Clinical Use of Antivirals (non-HIV) Flashcards
1
Q
Herpes simplex virus
A
-double stranded virus
-active/lytic or latent
-uncurable but manageable
2
Q
HSV1 acts in
A
oral mucosa
3
Q
HSV2 acts in
A
genital mucosa
4
Q
HSV1 presentation
A
-blisters or ulcers around mouth (cold sore) or in mouth
5
Q
HSV1 transmission
A
via infected oral secretions
6
Q
HSV1 first episode
A
-fever
-body aches
-sore throat
-headache
-swollen lymph nodes
-most severe
7
Q
HSV1 recurrence
A
-prodrome -> sign its coming
-less severe
8
Q
HSV1 establishes chronic infection in the
A
sensory ganglia
9
Q
HSV1 diagnosis
A
-mainly presentation
-swab and pcr
10
Q
HSV2 clincal presentation
A
-bumps, blisters, or ulcers around genitals or anus
11
Q
HSV2 is transferred via
A
infected secretions
12
Q
HSV2 recurrence
A
-prodrome
-shorter and less severe than initial outbreak
13
Q
HSV2 establishes chronic infection in the
A
sacral ganglia
14
Q
HSV2 diagnosis
A
swab and pcr
15
Q
HSV encephalitis is caused mostly by
A
-HSV1 (90%)
-can be by HSV2
16
Q
HSV encephalitis symptoms
A
- fever
- confusion
- abnormal behavior/ personality changes
- HA
- seizures
- focal neurological deficits
17
Q
HSV encephalitis acts in
A
the CNS
18
Q
HSV encephalitus diagnosis
A
-changes on imaging
-lumbar puncture and PCR testing for virus
19
Q
T/F:
Acyclovir is a prodrug
A
true
20
Q
Acyclovir is activated by
A
triphosphoylation
21
Q
Acyclavir MOA
A
- completely inhibits viral DNA polymerase to inhibit viral replication
- incorporated into viral DNA causing premature chain termination
22
Q
Acyclovir is eliminated
A
-renally
-> dose adjustments
-> removed by hemodialysis
23
Q
Acyclovir in obesity
A
adjusted body weigh
24
Q
Acyclovir AEs
A
-n/v/d
-rash
-Headache (oral)
-Nephrotoxicity* (IV)
-neurotoxicity (reversible)
-thrombophlebitis (IV)
25
Acyclovir Uses
-genital HSV
-oral HSv
-HSV ENCEPHALITIS
26
Drug of choice for encephalitis
acyclovir
27
Acyclovir Dosing
genital hsv
primary infection
- 400mg po tid for 7-10days
-200mg q 4h for 7-10 days (non-adherence)
28
Acyclovir Dosing
genital HSV
recurrent infection
-800mg tid x 2 days
-800mg bid x 5 days
-start w/ prodrome or w/in 1 day
29
Acyclovir Dosing
Suppresion
-400mg tid for 5-10 days
->10/yr
30
Acyclovir Dosing
oral HSV
-400mg tid for 5-10days
31
Acyclovir Dosing
HSV encephalitis
-10mg/kg iv q8h for 14-21 days (adjusted body weight)
32
T/F:
Valacyclovir is a prodrug
true
33
Valacyclovir is a prodrug of
acyclovir
34
Valacyclovir is absorbed and completely converted to acyclovir by
intestinal and hepatic metabolism
35
Valacyclovir is eliminated
renally
-dose adjust
-removed by dialysis
36
Valacyclovir dosing
oral herpes
-2g q12h for 1 day
37
Valacyclovir dosing
genital herpes
primary
- 1g po bid x 7-10days
38
Valacyclovir dosing
genital herpes
recurrent
-500mg bid x 3 days
-1g qd x 5 days
39
Drug of choice for recurrent HSV
valacyclovir
40
Valscyclovir dose
supression
-500-1000mg qd (1g if >10/yr)
500mg bid in HIV
41
famaciclovir is a prodrug of
penciclpvir
42
famaciclovir is eliminated by
the kidneys
-decrease dose in renal dysfunction
43
Famaciclovir drug interaction
probenecid
-decreases renal clearance
-increased serum concentration
44
Famciclovir AEs
-well tolerated
-HA
-N/V/D
-acute renal dysfunction
45
famciclovir dosing
oral HSV
1.5g single dose
46
Famciclovir dosing
genital HSV
primary
250mg po tid x 7-10 days
47
