Herpes, EBV & CMV Meds Flashcards
Anti-HSV/VZV Medications
- Acyclovir
- Valacyclovir
- Famciclovir
MOA of Anti-HSV/VZV
- Competes with deoxyguanosine for viral DNA polymerase & is incorporated into viral DNA
- DNA chain termination
When should we optimally initiate acyclovir and other anti-HSV meds?
-within 24-72 hours*
Acyclovir indications
- Primary and recurrent genital HSV
- Orolabial HSV
- Encephalitis (HSV)*
- Primary VZV (chickenpox) and secondary VZV (shingles)*
Acyclovir ADRs
- Usually well tolerated
- Large doses may lead to crystalline nephropathy causing a reversible AKI*
Valacyclovir clinical indications
- Primary and recurrent genital HSV
- Suppressive tx decreases transmission to seronegative partner**
Valacyclovir is a prodrug of acyclovir when given orally. Tell me about its bioavailability
-Drug resembles concentrations achieved with IV acyclovir
Famciclovir pearls
- Same indications as valacyclovir
- Administered orally as a prodrug
About what percentage of adults >40 have been infected with CMV?
> 50%
-Most common causes of OI in solid organ or HCT patients
Anti-EBV/CMV therapeutics
- Ganciclovir
- Valganciclovir
- Letermovir
What are the clinical indications for Ganciclovir?
- Active retinitis
- Suppression of retinitis
- Colitis, esophagitis, prevention of CMV in transplant pts
-10x more potent against CMV than acyclovir
What is a big ADR of ganciclovir to be aware of?
-Bone marrow suppression
Valganciclovir pearls/indications
-prodrug of ganciclovir (same ADRs)
- Used for induction and maintenance of CMV retinitis
- Prevention of CMV disease following transplantation*****
Letermovir MOA
-CMV DNA terminase complex inhibitor which blocks viral DNA processing and packaging
Letermovir Indications
***Prophylaxis of CMV infection & disease in CMV+ adults of an allogeneic HCT
