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Pharmacology > Chapter 37: Viral Infections > Flashcards

Chapter 37: Viral Infections Flashcards

1
Q

Maraviroc MOA

A

blocks the chemokine receptor CCR5

CCR5 is what some HIV strains use for attachment and host entry

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2
Q

What is the approved use of Maraviroc?

A

Used to tx HIV strains that use CCR5

Used in combo with other HIV drugs

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3
Q

Which drug blocks HIV attachment and entry by inhibiting gp41 mediated fusion of HIV envelope w/host plasma membrane?

A

Enfuvirtide (T-20)

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4
Q

Enfuvirtide is a peptide that must be administered ___

A

parenterally with twice daily injections

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5
Q

Which drug blocks the M2 proton channel of influenza virus A and can also be used to treat Parkinson disease? (thus blocks uncoating)

A

Amantadine

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6
Q

Which drug - amantadine or rimantadine - has fewer adverse effects? What are these adverse effects?

A

Rimantadine has less

Neuroleptic malignant syndrome; exacerbation of mental disorders

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7
Q

Which drugs are most commonly used to treat influenza A - inhibitors of viral uncoating or neuraminidase inhibitors?

A

neuraminidase inhibitors

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8
Q

Acyclovir MOA?

A

monophosphorylated by viral kinases (thmidine kinase), which leads to inhibition of DNA synthesis in virus-infected cells by inhibiting DNA polymerase

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9
Q

Drug of choice for HSV or VZV?

A

Acyclovir

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10
Q

What is the prodrug of acyclovir that has a greater oral bioavailability?

A

valacyclovir

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11
Q

How do you develop acyclovir resistance?

A

mutation in viral thymidine kinase

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12
Q

Famciclovir use?

A

HSV infections and shingles (VZV reinfection)

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13
Q

Penciclovir use?

A

Used as an ointment to treat cold sores caused by HSV

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14
Q

Which drug is used to treat CMV but can cause neutropenia, thrombocytopenia, anemia, fever, and renal toxicity?

A

Ganciclovir

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15
Q

Which drug is used to treat CMV retinitis and must be co- administered with probenecid?

A

Cidofovir

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16
Q

Cidofovir MOA?

A

Inhibits CMV DNA polymerase…

Unlike the other “clovirs” cidofovir is phosphorylated by cellular enzymes (NOT VIRAL ENZYMES!)

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17
Q

What is the major issue with cidofovir?

A

nephrotoxicity is a major adverse effect

(unbalanced) tradeoff - only needs to be administered once a week!

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18
Q

Vidarabine, idoxuridine, and trifluridine usage?

A

HSV keratitis

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19
Q

Rank ACT, ACV, and ganciclovir from most selective to least selective

A

Most - AVC –> ganciclovir –> ACT - Least

20
Q

What are the serious negative side effects of AZT (zidovudine)?

A

bone marrow suppression –> neutropenia and anemia

21
Q

What is the major cause of toxicity in zidovudine?

A

inhibition of mitochondrial DNA polymerases + phosphorylated AZT accumulates in all dividing cells in the body

22
Q

Zidovudine MOA?

A

anti HIV nucleoside analogue - phosphorylated by cellular kinases and then inhibit viral reverse transcriptase

23
Q

Which nucleoside/nucleotide analogue has less toxicity and can be used to treat HBV?

A

lamivudine

24
Q

What drug can you use to treat serious HSV or CMV infections where acyclovir or ganciclovir have failed?

A

foscarnet

25
Q

foscarnet MOA? dose limiting adverse effect?

A

mimics the pyroFOSphate product of DNA polymerization

renal impairment

26
Q

Name the four NNRTIs. What is the clinical use? Major adverse effect? Why do you need to administer with other drugs?

A

Efavirenz
Nevirapine
Delavirdine
Etravirine

HIV

Rash

Resistance develops quickly

27
Q

What is the MOA of NNRTIs?

A

bind near the catalytic site of reverse transcriptase and inhibit the enzyme

28
Q

What is the MOA of raltegravir?

A

inhibits integrase (viral enzyme that helps HIV get into cellular genome)

29
Q

What is the major risk factor of raltegravir and what is its approved use?

A

suicide risk

HIV but ONLY IN COMBO w other anti-HIV drugs

30
Q

Which drugs inhibit HIV protease?

A

-navirs

you “navir” tease a protease

31
Q

How do the HIV protease inhibitors work?

A

they prevent maturation of new viruses

32
Q

Do not administer HIV protease inhibitors with…

A

P450 substrates or to patients with severe hepatic impairment

33
Q

what is the major adverse effect of protease inhibitors?

A

dylipidemia - increased cholesterol and triglycerides

34
Q

Which protease inhibitor is combined with other protease inhibitors to reduce the # of pills that need to be taken per day?

A

ritonavir

35
Q

NNRTIs and protease inhibitors should NOT be administered together why?

A

both classes of drugs undergo hepatic metabolism

36
Q

NNRTI class toxicity?

A

liver toxicity

efavirenz
nevirapine
delavirdine
etravirine

37
Q

What are the common side effects of NRTIs? (zidovudine, stavudine, lamivudine, tenofovir…)….what is the underlying cause?

A

lactic acidosis
neutropenia
myelosuppresion
myopathy

mitochondrial DNA polymerase toxicity

38
Q

Zanamivir and Oseltamivir MOA? Clinical app?

A

inhibits influenza neuramidase

influenza A & B

39
Q

What are the differences between zanamivir and oseltamivir?

A

O - prophylaxis and tx; used to treat bird and swine flu

Z - prophylaxis only; inhaler form

40
Q

Fomivirsen (unknown MOA) clinical app?

A

CMV retinitis

41
Q

WHat drug with an unknown MOA can be used to tx RSV and in combo with interferon alpha, Hep C?

A

ribavirin

42
Q

Docosanol clinical app?

A

HSV

43
Q

Interferon alpha clinical app

A 
Hep C, hep B
kaposi sarcoma
CML
hairy cell leuk
malignant melanoma
renal cell carcinoma
44
Q

interferon alpha can cause what besides flu symptoms?

A

autoimmune disease, neutropenia, thrombocytopenia

45
Q

Imiquimod

A

tx HPV, basal cell carcinoma, and actinic keratosis

can cause skin irritation so wash hands before and after

Pharmacology (22 decks)

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