Clinical Pharmacology of antiviral (non-HIV)

Question 1

Spectrum of activity
HSV 1/2 and VZV

Answer 1

Acyclovir, valacyclovir - drugs of choice
ganciclovir
valganciclovir
famciclovir
foscarnet

Question 2

Spectrum of activity
CMV

Answer 2

Ganciclovir, valganciclovir- (DOC(s) for CMV)
Letermovir
Foscarnet

Question 3

Spectrum of activity
EBV

Answer 3

Ganciclovir
Valganciclovir
Foscarnet

Question 4

Spectrum of activity
Influenza A

Answer 4

Zanamivir
Oseltamivir
peramivir
Baloxavir Marboxil
Amantadine (not used clinically)
Rimantidine (not used clinically)

Question 5

Spectrum of activity
Influenza B

Answer 5

Zanamivir
Oseltamivir
peramivir
Baloxavir Marboxil

Question 6

Acyclovir dosing for HSV 1/2 and VZV

Answer 6

Genital herpes
400mg Po TID x 7-10 days

Recurrent infection
800mg PO TID/BID for 2/5 days

Oral herpes:
400mg PO TID for 5-10days

HSV encephalitis:
10mg/kg IV q8h for 14-21 days - EXAM Q

Varicella (chickenpox)
800mg PO q4h for 5-7 days

Zoster (shingles)
800mg PO q4h for 7-10 days

Question 7

Valcyclovir dosing for HSV1/2 and VZV

Answer 7

Oral herpes
2g PO q12h x 1 day

genital:
primary 1g PO BID x 7-10 days
recurrent: 500mg po BID x 3 days

Varicella (chickenpox)
1g PO q8h for 5-7 days

Zoster (shingles)
1g PO q8h for 7 days

Question 8

Ganciclovir dosing in CMV
and clinical pearl

Answer 8

Commonly used for induction of CMV:
5mg/kg IV q12h for 14-21 days

Organ transplant pts:
5mg/kg IV q12h for 7-14 days then 5mg/kg IV once daily for 7 days

Can cause bone marrow supression that is rate limited - if patient experiences this we must D/C therapy - EXAM Q

Question 9

valganciclovir dosing in CMV

Answer 9

Commonly used for maintenance therapy of CMV

900mg PO daily

Prevention of CMV disease in transplant patients at high risk
900mg PO daily started 10 days prior of transplant and for 100-200 days following

Question 10

Foscarnet MOA and dosing for CMV, HSV and VZV

Answer 10

MOA: Directly inhibits DNA polymerase (not a prodrug) - EXAM Q

CMV
induction: 600mg/kg IV q8h for 14-21 days

HSV and VZV
40mg/kg IV q8h for 14-21 days

Question 11

Oseltamivir clinical pearls

Answer 11

used for patients > or equal to 2 weeks old with symptoms starting no more than 2 days ago

weight based dosing

treatment usually 5 days

Do not administer live vaccine 2 weeks prior or 48 hours after starting oseltamivir can give the inactive vaccine - EXAM Q