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Spring Pharm Block 4 > FR Review 6 - Antifungals, Antivirals, HIV, Immunizations > Flashcards

FR Review 6 - Antifungals, Antivirals, HIV, Immunizations Flashcards

1
Q

What anti-fungal is commonly used to kill table grade candida?

A

Fluconazole

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2
Q

Which drug is most commonly used to treat histoplasmosis?

A

Itraconazole

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3
Q

In what formulation is itraconazole commonly administered?

A

PO capsules in a solution that require acid to be absorbed in the stomach

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4
Q

What is the drug most commonly used to treat aspergillus?

A

Voriconazole

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5
Q

What is the most common AE of Voriconazole?

A

Visulal side effects

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6
Q

Describe the potency of isavuconazole.

A

Very potent –> highest of the Azoles

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7
Q

What anti-fungal is commonly used to kill severe candida, including glabata? List two examples.

A

IV Echinocandins

Exs: caspofungin and micafungin

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8
Q

What changed in the new formulations of amphotericin B and how many of the new versions are there?

A

Wrapped in lipids to keep it away from the kidneys because ampho B is nephrotoxic. 3 new formulations.

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9
Q

T/F: All of the amphotericin B formulations are dosed the same.

A

False –> they all have different doses

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10
Q

What is amphotericin B most commonly used to treat?

A

Kills almost all fungi –> atomic bomb of anti-fungals

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11
Q

List the 3 most common AEs associated with amphotericin B.

A
  1. Infusion Rxns –> rigors and fever
  2. Nephrotoxicity
  3. Electrolyte abnormalities: HypoK and HypoMg
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12
Q

What drugs are used prophylactically against the infusion reaction associated with amphotericin B?

A

acetaminophen, diphenhydramine, prednisone, meperidine

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13
Q

By what route is nystatin administered and why?

A

Only topical - systemic use associated with many AEs - can be swish and spit for thrush.

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14
Q

What is onychomycosis and what allylamine drug is used in treatment?

A

Nail bed infection

Treated with PO terbinafine

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15
Q

What lab value must be followed when administering terbinafine?

A

LFTs

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16
Q

Differentiate HSV-1 from HSV-2.

A

HSV-1: cold sores, mostly in the oral mucosa

HSV-2: genital herpes

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17
Q

What drugs are used to treat HSV, varicella, and zoster? Which is used most commonl?

A

Acyclovir, valacyclovir, penciclovir, famciclovir

Valacyclovir is most commonly used

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18
Q

What drugs are used to treat CMV and what is the most significant AE of each?

A

Ganciclovir: neutropenia
Foscarnet: renal toxicity
Cidofovir: renal toxicity

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19
Q

What are the first generation treatments for hepatitis C and B and why are they no longer first line?

A

Interferons and Ribavirin –> lots of baggage/AEs

20
Q

List four drugs used to treat HIV that can also be used to treat Hep B and list an important fact about each.

A 
Lamivudine: bid dosing
Emtricitabine: qd dosing - same drug as lamivudine
Tenofavir Dispoxil (TDF): original tenofavir formulation
Tenofavir Alfenamide (TAF): newer version of TDF that has fewer AEs and is given at a lower dose
21
Q

What is the general class of the second generation drugs used to eradicate Hep C and what are their disadvantages?

A

Direct acting antivirals used in combination. They are very expensive and have many drug interactions.

22
Q

In relation to influenza, differentiate between antigenic drift and antigenic shift.

A

Drift: change in virus every year which is why we re-vaccinate every year.
Shift: significant viral change that can cause a pandemic.

23
Q

Differentiate flu A from flu B.

A

flu A usually affects adults

flu B mostly affects children.

24
Q

Name the three neuraminidase inhibitors and state the route by which each is administered.

A

Zanamivir: inhaler - never used bc it is contraindicated in asthma
Oseltamivir: PO
Peramivir: Parenteral (injection)

25
Q

In what time frame are neuraminidase inhibitors and baloxavir used?

A

Must be used within 48 hours of symptom onset.

26
Q

Describe the dosing of baloxavir and the neuraminidase inhibitors.

A

boloxavir: single dose

neuraminidase inhibitors: dosed for 5 days

27
Q

What are two cons of baloxavir?

A
  1. Must avoid chelating agents (Mg, Fe, Zn, milk, etc.)

2. Expensive

28
Q

Describe how HIV enters human cells.

A

Binds to CD4 receptor and coreceptor to inject its viral RNA

29
Q

What are the two coreceptors that HIV uses to enter human cells.

A

R5 and X4 –> R5 is much more common in US (99%)

30
Q

Describe the steps of the HIV life cycle inside human cells after HIV RNA enters.

A
  • Viral RNA is made into DNA via reverse transcription
  • Viral DNA is integrated into the host cell DNA inside the host cell nucleus
  • Virus integrated DNA make HIV pro-proteins
  • The pro-proteins are cleaved and activated in the cell cytoplasm
  • The activated HIV protein is packaged and departs the cell
  • This departed protein restarts this process in a new healthy cell
31
Q

After exposure to HIV, how long is the window of opportunity for effective treatment?

A

48 - 72 hours –> Needle sticks must be treated within this time to prevent HIV

32
Q

Differentiate between HIV and AIDS.

A

HIV becomes AIDS when CD4 is or ever has been below 200 or the patient develops a serious opportunistic infection. At CD4 < 200, patient begins Bactrim for PCP pneumonia prophylaxis.

33
Q

What class of HIV drugs are NRTIs and how do they work?

A

Nucleoside Reverse Transcriptase Inhibitors - drug inserts into growing DNA chain and prevents further growth.

34
Q

What is the clinical difference between Nucleotide RTIs and Nucleoside RTIs?

A

None - same mechanism with slightly different structure

35
Q

What is the mechanism of action of protease inhibitors.

A

Prevents clipping/activation of pro-proteins by inhibiting protease enzyme

36
Q

Describe the mechanism of action of NNRTIs?

A

They are not nucleosides or nucleotides. They bind to the reverse transcriptase enzyme and deactivate it.

37
Q

What is the mechanism of action of fusion inhibitors?

A

Blocks the CD4 receptor

38
Q

What is the mechanism of action of Maraviroc?

A

R5 receptor blocker - no effects on X4

39
Q

What is the mechanism of action of integrase inhibitors?

A

Block integrase preventing entry of viral DNA into the cell nucleus and thus preventing integration of viral DNA with host cell DNA

40
Q

What is the hottest class of HIV drugs in 2021?

A

Integrase inhibitors

41
Q

What are the three standard recipes used when administering drugs to treat HIV?

A

2 NRTIs and 1 NNRTI
2 NRTIs and 1 Protease Inhibitor
2 NRTIs and 1 Integrase Inhibitor –> hottest

42
Q

What is a hot method for administration of HIV drug cocktails?

A

STR –> single tablet regimen, IE, all three drugs in one pill.

43
Q

Describe and differentiate between PEP, NPEP, PREP, and TasP.

A
  • PEP: post exposure prohylaxis –> 3 drugs x 30 days within 48-72 hours
  • NPEP: non-occupational PEP –> same as PEP if high risk exposure
  • PREP: Pre-Exposure Prophylaxis –> people at high risk for HIV get 2 drugs QD
  • TasP: Treatment as Prevention –> undetectable = untransmittable
44
Q

What are two drug combinations given for PREP?

A

Truvada: Tenofovir (TDF) and Emtricitabine
Descovy: Tenofovir Alfenamide (TAF) and Emtricitabine

45
Q

Name one unique qulaity of each of the HIV drugs atazanavir and darunavir.

A

Atazanavir needs acid in the stomach to be absorbed

Darunavir has a sulfa-moiety

46
Q

List six live vaccines.

A

MMR
Varicella
Zoster/Zostavax –> been replaced by Shingrix (killed vax)
Intranasal influenza
Oral typhoid
Oral Pollio Virus –> no longer used in US

Spring Pharm Block 4 (17 decks)

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