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Pharmacology #1 > Herpes Viral Infxns Treatment > Flashcards

Herpes Viral Infxns Treatment Flashcards

1
Q

Agents used for herpes viral infections are…

A

acyclic guanosine analogs

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2
Q

Acyclic guanosine analogs are:

A

1) Acyclovir
2) Valacyclovir
3) Famciclovir
4) Penciclovir

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3
Q

Two drugs that treat herpes viral infections that are NOT acyclic guanosine analogs:

A

1) Trifluridine (Viroptic)

2) Docosanol (Abreva)

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4
Q

Herpeviridae causes a family of viruses such as:

A

1) HSV-I
2) HSV-II
3) VZV
4) EBV (Epstein Bar Virus)
5) CMV (cytomegalovirus)

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5
Q

Acyclovir is effective against:

A

1) HSV-I
2) HSV-II
3) VZV

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6
Q

Acyclovir has weaker activity against which viruses?

A

1) EBV
2) CMV
3) Human herpes virus 6

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7
Q

What is acyclovir’s MOA?

A

1) Viral thymidine kinase converts to monophosphate
2) Host enzyme phosphorylate monophosphate to di & triphosphate
3) Triphosphate is used during polymerization which causes chain termination

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8
Q

Acyclovir is only activated where?

A

Viral infected cells

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9
Q

Acyclovir acts as a what?

A

competitive inhibitor of viral DNA polymerase by forming an irreversible complex on DNA and causing chain termination due to lack of OH groups required for chain extension

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10
Q

The only antiherpes drug available for IV admin?

A

Acyclovir

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11
Q

In HSV-I and HSV-II acyclovir’s clinical use is used to what?

A

1) Shorten duration of symptoms
2) Decrease virus shedding
3) Shorten time of resolution of lesion by 5 days

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12
Q

In recurrent genital herpes, acyclovir shortens time course by:

A

1-2 days

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13
Q

Long term chronic therapy of acyclovir decreases what?

A

1) symptomatic reoccurrences
2) asymptomatic viral shedding (prevents viral shedding)
3) Reduces sexual transmission

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14
Q

If acyclovir for long term therapy of HSV is d/c’d, what will happen?

A

outbreaks will resume

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15
Q

For varicella zoster virus, if oral acyclovir is administered within 24 hours of rash, what will happen?

A

It will decrease total number of lesions AND duration

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16
Q

Acyclovir will decrease lesions and duration of cutaneous zoster (shingles) if administered within how many hours?

A

72 hours

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17
Q

Acyclovir will decrease lesions and duration of herpes zoster virus (chicken pox) if administered within how many hours?

A

24 hours

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18
Q

What prevents reactivation of HSV in TRANSPLANT patients on immunocompromised therapy?

A

Acyclovir

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19
Q

IV Acyclovir is the the treatment of choice for what SEVERE infections?

A

1) herpes simplex encephalitis
2) neonatoal HSV infection
3) serious HSV or VZV infection

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20
Q

Are high doses of Acyclovir required for treatment of HSV or VZV?

A

Higher doses are needed for VZV therapy

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21
Q

In immunocompromised patients, IV acyclovir reduces both…

A

cutaneous (skin) AND visceral (organ) dissemination (spread)

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22
Q

Topical acyclovir has what effect on reoccurence of herpes?

A

Less effective, no benefit

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23
Q

Resistance of Acyclovir occurs do to:

A

mutations in either the Viral Thymidine Kinase or Viral DNA Polymerase

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24
Q

Cross resistance of acyclovir occurs in what drugs?

A

1) Valacyclovir
2) Famciclovir
3) Ganciclovir

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25
Q

Cross resistance of acyclovir occurs b/c:

A

drugs require activation by viral TK

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26
Q

What drugs are used when there is resistance to acyclovir?

A

1) Foscarnet

2) Cidofavir

27
Q

IV Infusion of Acyclovir may cause what adverse effects?

A

Reversible renal dysfunction due to crystalline nephropathy and neurotoxicity, but rare.

28
Q

The L-valyl ester of acyclovir is?

A

Valacyclovir

29
Q

Valyl derivation does what?

A

improves bioavailability (48%) and gets rapidly converted to acyclovir

30
Q

Valacyclovir is indicated for what?

