Drugs: Anti-Virals (Non-HIV)

Question 1

Prophylactic Immunizations

Answer 1

MMR, varicella, HPV, polio, HAV, HBV, shingles, influenza

Question 2

Gamma Globulins

Answer 2

endogenous and very specific. Given IM or IV to block penetration of viruses during early incubation.

Question 3

Treatment of Influenza

Answer 3

Amantadine/Rimantadine

Zanamivir (relenza)/Oseltamivir (tamiflu)

Question 4

Amantadine/Rimantadine

Answer 4

inhibits uncoating of virus by bind M2 protein (ion channel allowing for acidification of virus core-> RNA tx).
(improves Parkinson’s sx)
Adverse Rxn: anorexia, insomnia, drowsiness, * ataxia, dizziness, hallucinations.
Amantadine- 90% excreted unchanged.
Rimantadine- metabolized by liver, fewer CNS effects

Question 5

Zanamivir/Oseltamivir

Answer 5

*Neuraminidase inhibitors that reduce the release of virus from infected cells. Reduce duration of symptoms and transmission.
Zanamivir (nasal spray)- bronchospasm
Oseltamivir (oral)- GI upset

Question 6

Treatment of Herpes and CMV

Answer 6

Acyclovir
Valacyclovir (valtrex)
Gancyclovir

Question 7

Acyclovir

Answer 7

MOA: Chain terminator….guanosine analogue -> phosphorylates by viral TK (thymidine kinase) to acycloGTP => inhibition of viral DNA polymerase.
Use: HSV, varicella zoster, EBV
Ad rxn: well tolerated. CNS, tremor, renal tox.
**10-20% bioavailability

Question 8

Valacyclovir (valtrex)

Answer 8

prodrug = hydrolyzed to acyclovir in liver. 48% bioavailability!
(also: Penciclovir, Famciclovir)

Question 9

Docosanol

Answer 9

OTC inhibits fusion of HSV envelope to membrane = reduced healing time and replication.

Question 10

Ganciclovir

Answer 10

More potent than acyclovir.
Use: CMV, CMV RETINITIS and CMV infection in HIV, immunocompromised pts.
***Ad rxn: MYELOSUPPRESSION, THROMBOCYTOPENIA, ANEMIA, renal impairment.
->valganciclovir = better bioavailablity

Question 11

Foscarnet

Answer 11

Use: acyclovir resistant herpes. HIV + CMV or herpes
MOA: Non-nucleoside inhibitor of DNA polymerase. Can be combined with ganciclovir

Question 12

Treatment of Chronic Hep B

Answer 12

Pegylated IFN 
Lamivudine 
Adefovir 
Enecavir 
Telbivudine 
(HIV drugs may be used to help manage infections as well)

Question 13

Treatment of Chronic Hep C

Answer 13

*Pegylated IFN + Ribavirin + Protease Inhibitor

PIS: telaprevir, simeprevir, boceprevir, (serine) sofosbuvir

Question 14

Interferons

Answer 14

Use: genital warts, HCV, HBV, AIDS- Karposi’s sarcoma
MOA: phosphorylate signal transducers and activate tx of proteins that aid in cellular immunity. Blocks penetration. Ie. JAK kinase
1) degrade mRNA (oligo)
2) inactivate elongation initiation factor-2 (protein kinase)
3) inhibit tRNA peptide elongation
*AE: flu like symptoms, fever, decreased WBCs

Question 15

Ribavirin

Answer 15

MOA: guanosine analogue, depleted intracellular GTP - inhibits protein synthesis.
Use: Hep C, RSV in children, Lassa Fever

Question 16

Protease Inhibitors

Answer 16

telaprevir, simeprevir, boceprevir = serine protease inhibitors
sofosbuvir = inhibits RNA-dependent RNA polymerase

Question 17

Palivizumab

Answer 17

humanized monoclonal antibody - block viral attachment.

Use: prevention of RSV in high risk babies/kids.

Question 18

Treatment of HPV

Answer 18

HPV vaccine (Gardisil)
Trichloroacetic acid
Podophyllin
Cryotherapy

Question 19

Treatment of CMV

Answer 19

ganciclovir, foscarnet

Question 20

Treatment of RSV

Answer 20

ribavirin, palivizumab

Question 21

Treatment of EBV

Answer 21

Acyclovir or Cyclophosphamide (if TK target for acyclovir not expressed)

Question 22

Treatment of Kaposi’s Sarcoma Castleman’s Disease

Answer 22

HHV-8 (production of VEGF -> purple lesions)

Rituximab