GYN/Final: anti-virals

Question 1

do viruses carry out metabolic processes

Answer 1

no

Question 2

to target viral therapy, we need to target?

Answer 2

areas infected by the host

Question 3

list the respiratory viruses

Answer 3

Influenza A, B

RSV

Question 4

preferred method for tx of the resp viruses

-other tx

Answer 4

vaccination *****

Other tx= Neuraminidase inhibitors—for influenza A/B

• **Oseltamivir
• **Zanamivir

Question 5

Oseltamivir

• MOA
• Kinetics (routes, metabolism)
• SE

Answer 5

MOA= inhibition of neuraminidase (viruses exhibit this into the host cell for replication of virons)

Kinetics

• PO
• Hepatic metabolism

SE

• N/V
• take with food

Question 6

Zanamivir

• MOA
• Kinetics (route, excretion)
• SE

Answer 6

MOA=inhibition of neuraminidase (viruses exhibit this into the host cell for replication of virons)

Kinetics

• inhaled
• Excreted via urine

SE

• Irritation of respiratory tract
• N/V

Question 7

when do you start neuraminidase inhibitors?

Answer 7

within 48 hours of s/s

*after 48 hrs—— cannot give

Question 8

RSV

• what is it
• what is MC infected
• s/s
• dx
• tx

Answer 8

viral pathogen that causes severe resp tract infections in INFANTS
***infects mucosal lining of the lung–causing SYNCYTIUM

**lower resp tract most commonly infected

s/s
*onset in premies + infants–>cough, wheezing that does not subside

DX: nasal swab + clinical

Tx: Ribavirin PO or INH

Question 9

Ribavirin

• MOA
• inds
• routes
• SE

Answer 9

MOA: inhibs replication of RNA and DNA viruses

Inds: RSV

Kinetics

• PO
• INH

SE:

• dose dependent anemia….. elevated bilirubin
• **most premies have elevated bilirubin already*

Question 10

list the other viral infections we can treat (5)

Answer 10

Active Hep B and C
CMV
HSV 1
HIV

Question 11

Hep B

-diagnosis for active infection

Answer 11

SEROLOGY: 
\+HBsAG 
\+IgM anti-HBc 
\+anti-HBc 
-anti-HBs

Question 12

what must you always do before tx for Hep B or any other hepatic dz?

Answer 12

baseline creatinine

Question 13

tx for Hep B

• class of drugs?
• list them

Answer 13

Nucleoside Reverse Transcript inhibitors (NRTIs)

• Lamivudine
• Tenofovir
• Entecavir

Question 14

Lamuvudine

• inds
• moa
• se

Answer 14

inds=HIV***, Acute Hep B
**NOT FOR chronic Hep B bc of resistance

MOA: NRTI

SE:

• Nausea
• very well tolerated

Question 15

Tenofovir

• inds
• moa
• se (4)

Answer 15

MOA: NRTI

INDS

• Acute and chronic HBV infection
• HIV

SE

• Depression
• backache
• cough
• N/V/D

Question 16

Entecavir

• moa
• inds
• se

Answer 16

MOA: NRTI

INDS

• **HBV infection
• effective against Lamivudine resistant strains

SE=Nephrotoxicity

***needs renal dosing

Question 17

Which NRTI needs renal dosing

Answer 17

Entecavir

Question 18

Chronic Hep B treatments–list the drug class

Answer 18

Interferons: alpha, beta, gamma and pegylated

**Peginterferon alfa-2

Question 19

Peginterferon-alfa 2

• MOA
• inds
• se

Answer 19

MOA: not widely understood— believed to inhibit viral RNA translation

INDS: Chronic Hep B

SE
*Flu like s/s—>fever, chills, myalgias, GI

Question 20

How does Hep C virus infect liver

Answer 20

• enters hepatocyte–>cleaving proteins–>replication complex–>replicates viral genome
• very very slow replication **

**proteins that it cleaves= NS3/ Ns4A, NS5A, NS5B— can be inhibited from forming– target of therapy

**DAAs= direct acting antivirals

Question 21

what is DAA

Answer 21

direct acting anti-virals

**prevent the proteins NS3/ NS4A,NS5A, NS5B from forming HEp C

Question 22

Hep C treatments– list the drugs

Answer 22

Ledipasvir-Sofobuvir**

Ledipasvir=NS5A-replication complex inhib
Sofobuvir=PI

*****Ribavirin and Interferon (but older txs)

Question 23

Ledipasvir-Sofobuvir

• inds
• drug class/MOA

Answer 23

Hep C infection

NS5A replication comple inhibitor (Ledipasvir) + protease inhibitor (sofobuvir)
–inhibit the proteins on viral cells

Question 24

Ribavirin
-inds

-SE

Answer 24

INDS

• Chronic Hep C + other DAAs
• Hep C, Hep B, RSV–>good with combination tx for synergism

