Nucleotide Analogues

Question 1

Examples:

Answer 1

1. Acyclovir
2. Valcyclovir
3. Ganciclovir

Question 2

MOA:

Answer 2

1. Nucleotide analogue
2. Blocks replication of viral DNA or RNA
3. Inhibits viral replication

Question 3

Spectrum:

Answer 3

1. HSV 1 & 2
2. VZV (chickenpox, shingles)
3. CMV - Ganciclovir

Question 4

Indications:

Answer 4

1. Genital herpes (HSV type 2) - Valacyclovir
2. Recurrent genital herpes - oral Acyclovir
3. Shingles - high dose Acyclovir
4. Chickenpox within 24 hours after rash in children, adolescents & adults - high dose Acyclovir
5. HSV encephalitis - IV Acyclovir
6. Severe VZV infections (localised & disseminated) - IV Acyclovir
7. Severe CMV disease (retinitis, colitis) in immunocompromised - Ganciclovir, Valganciclovir

Question 5

Acyclovir: S/E:

Answer 5

1. GI upset
2. Diarrhoea
3. Vertigo
4. Arthralgias
5. Myalgias
6. Neurotoxicity (hallucinations, involuntary movements) -IV Acyclovir

Question 6

Ganciclovir S/E:

Answer 6

1. Neutropenia
2. Thrombocytopenia
3. Anaemia
4. GI upset
5. Seizures
6. Confusion

Question 7

Stewardship:

Answer 7

1. Monitoring renal Fx
2. Risk of interstitial nephritis & crystalline nephropathy