Flu Flashcards
Amantadine
Prevention and treatment of Influenza A
MOA- Block viral particle uncoating and nucleic acid release into host cell-inhibiting viral replication
crosses BBB used as Parkinsons Drug
Monitor- SCr st baseline
CDC not recommended for influenza A
Rimantadine
Treatment and prophylaxis of influenza A
MOA- Inhibits viral uncoating and replication?
Hepatic impairment
Monitor- SCr at baseline/ LFT
CDC not recommended for influenza A
Osetamvir
Treatment and prophylaxis of influenza A and influenza B
MOA- inhibits neuraminidase of influenza A and B- prevents the release if virons from the host cell and prevents entry into the cell
prodrug- converts to oseltamvir carboxylate
Renal adjustment required DOC for pregnancy
Zanamivir
Treatment and prophylaxis of influenza A and influenza B
MOA- inhibits neuraminidase of influenza A and B- prevents the release if virons from the host cell and prevents entry into the cell
oral inhalation formualtion
caustion in Asthma/ COPD
avoid in milk allergy- contains milk proteins as vehicles
Peramivir
Treatment influenza A and influenza B ONLY
MOA- inhibits neuraminidase of influenza A and B- prevents the release if virons from the host cell and prevents entry into the cell
IV-used for patients who cannot take oral medication Monitor-
SCr at baseline
Good Kidney function required- CrCl < 50ml/min
Baloxavir Marboxil
Treatment of influenza A and B
MOA- inhibits viral polymerase acidic protein endonuclease activity- inhibits viral replication
Dose- weight based dosing
separate from diary products and calcium- fortified beverages
one dose compared to five doses for other meds
expensive
Influenza drugs special considerations
- Oseltamivir
- Zanamivir
- Peramivir
- Baloxavir
- Oseltamivir- safe in pregnancy and breast feedings (possible pneumonia post flu), any age for treatment and over 3 months for prevention
- Zanamivir- over 7 for treatment and over 5 for prevention
- Peramivir- over 2 for treatment
- Baloxavir- over 12 years for treatment
HHV MOA for nucleoside analogs
Pyrimadine and purine analogs- inhibit viral replication -
- competitive inhibition of DNA polymerase
- Incorporation and termination of viral DNA chains
- inactivation of viral DNA polymerase
Trifluridine
Pyrimadine analogs indication for ocular HSV
opthalmic solution- less systemic side effects
keep refrigerated
Cidofivir
Pyrimadine analogs
indication for CMV retinitis in AIDS (not first line)
Active metabolite
Patient needs to be hydrated and coadminister probenecid
Monitor- SCr, urine protein (48 hours before each dose), WBC with diff before each dose
BBB- renal impairment, neurtropenia, carcinogens/teratogens
Acyclovir
Purine analog
Indication for HSV, VZV (first line), CMV (limited), EBV (limited) only effective against actively replicating virus
multiple formulation- IV (hydrate), oral and topical
Poor bioavailability
Monitor renal function
*Crosses BBB treatment for HSV encephalitis and viral meningitis*
Valacyclovir
Purine analog
Indication for HSV and VSV (DOC)
*Produg of acyclovir - better bioavailability*
oral formulation only
Monitor- SCr at baseline
Famciclovir
Purine analog
Indication- prevention and treatment of HSV/VZV
*Prodrug of penciclovir*
Monitor- SCr
Peniclovir
Purine analog
Indication- recurrent herpes labialis
active metabolite of famciclovir
Available in topical formulation only
Valganciclovir
Purine analog
Indication- for treatment and prevention of CMV infection *Prodrug of ganciclovir*
Renally eliminated
Monitor- SCr/ pregnancy test/ CBC with diff (bone marrow toxicity)
*Use in immunocompromised patients (organ transplant) with positive CMV infection*