A

1) HSV-I
2) HSV-II
3) VZV
4) CYTOMEGALOVIRUS (NEW***)

31
Q

Which is slightly more effective for treatment of HSV I, II, and VZV?

A

Valacyclovir

32
Q

What is considered a high doses of Valacyclovir?

A

8g/ day

33
Q

High doses of Valacyclovir causes what in AIDS patients?

A

1) GI Intolerance
2) thrombotic thrombocytopenia purpura (TTP) (can be fatal!)
3) Hemolytic-uremic syndrome

34
Q

High doses of Valacyclovir can cause what in transplant patients?

A

Confusion and hallucinations

35
Q

A diacetyl ester prodrug of 6-deoxypenciclovir is…?

A

Famciclovir (Famvir)

36
Q

Famciclovir (Famvir) is what kind of ester?

A

a di-acetly ester prodrug of 6-deoxy-penciclovir

37
Q

Famciclovir’s MOA?

A

1) activated by phosphorylation into monophosphate by VIRAL TK (same as Acyclovir)
2) inhibits Viral DNA polymerase

38
Q

Famciclovir’s MOA is the same as Acyclovir’s except…

A

it does not cause chain termination

39
Q

Famciclovir’s resistance is due to:

A

TK mutation

40
Q

Famciclovir shows cross resistance to:

A

1) Acyclovir

2) Valacyclovir

41
Q

What is the preferred treatment for Shingles (cutaneous zoster)?

A

Famciclovir

42
Q

What drug has better oral bioavailability and is a pro-drug, so it is often prescribed?

A

Famciclovir

43
Q

What is the oral bioavailability of Famciclovir?

A

70%

44
Q

Famciclovir undergoes what elimination?

A

Renal

45
Q

First line treatment for recurrent genital herpes (HSV-2)?

A

Famciclovir

46
Q

First line treatment for acute herpes zoster (shingles)?

A

Famciclovir

47
Q

Viral proliferation in what infection causes neuralgia?

A

Herpes zoster virus (shingles)

48
Q

Famciclovir does not prevent what complication in shingles?

A

postherpatic neuralgia

49
Q

Famciclovir is accompanied by what drugs to alleviate neuralgia in herpes zoster patients?

A

1) Gabapentin
2) carbamazepine
3) Pregablin (lyrica)

50
Q

Famciclovir should be used cautiously in what patient population?

A

Elderly, due to neuralgia

51
Q

Viral proliferation in the dorsal root ganglia can cause…

A

neuralgia

52
Q

What is the active metabolite of Famciclovir?

A

Penciclovir (denavir)

53
Q

What therapy is effective for reoccurrent herpes libialis (oral HSV-I) in immunocompromised adults?

A

Penciclovir 1% topical cream

54
Q

Penciclovi 1% topical cream must be administered how to be effective?

A

1) Within an hour of eruption

2) Applied every 2 hours during waking hours for 4 days

55
Q

Trifluridine (virpotic) is actually…

A

tri-fluro-thymidine

56
Q

Trifuluridine MOA?

A

1) It is phosphorylated by CELLULAR TK
2) and becomes incorporated into BOTH viral and chromosomal DNA
3) This is why it cannot be used systemically!!**
4) So, it inhibits viral DNA synthesis

57
Q

Trifluridine is an effective treatment for what?

A

1) viral keratoconjunctivitis (eye infxn)

2) recurrent epithelial keratitis due to HSV-1 and HSV-2

58
Q

How should Trifluridine be used?

A

as a topical 1% solution

59
Q

What can be used in conjunction with INF-a for acyclovir resistant HSV?

A

Trifluridine

60
Q

Docosonal is a what?

A

saturated 22-carbon aliphatic alcohol

61
Q

How is Docosonal available?

A

an OTC 10% cream for topical application

62
Q

Docosonal MOA?

A

inhibits fusion b/w the plasma membrane and HSV envelope, preventing viral entry into the cells

63
Q

You must use Docosonal when?

A

As soon as you have symptoms!

64
Q

Docosonal (abreva) shortens duration of…

A

recurrent oro-labial herpes (oral herps, HSV-1)

Pharmacology #1 (15 decks)

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