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Pharm 585 > MCP Antivirals/Antifungals > Flashcards

MCP Antivirals/Antifungals Flashcards

1
Q

Oseltamivir

A

Tamiflu®

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2
Q

Docosanol

A

Abreva®

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3
Q

Acyclovir

A

Zovirax®

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4
Q

Valacyclovir

A

Valtrex®

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5
Q

Famciclovir

A

Famvir®

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6
Q

Miconazole

A

Monistat®

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7
Q

Terconazole

A

Terazol®

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8
Q

Tioconazole

A

Vagistat®

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9
Q

Ketoconazole

A

Nizoral®

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10
Q

Clotrimazole

A

Lotrimin®

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11
Q

Fluconazole

A

Diflucan®

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12
Q

Itraconazole

A

Sporanox®

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13
Q

Voriconazole

A

VFEND®

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14
Q

Terbinafine

A

Lamisil®

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15
Q

Nystatin

A

Nystop®

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16
Q

Griseofulvin

A

Grifulvin V® or Gris-PEG®

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17
Q

Influenza: Morbidity/Mortality; Surface proteins targeted in treatment

A
  • Greater than 30,000 deaths/year
  • Hemagglutinin
    • allows virus to enter host cells
  • Neuraminidase
    • Allows release of new viral particles from host cells
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18
Q

Signs and Symptoms of Influenza

A
  • Rapid onset of fever
  • Myalgia
  • Headache
  • Non-productive cough
  • Sore throat
  • Rhinitis
  • Symptoms resolve 3-7 days
    • Cough and malaise may persist for >2 weeks
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19
Q

Influenza: Pathogenesis

A
  • Transmission via inhalation of respiratory droplets
  • Incubation period 1-4 days (2 day average)
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20
Q

Flu Prevention Strategies

A
  • Vaccination
    • Best way to prevent morbidity/mortality
  • Hand Hygiene
  • Respiratory etiquette
  • Contact avoidance
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21
Q

Tamiflu: MOA, take w/i…

A
  • Oseltamivir
  • Neuraminidase inhibitor to prevent release of virus from cell
  • Take w/i 48 hours of start of symptoms or else benefits go down
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22
Q

Tamiflu Treatment Benefits

A
  • Viral replication decreased
  • Reduces duration of illness by 1 day
  • May reduce bronchitis, sinusitis, otitis media, antibiotic use, hospitalization, and pneumonia
  • Reducation in societal costs associated with flu
23
Q

Who should get Tamiflu

A
  • Very old: >75 yo
  • Very young: <2 yo
  • Hospitalized
  • High risk patients
  • Important to follow these guidelines, especially during shortages.
24
Q

Tamiflu SE

A
  • Nausea
  • Vomiting
  • Neuropsychiatric events
    • very rare
    • confusion, delirium, self-injury
    • younger kids of Japanese decent at higher risk
25
Q

Dosing for Tamiflu: Treatment, prophylaxis, starting, dose adjustment

A
  • Effective for Influenza A and B for patients age 1 and older
    • Treatment: 75 mg PO BID x 5days
    • Prophylaxis: 75 mg PO QD x10 days
    • must be used within 48 hours of symptom onset
    • Dose ajust for CrCL <30mL/min and children <40kg
26
Q

Tamiflu Formulations/Administration

A
  • Capsules
  • Suspension: 6mg/mL
    • Fridge (17 days)
    • Room Temp (10 days)
  • Shake well and may take with or without food
27
Q

Current Flu Season

A
  • Predominant Strain
    • H3N2
    • Suseptible to Oseltamivir and Zanamivir (Relenza)-oral inhalation
  • Vaccination best way to prevent infection
    • H1N1
    • H3N2
    • B strain
    • CDC does not recommend quadravalent over trivalent, extra B not better
  • This year 90% A and 10% B strain.
    • 99% H3N2 and 1% H1N1
    • 67% A strain has mutated
      *
28
Q

Herpes Simplex Virus 1

A
  • Herpes labialis (cold sores)
29
Q

Herpes Simplex Virus 2

A
  • Herpes genitalis (genital herpes)
    • acquired through sexual contact
    • Can transmit infection while asymptomatic
30
Q

Herpes Zoster Virus

A
  • Primary infection–>Varicella–>Chickenpox
  • Reactivation–>herpes zoster–>Shingles
  • Vaccines available
31
Q

MOA Abreva

A
  • Docosanol
  • Inhibits fusion of HSV envelope with cell membrane to stop spread of virus
  • Take at start of symptoms
32
Q

MOA Acyclovir

A
  • Intracellulary phosphorylated by viral thymidine kinase, then converted to triphosphorylated acyclovir by host cell kinase
  • Incorporated into viral DNA and causes strand termination and cell death
33
Q

MOA Valacyclovir

A
  • Prodrug of acyclovir
  • Better bioavailability (3-5x)
34
Q

MOA Famciclovir

A
  • Prodrug converted to penciclovir (Denavir®)
  • Denavir is an older topical cream
35
Q

Herpes Antiviral Therapies

A
36
Q

Herpes Genitalis: Dosing/Drug

A
  • Acyclovir
    • Initial:
      • 200mg 5x/d for 7-10 days
      • 400mg TID for 7-10 days
    • Recurrent:
      • 200mg 5x/d for 5 days
      • 400mg TID for 5 days
    • Chronic
      • 400mg BID​
  • ​Valacyclovir
    • Initial:
      • 1g BID for 10 days
    • Recurrent:
      • 500mg BID for 5 days
    • Chronic
      • 500-1000mg QD
  • ​Famyclovir
    • Initial:
      • 250mg TID for 7 days
    • Recurrent:
      • 200mg 5x/d for 5 days
      • 400mg TID for 5 days
    • Chronic:
      • 400mg BID
37
Q

