Mon Test- week 4 day 2- pharma

Question 1

What are the general mechanisms antivirals act? 6 things

Answer 1

Block:

1) viral attachment to cell membrane
2) entry of cell via endocytosis or fusion
3) uncoating of virus
4) viral DNA or RNA replication (and transcription for retroviruses)
5) viral protein synthesis by cell
6) viral exit from cell

Question 2

Are antivirals effective agains latent viruses?

Answer 2

no, only actively replicating

Question 3

What are the main difference in DNA and RNA viruses regarding prevention and tx?

Answer 3

DNA: Easier to prevent with vaccines vs RNA viruses due to relative stability of DNA viruses. More treatments than for RNA viruses.

RNA: Fewer treatments compared to DNA viruses
– Breakthrough in hepatitis C treatment in last decade
– Antiretroviral treatment now highly effective

Question 4

What are the three most common agents for antiretroviral therapy?

Answer 4

1. reverse transcriptase inhibitor (RTI)
2. protease inhibitor (PI)
3. integrase strand transfer inhibitor

Question 5

What is contemporary antiretroviral therapy?

Answer 5

uses combinations of 2 or 3 agents to maximize suppression and minimize ADRs

Question 6

What are the ADRs with antiretroviral therapy?

Answer 6

1. Metabolic effects (e.g., fat redistribution, immune reconstitution syndrome) with NRTIs, NNRTIs, PIs
2. Glucose metabolism abnormalities, osteoporosis, QTc prolongation with PIs

Question 7

What are DDIs with antiretroviral agents?

Answer 7

almost none for NRTIs (Nucleoside reverse transcriptase inhibitors) , but many for other agents.

Check with pharmacist when considering prescribing a macrolide (bacterial infection) or triazole (fungal infection)

Question 8

two drugs you should be careful prescribing and consult with pharmacists for people on antiretroviral therapy

Answer 8

macrolide (bacterial inf) and triazole (fungal)

Question 9

What is the most common class of drugs used in combination therapy for people with HIV?

Answer 9

NRTI (emtricitabine and TDF/TAF)

Question 10

What are the main mechanism of action for herpes virus agents?

Answer 10

most agents are nucleoside inhibitors, competitively binding during DNA transcription and thus terminating it

Question 11

4 main herpes agents and their benefits?

Answer 11

1. Acyclovir (less side effects)
2. Valacyclovir (more absorbtion)
3. Famcyclovir single oral dose but more side effects
4. Docosanol - OTC

Question 12

what are herpes agents ADRs?

Answer 12

nausea, headache (lower incidence with acyclovir)

Question 13

what are herpes agents DDIs?

Answer 13

: few with acyclovir/valacyclovir (weak CYP 1A2 inhibitors), famciclovir: almost none

Question 14

Which herpes agent is safe to use during pregnancy and lactation?

Answer 14

acyclovir

Question 15

What are the. herpes agents for HSV1, HSV2, VZV, EBV, CMV?

Answer 15

• HSV-1 and HSV-2: acyclovir/valacyclovir, famciclovir
• VZV: acyclovir (chickenpox and shingles), valacyclovir (shingles), famciclovir (shingles)
• EBV: no agent approved for EBV—supportive care only
• CMV: valgancyclovir (immunosupression is main concern)

Question 16

What is MOA for influenza drugs?

Answer 16

blocks viral RNA transcription and replication (baloxavir) or inhibit virus exit from cell (amivers)

Question 17

Three agents for influenza infection?

Answer 17

1. oseltamivir
2. zanamivir b
3. baloxavir single dose, less efficient but less side effects

Question 18

Influenza agents ADRs?

Answer 18

nausea, vomiting, headache (minimal for baloxavir)

Question 19

Influenza agents DDIs?

Answer 19

nothing

Question 20

What influenza agent is safe diring pregnancy?

Answer 20

Oseltamivir (tamilfu)

Question 21

When should one start antiviral flu therapy?

Answer 21

Start treatment within 2 days of symptoms in otherwise healthy patients; in patients at high risk of severe illness there is benefit seen even at start 5 days after symptom onset; later start OK in immunocompromised; longer therapy needed

Question 22

HepC agents MOA?

Answer 22

multiple MOAs for the 3 classes of agents; referred to as “direct acting antivirals” (DAAs); these agents are not taken up by non-infected cells

Question 23

three classes of drugs for HepC? What do they end with to easier figure out a class? how long is the tx?

Answer 23

1. NS3-4 protease inhibitors; suffix is -previr
2. NS5a inhibitors; suffix is -asvir
3. NS5b nucleoside/non-nucleoside inhibitors; suffix is –buvir

Used in combinations typically, 8-12 weeks

Question 24

ADRs of hepC agents?

Answer 24

fatigue, headache, insomnia

Question 25

DDIs of hepC agents?

Answer 25

potential for many; most are 3A4 substrates

Question 26

What is considered to be mild covid disease?

Answer 26

Fever, cough, sore throat, diarrhea; normal O2 sat & CXR, no tx

Question 27

What is considered to be moderate covid disease and what is the tx?

Answer 27

Mild disease + LRTI on CXR or O2 sat ≥ 94% room air

tx: Monoclonal antibody if risk factors

Question 28

What is considered to be severe covid disease and what is the tx?

Answer 28

Moderate disease + O2 sat < 94% or CXR ≥ 50% infiltrates

Remdesivir ± steroid ± tocilizumab

Question 29

What is considered to be critical covid disease and what is the tx?

Answer 29

Septic shock, intubated and or multisystem organ failure

tx: Steroid + tocilizumab + anticoagulation

Question 30

viral infections that are vaccine preventable?

Answer 30

• Norovirus: gastrioenteritis
• URTI “cold” COVID
• Ebola (Filoviridae)
• Yellow fever (Flaviviridae)
  Influenza (Orthomyxoviridae)
• Mumps and measles (Paramyxoviridae)
• Hep A and polio (Picornaviridae)
• Rotavirus: gastroenteritis (Reoviridae)
• Rabies (Rhabdoviridae)
• Rubella (Togaviridae)
• HepB (hepadnaviridae) ,
• VZV,
• papillomaviridae (genital warts),
• Poxviridae (smallpox)
  *