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Fall Pharm Block 4 > Antivirals Part II > Flashcards

Antivirals Part II Flashcards

1
Q

What are the routes by which the various types of hepatitis are transmitted?

A

A: fecal-oral route
B: blood and bodily fluids - STI
C: primarily blood-bourne - can be STI but uncommon

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2
Q

What is the treatment for hepatitis A?

A

A: no treatment - infection is self-limiting

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3
Q

Describe the vaccine courses for hepatitis.

A

A: 2 injections - 0 and 6 months
B: 3 injections - 0, 1, and 6 months
C: no vaccine

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4
Q

Describe the current (2nd generation) treatment of Hepatitis C and how it is determined who gets treatment.

A

Hepatitis C can be eradicated, but the treatment is very expensive (6 figures) and the patient can be reinfected. Patient must mitigate IV drug use or other risk factors before treatment will be approved.

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5
Q

What are the first generation treatments for hepatitis C and B and what is the mechanism of each?

A

Interferons:
Ribavirin: inhibits several key steps in viral replication

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6
Q

How are the first generation treatments for Hep B/C administered?

A

Ribavirin: PO
Interferons: Injection - qd or q week

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7
Q

What are the AEs of the first generation treatments for Hep B/C?

A

Ribavirin: anemia –> nausea, lethargy, headache. Teratogenicity –> contraception up to 6 months post treatment
Interferon: flu symptoms and severe depression with SI –> prescribe SSRI with interferons.

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8
Q

Describe pegylation of IV drugs.

A

A way of making IV drugs sustained release. The q week injection of interferon is pegylated.

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9
Q

How long must a patient be on an SSRI before you can start administering interferon?

A

Give SSRI for 3 - 6 weeks before starting interferon

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10
Q

List four drugs used to treat HIV that can also be used to treat Hep B and list an important fact about each.

A 
Lamivudine: bid dosing
Emtricitabine: qd dosing - same drug as lamivudine
Tenofavir Dispoxil (TDF): original tenofavir formulation
Tenofavir Alfenamide (TAF): newer version of TDF that has fewer AEs and is given at a lower dose
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11
Q

Describe the cross reactivity between the treatments of HIV, Hep B, and Hep C.

A

Four HIV drugs also cover Hep B
No HIV drugs also cover Hep C
No Hep B/C drugs also cover HIV (interferon/ribavirin)

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12
Q

T/F: first generation Hep C treatments eradicate the disease.

A

False: ribavirin and interferon only control the disease.

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13
Q

What are the second generation drugs used in combination to eradicate Hep C and what is the mechanism of each?

A
  • –previr: protease inhibitor - protease is the enzyme that cleaves viral proteins and activates them
  • –asvir: NS5A inhibitor - interferes with the reassembly of the virus.
  • –buvir: NS5B inhibitor - interfere with building of viral proteins
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14
Q

By what route are the second generation Hep C treatments administered?

A

All given PO

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15
Q

In relation to influenza, differentiate between antigenic drift and antigenic shift.

A

Drift: change in virus every year which is why we re-vaccinate every year.
Shift: significant viral change that can cause a pandemic.

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16
Q

What are the two types of flu-vaccine in the US?

A

Trivalent: 3 flu starins (2 As and 1 B)
Quadravalent: 4 flu strains (2 As and 2 Bs) - give to kids

17
Q

Differentiate flu A from flu B.

A

flu A usually affects adults

flu B mostly affects children.

18
Q

What was the first drug used for flu and what is its mechanism?

A

Amantidine - DA agonist used in Parkinson’s that also has anti-viral properties.

19
Q

What are two problems with amantidine in treatment of flu?

A
  1. Only covers flu A

2. High levels of resistance develop quickly

20
Q

What is the primary AE of amantidine?

A

CNS psych disturbances - hallucinations & delusions

21
Q

Describe rimantidine.

A

Hydrophilic analog of amantidine used to eliminate CNS side effects.

22
Q

Describe the mechanism of neuraminidase inhibitors.

A

Neuraminidase is the enzyme that cleaves viral particles and releases them so they can replicate.

23
Q

T/F: rimantidine and amantidine are strong neuraminidase inhibitors?

A

False: they are weak neuraminidase inhibitors

24
Q

Describe the efficacy of pure neuraminidase inhibitors used in the treatment of flu compared to amantidine.

A

More potent
Less resistance
Effective against both flu A and flu B

25
Q

Name the three neuraminidase inhibitors and state the route by which each is administered.

A

Zanamivir: inhaler - never used bc it is contraindicated in asthma
Oseltamivir: PO
Peramivir: Parenteral (injection)

26
Q

In what time frame are neuraminidase inhibitors and baloxavir used?

A

Must be used within 48 hours of symptom onset.

27
Q

Describe the mechanism of action of baloxavir.

A

Capsnatch inhibitor that prevents viral DNA chain capping which makes the virus unstable.

28
Q

Describe the dosing of baloxavir and the neuraminidase inhibitors.

A

boloxavir: single dose

neuraminidase inhibitors: dosed for 5 days

29
Q

What are two cons of baloxavir?

A
  1. Must avoid chelating agents (Mg, Fe, Zn, milk, etc.)

2. Expensive

30
Q

Describe the three treatments for Covid-19.

A

Remdesavir: An RNA polymerase inhibitor
Antibody Therapy: synthesized in lab for Covid-19
Dexamethasone: steroid used to treat inflammatory storm associated with Covid-19

31
Q

How is remdesavir administered?

A

PO for 5 days in hospitalized patients with Covid-19 that require oxygen. It is the only PO drug approved for use in Covid-19

32
Q

Differentiate between the Moderna and Pfizer vaccines for Covid-19.

A

Moderna: A killed vaccine that mimics the external spikes on caronavirus.
Pfizer: mRNA injected into patient. The mRNA gets into cytoplasm and encodes for the caronavirus spike protein causing antibody production against the spike.

33
Q

What is the logistical problem with distributing the Pfizer vaccine?

A

It is unstable - it must be stored at -70 degrees F.

34
Q

List the viruses for which there are a vaccine.

A 
MMR: measles, mumps, and rubella
Varicella: chicken pox
Shingles: zostavax (not hot) and shingrix (hot)
Polio: IPV is inactivated polio vaccine
Influenza
Hep A and B
Rabies

Fall Pharm Block 4 (4 decks)

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