Herpes Labialis: Dosing/Drug

A
  • Acyclovir
    • 400mg 5x/d for 5 days
  • Valacyclovir
    • 2g BID for 1 days
  • Famcyclovir
    • 1500mg x 1 dose
38
Q

Herpes Zoster: Dosing/Drug

A
  • Acyclovir
    • 800mg 5x/d for 7-10 days
  • Valacyclovir
    • 1g TID for 7 days
  • Famciclovir
    • 500mg TID for 7 days
39
Q

Varicella: Dosing/Drugs

A
  • Acyclovir
    • 800mg QID for 5 days
      ​
40
Q

Herpes Antiviral Therapies Dosing

A
41
Q

Herpes Antiviral Therapies: Counseling Pearls

A
  • Docosanol (Abreva)-OTC cream indicated for herpes labialis
    • Use at first sign of reactivation
    • Apply 5 times a day (max 10 days)
  • Acyclovir, valacyclovir, famciclovir
    • Take with full glass of water/drink plenty of fluids
      • Prevents crystals from forming in kidneys
    • ​Initiate therapy within 24 hours of symptom onset (genitalis/varicella)
      • Initiate 48-72 hours after sign of rash (herpes zoster)
  • ​Higher doses for treatment of herpes zoster could cause N/V/D, constipation, headache
  • Chronic suppressive therapy for herpes genitalis
    • Recommended for individuals with 6 or more outbreaks per year
    • Decreases reoccurence by 70-80%
    • Stress safe sex practices
      • Disease can be transmitted in absence of symptoms
    • Reassure patients that minimal risk with long term therapy
  • Encourage adherance to daily suppressive therapy
    • Valacyclovir QD dosing vs. acyclovir BID times a day dosing.
      ​
42
Q

Vulvovaginal Candidiasis: Overview

A
  • Most common vaginal infection affecting women of childbearing age
    • Up to 75% of women-1 episode (50% more than 1 episode)
  • Normal vaginal flora (Candida) can become pathogen during a change in the vaginal environment
    • Antibiotic therapy
    • High levels of estrogen
    • Immune status
    • Vaginal pH
    • Pregnancy
  • Candida albincans is responsible for 80-90% of all infections
43
Q

Vulvovaginal Candidiasis: Complicated/Uncomplication

A
  • Uncomplicated:
    • Sporadic episodes
    • Mild symptoms
    • Majority of episodes are considered uncomplicated
  • Complicated
    • Reurrent (4 or more episode/yr)
    • Severe symptoms
    • Non-albican species
    • Immunocompromised
    • Pregnancy
    • Unconrolled diabetes
44
Q

Vulvovaginal Candidiasis: Treatment

A
  • ​Uncomplicated:
    • Topical antifungal x 1 dose, 3 days, or 7 days
    • All regiments equally effective
    • Price varies
    • Topical preferred over PO
    • Oral fluconazole: 150mg x 1dose
  • Complicated:
    • Severe Infection:
      • Topical antifungal x 7-14 days
      • PO Fluconazole 150mg x 3 doses
    • Pregnancy:
      • Topical antifungal x 7days
    • ​​Uncontrolled Diabetes:
      • Topical or PO x 7-14days
    • Recurrent:
      • Topical or PO x 7-14days
      • Maintenance fluconazole 150mg weekly times 6 months
45
Q

Vulvovaginal Candidiasis Therapies

A
46
Q

Oropharyngeal and esophageal candidiasis

A
  • Infection can spread from oral mucosa into esophagus
  • Risk factors; inhaled corticosteroids, antibiotics, smoking, immunocompromised.
47
Q

Dermatophytes

A

Ring-shaped, erythematous; well demarcated, scaly to vesicular region accomplished by puritis

48
Q

Antifungal Medications: Organized by MOA

A
  • Damage Fungal Cell Wall
    • Azole Antifungals
      • Ketoconazole
      • Clotrimazole
      • Fluconazole
      • Itraconazole
      • Voriconazole
    • Terbinafine
    • Nystatin
  • Inhibit mytosis
    • Griseofulvin
49
Q

Antifungal Medication Formulations

A

Focus on which are OTC and what are topical

50
Q

Antifungal Indication and Treatment Durations

A

Focus on Duration of Therapy

51
Q

Counseling Pearls: Azole Antifungals

A
  • Adverse reactions: N/V/D
  • Drug interactions: strong CYP3A4 and 2C9 inhibitor
    • oral contraceptives
    • Simvastatin
    • Warfarin
  • Take voriconazole 1-2 hours before meal
  • Ketoconazole and itraconazle need acid for absoroption (separate by antacide by 2 hours)
  • Monitor liver function
52
Q

Counseling Pearls: Terbinafine

A
  • Improvement in nailbeds may take months; cure rate approximately 40-75% of patients
  • Adverse reactions:
    • N/V/D, disorder of taste, indigestion, headache
  • Monitor liver function: report persistent nausea, fatigue, vomiting, dark urine, right upper abdominal pain, or jaundice
53
Q

Counseling Pearls: Griseofulvin

A
  • Drug of choice for tinea capitis
  • Adverse effects:
    • Rash, headache, photosensitivity, N/V/D, dizziness, drowsiness
  • Interactions:
    • Birth control pills: decreases effectiveness
    • Alcohol: flushing, tachycardia
  • Take with fatty meal to increase absorption

Pharm 585 (13 decks)

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