SE:
*Elevated bilirubin

Question 25

HSV-1 and CMV | -when do the drugs have greatest effect

Answer 25

drugs for tx have greatest effects during ACUTE phase of infections

Question 26

which herpetiform can lay dormant in body for life

Answer 26

CMV (HVV-5)**** and HSV-1

Question 27

when can CMV be fatal | list the s/s

Answer 27

``` immunocomp Congenital CMV ***colitis ***retinitis ***esophagitis ***encephalitis ```

Question 28

list the drugs we use to tx Herpes viruses

Answer 28

* Acyclovir * Cidofovir * Foscarnet * ganciclovir

Question 29

Acyclovir | *inds

Answer 29

INDS---"grandfather of antiherpetic tx agents" * ***TOC in HSV encephalitis * MC use is gential herpes

Question 30

Cidofovir -inds - SE - how to get rid of one of the SE?

Answer 30

INDDS *CMV retinitis in pt with AIDS SE * significant renal toxicity * neutropenia * metabolic acidosis*** Probenecid + NSS IV solution will help decrease risk of developing nephrotoxicity

Question 31

how to decr incidence rate of nephrotoxicty with IV Cidofovir ?

Answer 31

PO probenecid---uricosurics--lowers uric acid in body + IV NSS

Question 32

Foscarnet -inds -se

Answer 32

INDS * CMV retinitis in immunocomp * Acyclovir resistant HSV SE * nephrotoxicity * anemia * nausea * fever * *************HYPOmag and *HYPOcalcemia----can lead to arrhythmias

Question 33

Ganciclovir - INDS - SE

Answer 33

INDS----analog of acyclovir INDS * **greater efficacy against CMV * CMV retinitis * prophylaxis in transplant PTs SE * Dose dep neutropenia * carcinogenic * teratogenic

Question 34

which is better for kidneys--- acyclovir or ganciclovir

Answer 34

Ganciclovir

Question 35

HIV - list the drugs used to tx (6) - comination of drugs are called?

Answer 35

ANTI-RETROVIRALS: NRTIs NON NRTIs Protease inhibitors (PIs) Entry inhibitors Integrade inhibitors Boosters

Question 36

Nucleoside reverse transcriptase inhibitors - list them (3) - MOA - routes - SE - resistance?

Answer 36

1. Lamivudine---PO 2. Tenofovir---PO 3. Zidovudine---PO, IV (only one) Resistance

Question 37

what drug class was the first agents available to tx HIV

Answer 37

Nucleotide reverse transcriptase inhibs

Question 38

Non NRTIs | -MOA

Answer 38

MOA-->highly selective noncompetitive inhibitors of HIV reverse trnascriptase -->bind to allosteric site next to active site-->then cause a conformational change-->results in enzyme inhibition *****not as great as NRTIs

Question 39

Protease Inhibitors - drug names - name the MC one and why its MC - SE

Answer 39

MC ONE: Atazanavir bc it has least SE profile *Lopinavir/Ritonavir -avir SE * hypertriglyceridemia * parasthesias * hyperglycemia

Question 40

which drug class lowered mortality rates in HIV patients

Answer 40

Protease Inhibitors

Question 41

which drug class lowered mortality rates in HIV patients

Answer 41

Protease Inhibitors

Question 42

List the protease inhibitors

Answer 42

MC=Atazanavir Lopinavir/Ritonavir

Question 43

list the drugs that cannot be administered with Protease Inhibitors (10) -ex of each category

Answer 43

1. H2 Blockers--- bc it needs acidic envi for absoprtion 2. Antiarrhythmics-->Amiodarone 3. Ergot Derivatives 4. Antimycobacterial drugs--Rifampin 5. Benzos--Triazolam 6. Inhaled corticos---fluticasone 7. herbals--st. johns wort 8. HMG CoA Reductase Inhibitors-->Lovastatin, Simvastatin 9. Fentanyl 10. B2 agonists---Salmeterol

Question 44

Entry Inhibitors | -MOA

Answer 44

MOA * work on entry of HIV into the host cell * block conformational change that is necessary for HIV cell to enter host cell

Question 45

Enfuviride - drug class - route - se

Answer 45

- entry inhibitors - SQ only - not given to tx in Naive patients (pt who never had this tx b4)

Question 46

Maraviroc - drug class - route - se

Answer 46

- entry inhibitors - PO - hepatoxicity

Question 47

Integrase Inhibitors (INSTIs) - MOA - drugs - SE - reistance?

Answer 47

MOA * inhibits insertion of pro viral DNA into host cell-->for this to work----active site of integrase inhibitor binds to DNA and serves as a target for the INSITI * INSTI stops viral integration * Raltegravir * Elvitegravir * Dolutegravir * Bictregravir SE * well tolerated * N/D MC Resistance can occur

Question 48

Pharmacokinetic Enhancers | -aka?

Answer 48

BOOSTERS MOA *two drugs are used to enhance bioavail of the drugs used in combination therapy for HIV Drugs: *Ritonavir & Cobicistat-->works as a potent inhibitor of CYP3A which allows the bioavail of a concomitant dose PI----boost PI to help prevent resistance