Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

840 > Non-HIV Antivirals > Flashcards

Non-HIV Antivirals Flashcards

1
Q

CMV

A

Cytomegalovirus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

HSV

A

Herpes Simplex Virus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

VZV

A

Varicella Zoster Virus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

HAV/HBV/HCV

A

Hepatitis A/B/C Virus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Antiviral Target Sites

A
  • Crucial for viral infection
  • Intracellular organisms whose replication depends on host cell machinery
  • Antivirals only work on active, replicating viruses
  • Antivirals work at site of viral attachment/entry, uncoating, nucleic acid synthesis, transcription/translation, packaging/assembly, and release
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Influenza

A
  • Single-stranded RNA virus
  • Antigenic differences: A (pandemic causing) and B
  • Frequent antigenic variation: Drifts and Shifts
  • Drifts (epidemics) - minor changes like point mutations
  • Shifts (pandemic): major genetic change resulting in alterations of antigen structure cause by reassortment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Neuraminidase Inhibitors

A
  • Interfere with viral release from host cells
  • Activate against Influenza A and B
  • Work at site of packaging/assembly and release
  • Potential neuropsychiatric events (confusion, delirium, hallucination)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Neuraminidase Inhibitor Examples

A
  • Oseltamivir (Tamiflu): activated by hepatic estrases, excreted by kidney, AE: GI upset/HA
  • Zanamivir (Relenza Diskhaler): concentrated in respiratory tract, AE: bronchospasm (Not recc for asthma/COPD)
  • Peramivir (Rapivab): single IV dose, AE: diarrhea, skin hypersensitivity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Xofluza

A
  • Baloxavir Marboxil
  • First influenza drug approved by FDA
  • MoA: Endonuclease inhibitor, inhibits endonuclease cleavers from influenza, no viral mRNA leads to no infection
  • Single oral dose
  • Hepatic metabolization and excretion
  • Avoid dairy products
  • AE: secondary bacterial infections
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Herpes Virus

A
  • Large, double-stranded DNA genome with icosahedral capsid/envelope
  • HSV1: typically oral
  • HSV2: anogenital ulcers
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Varicella Zoster Virus

A
  • Commonly known as chickenpox

- Later emerges as herpes zoster (shingles)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Cytomegalovirus

A
  • Infects severely immunocompromised patients (organ transplants)
  • Infect often results in viral reactivation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Nucleoside Analogs + HSV 2

A
  • Acyclovir and Valacyclovir

- MoA: prevent viral replication, incorporated into growing DNA strands and acts as chain terminators

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Acyclovir

A
  • Zovirax
  • Topical or IV
  • Activation by viral kinase
  • Host enzymes convert to di- then tri-phosphate form where it competes for viral DNA polymerase
  • Resistance occurs by alteration of viral TK or DNA polymerase
  • Poorly absorbed (several small doses), excreted by urine
  • AE: GI upset, neurotoxicity, renal impairment
  • Monitoring: Urinalysis, BUN, SCr, LFTs, CBC
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Valacyclovir

A
  • Valtrex
  • Prodrug of acyclovir
  • Converted by 1st pass or hepatic metabolism
  • Higher [plasma] than acyclovir
  • Rapid GI absorption
  • Excreted by urine
  • AE: thrombotic thombocytopenic purpura, hemolytic uremic syndrome, renal impairment
  • DDI: cimetidine, probenecid
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Nucleoside Analogs + CMV

A
  • Ganciclovir (Cytovene)
  • Valganciclovir (Valcyte)
  • Refractory options: Foscarnet (Foscavir), Cidofovir
  • Prophylaxis: Letermovir (Prevymis)
17
Q

Ganciclovir

A
  • Cytovene
  • MoA: completes with dGTP for viral DNA polymerase incorporation into viral DNA
  • Resistance: mutations in viral DNA polymerase
  • Excretion: urine
  • AE: GI upset, myelosuppresion, infection, fever, increased SCr
  • Boxed warning: hematologic toxicity, impairment of fertility, fetal toxicity, mutagenesis/carcinogenesis
  • Monitoring: CBC with differentials/platelet counts, SCr, ophthalmic exams if retinitis
18
Q

Valganciclovir

A
  • Valcyte
  • Prodrug of ganciclovir
  • Once daily tablet
  • 60% bioavailability when taken with food
  • Renally eliminated
19
Q

Foscarnet

A
  • Foscavir
  • Used for refractory cases of CMV
  • MoA: noncompetitive inhibitor of viral DNA polymerase
  • IV
  • Excretion: renally
  • Boxed warning: Renal impairment, seizures
  • AE: HA, fever, GI upset, electrolyte imbalance, anemia, QTc prolongation
  • Monitoring, CrCl, ECG, electrolytes, CBC
20
Q

Cidofovir

A
  • Used for refractory cases for CMV
  • IV
  • MoA: selective inhibitor of viral DNA synthesis
  • Renally eliminated
  • Boxed Warning: nephrotoxicity, neutropenia, carcinogenic/teratogenic
21
Q

