Drugs to Treat Influenza (J-Staud)

Question 1

MOA of Neuraminidase Inhibitors

Answer 1

Inhibit viral neuraminidase enzymes.

This prevents viral reproduction by budding from the host cell.

(NA cleaves sialic acid which is found on glycoproteins on the surface of human cells that helps new virions to exit the cell)

Question 2

Indication of oral osteltamivir

Answer 2

Influenza A and B infections in patients that have been symptomatic for no more than 48 hours.

Prophylaxis of influenza

Question 3

Contraindications of Osteltamivir?

Answer 3

End-stage renal disease

Question 4

Warnings and precautions of Osteltamivir?

Answer 4

Serious bacterial infections

Don’t give flu vaccine within 2 weeks before or 48 hours after osteltamivir is given.

Question 5

Limitation of osteltamivir?

Answer 5

Not a substitute for early influenza vaccination

Question 6

Can you give osteltamivir to young children?

Answer 6

not indicated to treat flu in younger than 2 weeks.

Not indicated to prevent flu in kids younger than 1 year old.

Question 7

Metabolism of oral osteltamivir?

Answer 7

NOT a substrate for or inhibitor of cytochrome P450 or UDG-Glucuronosyl Transferase (UGT) enzyme isoforms.

Question 8

Route of administration of Zanamivir?

Answer 8

Inhalation

Question 9

Use of Zanamivir?

Answer 9

Give to treate acute uncomplicated illness due to Influenza A and B virus in patients 7 years and older. (not recommended if younger than 12 tho)

Question 10

Contraindications of inhaled zanamivir?

Answer 10

Seizures or history of seizures

Lung disease

Question 11

Warnings & Precautions of inhaled zanamivir?

Answer 11

Does not prevent bacterial infection that starts with flu like symptoms

If live nasal flu vaccine is planned, patient should not receive the vaccine within two weeks before or 48 hours after using this medicine.

Question 12

Pregnancy indication Inhaled Zanamivir?

Answer 12

Women in any trimester of their pregnancy who have suspected or confirmed influenza should receive prompt antiviral therapy with Tamiflu or Relenza.

Question 13

Metabolism of Zanamivir?

Answer 13

Kidney, undergoes no metabolic biotransformation

Not a substrate of CYPP450 or isoenzymes

Question 14

How is Peramivir administered?

Answer 14

IV

Question 15

MOA of Peramivir?

Answer 15

Neuraminidase inhibitor

Question 16

Indication of peramivir? Age?

Answer 16

Acute uncomplicated influenza in patients 18 years and older who have been symptomatic for no more than 2 days

Question 17

Contraindication of peramivir?

Answer 17

Hypersensitivity

Question 18

Warning and precautions of peramivir?

Answer 18

Neuropsychiatric events

Question 19

Is peramivir safe for pregnant patients?

Answer 19

Should only be used if clearly indicated

Question 20

Should peramivir be used in geratric patients?

Answer 20

Yes

Adjust dose if they have impaired renal function

Question 21

Metabolism of peramivir?

Answer 21

Not a substrate for CYP

Long half-life

Question 22

Indication of Baloxavir?

Answer 22

Acute uncomplicated influenza

Question 23

MOA of Baloxavir?

Answer 23

Polymerase acidic endonuclease inhibitor (inhibits virus mRNA replication)

Question 24

Indications of Baloxavir?

Answer 24

patients that are 12 years of age and older who have been symptomatic no more than 48 hours

Question 25

Warnings and precautions of Baloxavir?

Answer 25

Risk of bacterial infection

Question 26

Metabolism of Baloxavir

Answer 26

UGT1A3, CYP3A4

Question 27

Excretion of Baloxavir

Answer 27

14. 7% in urine

80. 1% in feces

Question 28

Class of amantidine?

Answer 28

Anti-viral and Anti-parkinson; MOA is not known, probably by interfering with the function of the transmembrane domain of the viral M2 protein

Question 29

Indication of Amantadine?

Answer 29

Prophylaxis and treatment of signs and symptoms of infection caused by various strains of influenza A virus

Question 30

Why do we have to be careful in dosing of Amantadine?

Answer 30

Lowest reported acute lethal dose was 1 gram

Overdose results in cardiac, respiratory, renal, or CNS toxicity

(Cardiac dysfunction includes arrhythmia, tachycardia, and HTN)

Question 31

Why do we have to be careful using Amantadine in patients with mental problems?

Answer 31

Can exacerbate them in patients with mental history or substance abuse history.

Increased risk of suicide.

Question 32

Why do we have to be careful of patients with CNS history when giving Amantadine?

Answer 32

Pts with history of epilepsy may have increased incidence of seizure.

Pts with CNS history should be cautioned against working or driving while taking.

Question 33

Amantadine has anticholinergic effects, because of this, it should not be given to patients with what condition?

Answer 33

untreated angle closure glaucoma

Question 34

What must we be careful of doing in patients taking amantadine with Parkinson’s?

Answer 34

Abruptly discontinuing. Can cause Parkinsonian crisis.

Or delirium, agitation, delusions, hallucinations, paranoid reaction, stupor, anxiety, depression, and slurred speech

Question 35

The early diagnosis of what condition is important when considering Amantadine or discontinuing amantadine?

Answer 35

Neuroleptic malignant syndrome

fever, muscle rigidity, involuntary movements, altered consciousness, mental status change

Question 36

Is renal disease a concern with Amantadine?

Answer 36

yes, with decreased function it accumulates in the plasma and in the body when renal fx declines.

(reduce in patients with renal impairment and in individuals who are 65 years or older.)

Question 37

Is liver disease a concern with amantadine?

Answer 37

Yes, reversible elevation of liver enzymes have been reported in patients receiving amantadine.

Question 38

What skin condition should be monitored in patients with Parkinson’s or anyone taking amantadine?

Answer 38

Melanoma

Question 39

Metabolism of Amantadine?

Answer 39

No P450s or UGT enzymes.

Mean half life is 10 to 14 hours

(Renal function can increased 7 to 10 days)