Famciclovir dosing
geniral HSV
recurret
-125mg po bid x 5 days
-1g po bid x 1 day
- 500mg x 1 day, the 250mg bid x 2 days
48
Famciclovir dosing
genital hsv
- 250mg bid
49
Varicella Zooster Virus (VZV)
-dna virus
-causes chickenpox and shingles
50
VZV stays in the body by becoming
dormant in the sensory nerve ganglia as a latent infection
51
VZV is reactivated by
stress or decreasing immune function
52
Reactivation of VZV is
shingles
53
VZV is transmitted
-by direct contact or inhalation
-highly contagious
-contagious until lesions have crusted
54
Acyclovir dosing
VZV
800mg q4h for 5-7days
55
Acyclovir dosing
Severe disease or VZV encephalitis
10mg/kg iv q8h for 14-21 days
56
Valacyclovir dosing
VZV
chickenpox -> varicella
1g q8h for 5-7 days and until lesions have crusted
57
Valacyclovir dosing
VZV
shingles -> zooster
1g q8h for 7 days
58
Disseminated zoster
-initial -> acyclovir
-tx for 10-14 days
- transition to valacyclovir once improved
59
Famciclovir Dosing
Zoster -> shingles
500mg tid for 7 days
60
Cytomegalovirus (CMV)
-opportunistic infection
-commonly in eyes and can cause end organ damage
61
Ganciclovir MOA
HSV/VZV
-prodrug turned into active form by viral thymidine kinase
62
Ganciclovir MOA
CMV
prodrug converted to active form mono-phosphorylated by a CMS-encoded protein kinase (UL97) then to di- and triphosphate forms by cellular kinases
triphosphorylation
63
Ganciclovir MOA
-inhibits viral DNA polymerase and/or incorporation into viral DNA which inhibits viral replication
64
Ganciclovir Resistance
UL97 gene
65
Ganciclovir has adequate concentrations in
CNS, brain tissue, and eye
66
Ganciclovir is eliminated by
-glomerular filtration and tubular secretion
-renal dose adjustment
67
Ganciclovir pk
low oral bioavailability
take w/ food
68
Ganciclovir drug interactions
Cytotoxic drugs w/ BM suppression
probenecid
69
Ganciclovir AEs
-bone marrow suppression
-phlebitis (IV)
-HA, confusion, psychosis
-rash
-fever
-n/v
70
Ganciclovir Dosing
CMV retinits
induction:
-5mg/kg IV q12h for 14-21 days
maintenance:
-not drug of choice
-5mg/kg iv q24h
-6mg/kg iv qd x 5days
-100mg po tid w/ food
intravitreal implants or injections
71
Ganciclovir Dosing
CMV esophagitis, colitis, pneumonitis, neurologic disease
5mg/kg iv q12h for 14-21 days
72
Ganciclovir Dosing
Prevention and treatment of CMV in bone marrow and organ transplant recipients
5mg/kg iv q12h for 7-14 days, then 5mg/kg qd 7days/week or 6mg/kg qd for 6days/week
73
Valganciclovir is a prodrug of
ganciclovir
74
Valganciclovir is rapidly converted by
intestinal and hepatic esterases
75
Valganciclovir should/ shouldnt be taken with food
SHOULD
76
Valganciclovir is eliminated
renally
-dose adjust
-HD removes
77
Valganciclovir dosing
CMV retinitis
induction
-900mg bid x 21 days
maintenace
-900mg po qd
78
Valganciclovir
prevention of CMV in high risk patients
900mg po qd
-start w/in 10 days of transplant
-continue 100-200 days
79
Letermovir MOA
-inhibits pUL56 subunit of the viral terminase complex of CMV
-inhibition of CMV replication and prevention of CMV infection
80
Letermovir
-94% bioavailability
-t1/2: 12h
81
letermorvir dose adjustment
if crcl < 10ml/min
82
Letermovir AEs
-n/v/d
-Perpheral edema
-cough
-HA
-fatigue
-abdominal pain
83
Letermovir use
Prophylaxis of CMV infection (not preferred)
84
Letermovir dose
480mg qd
-280 if administered with cyclosporin
85