Hepatitis Types

A
  • Type A is acute and self-limiting
  • B and C can be acute and can lead to chronic infection, cirrhosis, liver cancer, and death
  • HAV/HBV are vaccine preventable
22
Q

HAV

A
  • Non-enveloped
  • Single stranded positive sense RNA virus
  • Supportive Care
23
Q

HBV

A
  • Enveloped
  • Partially double-stranded DNA virus
  • 2-10% of acute infections lead to chronic infections
  • Viral DNA can insert into human chromosome and reactivate later
  • Use reverse transcription
24
Q

HCV

A
  • Enveloped
  • Single stranded positive sense RNA virus
  • Chronic infection
  • Curable
  • Untreated HCV clearance believed to be 20-35%
  • Treatment goal: Viral eradication
25
Q

HBV Chronic Treatment Goals

A
  • Suppression of HBV DNA to undetectable levels
  • Seroconversion of HBeAg from positive to negative (present when HBV is replicating)
  • Reduction in elevated serum aminotransferase levels (ALT, AST)
26
Q

HBV First-line Treatment Options

A
  • Nucleoside Reverse Transcriptase Inhibitors (NRTI)

- EX: Tenofovir (TDF/Viread and TAF/Vemlidy) and Entecavir (ETV/Baraclude)

27
Q

NRTIs+ HIV

A
  • Test all patients for HIV before starting therapy
  • Most HBV drugs have activity against HIV
  • HBV can be treated with 1 drug but HIV must have multiple
28
Q

Viread

A
  • Tenfovoir disproxil fumarate (TDF)
  • Potent adenosine nucleotide analog
  • MoA: AMP analog inhibits HBV polymerase and therefore its replication
  • Boxed warning: post-treatment acute exacerbation of HBV
  • Resistance: low rate of emergence, mutation of HBV’s polymerase/reverse transcriptase
  • AE: GI upset, potential renal toxicity, bone loss
  • Eat with high fat meals
  • Excreted renally
29
Q

Vemlidy

A
  • Tenofovir alagenamide (TAF)
  • Prodrug
  • Allows delivery to lymphoid cells and hepatocytes
  • Reduced dosing and toxicity
  • P-gp substrate: don’t use with St. John’s wort, rifampin, or phenytoin
30
Q

Baraclude

A
  • Entecavir (ETV)
  • Cyclopentyl guanosine nucleoside analog that competitively inhibits HBV polymerase
  • MoA: Inhibits all three functions of HBV DNA polymerase (base priming, reverse transcription of negative strand, and synthesis of positive strand of HBV DNA)
  • Boxed warnings: severe/acute HBV exacerbations, HIV/HBV coinfection, lactic acidosis, hepatomegaly
  • Hepatic metabolism, renally eliminated
  • AE: hepatic impairment, ALT elevation, peripheral edema, pyrexia, ascites, hematuria, nephrotoxicity, increased SCr
31
Q

DAA + Suffix

A
  • Direct-acting Antivirals
  • previr: NS3/4A protease inhibitor
  • asvir: NS5A
  • buvir: NS5B
  • Preferred to use two drugs with different sites of actions
32
Q

DAA Similarities

A
  • Boxed warning: risk of HBV reactivation upon DAA cessation in coinfected patients (test for HBV before starting DAA for HCV)
  • Significant DDI: CI with CYP3A4 inducers, most increase [statin] and myopathy risk
33
Q

Mavyret

A

-Glecaprevir/pibrentasvir (G/P)
-Covers all HCV genotypes
-MoA: combination of NS3/4A PI and NS5A inhibitors
AE: HA, fatigue, GI upset, hypoglyceia in diabetics
-Take WITH food
-Hepatically metabolized and excreted

34
Q

Epclusa

A
  • Sofosbuvir/Velpatasvir
  • Covers all HCV genotypes
  • MoA: combines NS5B and 5A inhibitors
  • AE: HA, fatigue, GI upset, hypoglycemia in diabetics
  • Take with or without food
  • No PPIs!!! (CI)
  • P-gp and CYP metabolized
  • Urine and fecal elimination
35
Q

Ribavirin

A
  • RBV (Ribatol)
  • Given with Epclusa to improve cute rates in those with decompensated cirrhosis
  • MoA: guanosine analog, interferes with GTP synthesis, inhibits viral RNA-dependent polymerase and mRNA capping
  • Boxed Warning: Don’t use alone for HCV, hemolytic anemia, teratogenic, embryocidal
  • AE: CNS effects, GI upset, dematologic/hematologic effects, muscle weakness, hepatic toxicity
  • Don’t give with antacids
  • Hepatic and intracellular metabolism
  • Excreted in urine and feces
36
Q

Vosevi

A
  • MoA: Combination of PI, NS5A, and 5B inhibitors
  • Boxed warning: HepB reactivation
  • Administer with food
  • AE: Fatigue, HA, Nausea, diarrhea, insomnia
  • PKPD specific to each component

840 (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions