FR Review 6 - Antifungals, Antivirals, HIV, Immunizations

Question 1

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

Answer 1

Fluconazole

Question 2

Which drug is most commonly used to treat histoplasmosis?

Answer 2

Itraconazole

Question 3

In what formulation is itraconazole commonly administered?

Answer 3

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

Question 4

What is the drug most commonly used to treat aspergillus?

Answer 4

Voriconazole

Question 5

What is the most common AE of Voriconazole?

Answer 5

Visulal side effects

Question 6

Describe the potency of isavuconazole.

Answer 6

Very potent –> highest of the Azoles

Question 7

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

Answer 7

IV Echinocandins

Exs: caspofungin and micafungin

Question 8

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

Answer 8

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

Question 9

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

Answer 9

False –> they all have different doses

Question 10

What is amphotericin B most commonly used to treat?

Answer 10

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

Question 11

List the 3 most common AEs associated with amphotericin B.

Answer 11

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

Question 12

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

Answer 12

acetaminophen, diphenhydramine, prednisone, meperidine

Question 13

By what route is nystatin administered and why?

Answer 13

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

Question 14

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

Answer 14

Nail bed infection

Treated with PO terbinafine

Question 15

What lab value must be followed when administering terbinafine?

Answer 15

LFTs

Question 16

Differentiate HSV-1 from HSV-2.

Answer 16

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

HSV-2: genital herpes

Question 17

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

Answer 17

Acyclovir, valacyclovir, penciclovir, famciclovir

Valacyclovir is most commonly used

Question 18

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

Answer 18

Ganciclovir: neutropenia
Foscarnet: renal toxicity
Cidofovir: renal toxicity

Question 19

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

Answer 19

Interferons and Ribavirin –> lots of baggage/AEs

Question 20

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

Answer 20

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

Question 21

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

Answer 21

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

Question 22

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

Answer 22

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

Question 23

Differentiate flu A from flu B.

Answer 23

flu A usually affects adults

flu B mostly affects children.

Question 24

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

Answer 24

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

Question 25

In what time frame are neuraminidase inhibitors and baloxavir used?

Answer 25

Must be used within 48 hours of symptom onset.

Question 26

Describe the dosing of baloxavir and the neuraminidase inhibitors.

Answer 26

boloxavir: single dose | neuraminidase inhibitors: dosed for 5 days

Question 27

What are two cons of baloxavir?

Answer 27

1. Must avoid chelating agents (Mg, Fe, Zn, milk, etc.) | 2. Expensive

Question 28

Describe how HIV enters human cells.

Answer 28

Binds to CD4 receptor and coreceptor to inject its viral RNA

Question 29

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

Answer 29

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

Question 30

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

Answer 30

- 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

Question 31

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

Answer 31

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

Question 32

Differentiate between HIV and AIDS.

Answer 32

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.

Question 33

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

Answer 33

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

Question 34

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

Answer 34

None - same mechanism with slightly different structure

Question 35

What is the mechanism of action of protease inhibitors.

Answer 35

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

Question 36

Describe the mechanism of action of NNRTIs?

Answer 36

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

Question 37

What is the mechanism of action of fusion inhibitors?

Answer 37

Blocks the CD4 receptor

Question 38

What is the mechanism of action of Maraviroc?

Answer 38

R5 receptor blocker - no effects on X4

Question 39

What is the mechanism of action of integrase inhibitors?

Answer 39

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

Question 40

What is the hottest class of HIV drugs in 2021?

Answer 40

Integrase inhibitors

Question 41

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

Answer 41

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

Question 42

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

Answer 42

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

Question 43

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

Answer 43

- 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

Question 44

What are two drug combinations given for PREP?

Answer 44

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

Question 45

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

Answer 45

Atazanavir needs acid in the stomach to be absorbed | Darunavir has a sulfa-moiety

Question 46

List six live vaccines.

Answer 46

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