Letermovir Drug Interaction
-CYP3A4 inhibitor
- substrate and inhibito of OATP1B1/3
86
Foscarnet MOA
directly inhibits viral DNA polymerase
-not a prodrug
87
Foscarnet place in therapy
last line in drug resistant HSV, VZV, and CMV
88
Foscarnet is only available
IV
89
Foscarnet drug interactions
nephrotoxic drugs; pentamidine
90
Foscarnet is excreted in the
kidneys
-dose adjust for renal dysfunction
-removed by hemodialysis
91
Foscarnet AEs
-Nephrotoxicity
-metabolic
-CNS: HA, tremor, irritability
-GI: n/v
-Hematologic: anemia, neutropenia
92
foscarnet uses
-CMV retinitis
-HSV and VZV resistant
93
Foscarnet dosing
CMV retinitis
induction
-60mg/kg iv q8h or 90mg/kg q12h for 14-21 days
maintenace
-90-120mg/kg iv q24h
Infusion rate not to exceed 1/mg/kg/min
94
Foscarnet dosing
resistant HSV and VZV
40mg/kg iv q8h for 14-21 days
95
influenza symptoms
-fever/chills
-cough
-sore throat
-congestion
-muscle aches
-HA
-fatigue
96
Neuraminidase inhibitors (drugs)
-zanamivir
-oseltamivir
-preamivir
97
Zanamirvir use
influenza
98
Zanamirvir
-dry powder diskhaler
-Breath activated
99
Oseltamivir use
influenza
100
Most commonly used agent for influenza
oseltamivir
101
oseltamivir
-prodrug
-powder for oral suspension
-capsules (30, 40, 75mg)
102
Peramivir use
influenza
103
Peramivir formulation
IV
104
Oseltamivir AEs
-n/v/d
-abdominal pain
-transient neuropsychiatric events (self injury or delirium)
105
oseltamivir is/isnt renally adjusted
is
106
Oseltamivir is for patients
- >2 yo
- Symptomatic for no more than 2 days
107
Zanamivir AEs
-bronchospasm
- worsening COPD
-neuropsychiatric
-HA
-nausea
-sinusitis
-bronchitis
-cough
-dizziness
108
Zanamivir used in patients
- >7 yo
- symptomatic no more than 2 days
109
Zanamivir is not recommended for
patients with underlying respiratory disease
110
Peramivir AEs
-diarrhea
-hypersensitivity rxns
111
Peramivir inhibits
influenza A and B
112
Cross resistance with Peramivir
no
113
Peramivir can be used in patients
- >18yo
-symptomatic for no more than 2 days
114
Peramivir dosing
-600mg iv infusion over > 15 min, SINGLE DOSE
-reanally adjusted
-> crcl: 30-49 -> 200mg
-> crcl: 10-29 -> 100mg
115
Baloxavir Marboxil MOA
-inhibits mRNA synthesis and viral replication
- inhibits polymerase acid
116
Baloxavir Marboxil metabolism
-prodrug
- activated by hydrolysis to baloxavir
117
Baloxavir Marboxil Counseling Points
-avoid taking w/ dairy
118
Baloxavir Marboxil AEs
-well tolerated
-diarrhea
-HA
-nausea
-no QTc effect
119
Baloxavir Marboxil use
Influenza
120
Baloxavir Marboxil is used in patients
with acute uncomplicated influenza
-pts >12 yo
-Symptomatic for no more than 2 days
121
Baloxavir Marboxil dosing
40-80kg:
- 40mg po single dose
>80kg
-80mg po single dose
122
Foscarnet can be used in
-HSV
-VZV
-CMV
-EBV
123
Letermovir can be used in
-CMV
-EBV
124
Famicilovir is used in
-HSV
-VZV
125
Valganciclovir is the drug of choice for
CMV
126
Valganciclovir is used for
-HSV
-VZV
-CMV
-EBV
127
Ganciclovir is drug of choice for
CMV
128
Ganciclovir is used for
-HSV
-VZV
-CMV
-EBV
129
Valacyclovir is the drug of choice for
-HSV
-VZV
130
Valacyclovir is used in
-HSV
-VZV
131
acyclovir is drug of choice for
-HSV
-VZV
132
Acyclovir is used for
-HSV
-VZV
133
Influenza A drugs
-zanamivir
-oseltamivir
-peramivir
-baloxavir marboxil
134
Influenza B drugs
-Zanamivir**
-oseltamivir
-peramivir
-baloxavir marboxil
