  • Non-vaccinated, foreign-born, etc.
  • Suppress viral replication (non-curative); slow progression of dz (many will get hepatocellular carcinoma); reduce need for transplant
  • HBeAg is indicative of active replication
  • Agents used for life otherwise rebound viral load; adults have less of a chance of going on to chronic infection
  • PO: Adefovir, lamivudine, entecavir, telbivudine, TENOFOVIR
  • SubQ: interferon alpha (usually too toxic)
32
Q

Tenofovir for HBV

-Uses

A
  • Used for lamivudine- and entecavir-resistance; good to start with if baseline resistance
  • Higher rate of response than adefovir: less likely to develop resistance, fewer ADEs
33
Q

Entecavir

  • Use
  • Adverse effects
  • Special considerations
A
  • Lamivudine-resistant HBV

- BLACK BOX: severe exacerbation of hepatitis upon discontinuation; Dizziness, fatigue

34
Q

Lamivudine for HBV

  • Dosing
  • Special considerations
A
  • Epivir HBV dosage form: 100 mg PO QD (vs. HIV)

- Rapid & potent HBV suppression: BUT resistance is common (70% at 5 yrs of tx) so not used as commonly

35
Q

Hepatitis C Virus

  • Goals of therapy
  • Chance of achieving SVR
  • Selection of candidates for tx
  • Standard of care
A
  • Eradicate the virus (CURABLE);
  • Achieve sustained virologic response (SVR): undetectable viral load for 6 months after completion of therapy (1,3,6 mo testing)
  • Improve liver histology (may not catch virus until liver damage occurs) & reduce risk of hepatocellular carcinoma

-HCV genotype; pt characteristics (women, Caucasians)

-Can still treat if pt has cirrhosis; would only withhold tx if fulminant/ uncompensated liver failure
Labwork & counseling: genotype, renal fxn, pt interviewing

-Combination therapy

36
Q

Interferons (Intro)

  • MOA
  • Dosing
A
  • Antiviral, immunomodulatory, antiproliferative

- Permits Qweekly dosing, injected SubQ

37
Q

Interferons for HCV

  • Adverse effects
  • Special considerations
  • Caution
A
  • Flu-like sxs w/in 8 hrs of injection: HA, myalgias/arthralgias, fatigue/malaise, fever/chills; improves as tx continues
  • Unmasking of autoimmune dz
  • CONTRAINDICATIONS: Hepatic decompensation (i.e. on a transplant list); autoimmune dz; h/o arrhythmias; pregnancy (usually d/t combination drugs)
  • Caution for pscyh dzs, thyroid dz, severe renal insufficiency, bone marrow suppresion
38
Q

Ribaviran

  • Adverse effects
  • Special considerations
A

-Hemolytic anemia (monitor CBC q4wks) can worsen fatigue; usually test viral load then too
TERATOGENIC (CAN LEAK THROUGH SKIN; pregnancy test; men shouldn’t conceive for at least 6 mo)
-Never used as monotherapy

39
Q

Sofosbuvir

  • Uses
  • Considerations
A

-Genotype 1 can use with interferon & Ribavirin x 12 wks
Genotypes 2,3 can use alone with Ribavirin x 24 wks
-Pan-genotypic activity –> 90% SVR
-$1000/tablet (ask if they’re ready to start tx before initiating)
-Makes it possible to treat some pts w/o interferon!

40
Q

Simeprevir

  • Uses
  • Dosing
  • Special considerations
A

-Genotype 1 only
-Dosed WITH FOOD
-TEST FOR Q80K MUTATION!!! otherwise drug won’t work
Drug interactions: CYP450

41
Q

Influenza Virus

  • Types
  • Significance of Influenza A
  • Complications
A

-Influenza A & B
-A has 2 surface antigens: hemagglutinin & neuraminidase in which the vaccines are formed around;
can combine with other type A strains (reassortment)
-Viral pna/ 2nd bacterial pna, sinusitis, OM
-Exacerbates other conditions esp pulm/cardiac
-May be fatal

42
Q

Antiviral Therapy

-H1N1

A

-Treat if hospitalized for suspected/confirmed flu OR if evidence of serious dz
-Treat if high risk group w/in 48 hours
Children < 2 y.o; Adults >65 y.o
Pregnant women –> 2 wks postpartum
Chronic medical/ immunosuppressive DOs; long-term ASA therapy

43
Q

Antiviral prophylaxis for Influenza

A

Persons w/ higher risk for complications & have had significant contact w/ flu

  • Early tx after a suspected exposure: if clinical sxs develop
  • Best method of routine prevention: INACTIVATED INFLUENZA VACCINE – everyone >6 mo
44
Q

Amantadine

  • Uses
  • Adverse effects
  • Special considerations
A
  • Against influenza A only; rapid resistance development
  • CNS toxicity (increased risk in elderly) d/t alteration of Dopa transmission
  • No longer recommended for prophylaxis; teratogenic; used to tx Parkinson’s & drug-induced EPs; dose adjustment for renal insufficiency, elderly
45
Q

Rimantadine

  • Uses
  • Adverse effects
  • Considerations
A
  • Only active against influenza A
  • As with amantadine but LESS CNS EFFECTS
  • Dose adjust in hepatic insufficiency too
46
Q

Oseltamivir

  • Uses
  • Adverse effects
  • Considerations
A
  • Active against both A & B; management of H1N1
  • Must start w/in 48 hrs of symptoms to decrease duration; can be used as prophylaxis
  • CNS effects
  • For >1 y.o
47
Q

Zanamivir

  • Dosing
  • Special considerations
A

-Diskhaler device for tx & prevention
-AVOID IN PTS WITH ASTHMA/ COPD
-Puncture disk only when ready to use – counsel!!
NOT SOLUBLE WITH NEBULIZER

48
Q

Disinfectant vs. antiseptics vs. sterilants

A
  • Disinfectants: inhibit or kill microorganisms but NOT spores – for inanimate surfaces
  • Antiseptics: can be applied to skin, mucus membranes, wounds d/t low toxicity – to prevent infection
  • Disinfectants AND antiseptics may become contaminated with spores/bacteria & transmit infection!!
  • Sterilants: kill both cells AND spores when applied for certain duration of time/ temp

Miscellaneous (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions