Pharm-Antivirals Flashcards
Acyclovir indications
Shingles, Chicken pox
Cidofovir indications
Pox, HHV6-8
Famciclovir indications
Shingles and HHV8 (Z8)
Foscarnet indications
HHV6
Ganciclovir indications
HHV6, HHV8
Valacyclovir indications
Shingles, chicken pox, HHV8
Valganciclovir indications
HHV6, HHV8 infection
Pox virus family treatment options
cidofovir
Varicella treatment options
acyclovir, valacyclovir
Chicken pox treatment options
Acyclovir, valacyclovir
HHV6 treatment options
Cidofovir, foscarnet, ganciclovir, valganciclovir
HHV7 treatment options
Cidofovir
HHV8 treatment options
ganciclovir, valacyclovir
HHV8 infection treatment options
Ganciclovir, valganciclovir
Which two drugs are prodrugs
Valacyclovir, valganciclovir
Which drug is metabolized to another active drug
Famciclovir to penciclovir
What are the two main mechanisms of action for these drugs
Competes with deoxyGTP or with deoxyCTP for incorporation into viral DNA
Which drugs competes with deoxyCTP
Cidofovir
Which drug also inhibits reverse transcriptases?
Foscarnet
Acyclovir MOA
competitive inhibitor of DNA pol as a deoxyGTP analog
Famciclovir MOA
competitive inhibitor of DNA pol as a deoxyGTP analog
Ganciclovir MOA
competitive inhibitor of DNA pol as a deoxyGTP analog
Valacyclovir MOA
competitive inhibitor of DNA pol as a deoxyGTP analog
Valganciclovir MOA
competitive inhibitor of DNA pol as a deoxyGTP analog
Cidofovir MOA
competitive inhibitor of DNA pol as a deoxyCTP analog
Foscarnet MOA
competitive inhibitor of pyrophosphate binding site of DNA pol, making triphosphates unusable; also blocks reverse transcriptase
Which drugs do not require sequential phosphorylation to triphosphate form for activation?
Cidofovir and foascarnet
What is the significance of requiring triphosphorylation to active form?
Viruses lacking kinases will fail to alter drug to active form
Describe the meta/elim of the antivirals
Mostly unchanged; renal elimination thus requiring dose adjustment
Describe the cross-reaction hypersensitivity of the antivirals?
Allergic to one, allergic to all!
Which drug has the mildest AEs?
Famciclovir (everybody loves family values)
Acyclovir AEs
Neurotoxic inc seizure (makes you go crACY)
Cidofovir AEs
Nephrotoxic; give with probenecid and hydration to minimize
dose-dependent renal tubular necrosis (proximal tubule cell injury) beginning as soon as the first one or two doses
Famciclovir AEs
none…
Foscarnet AEs
Electrolytes - specifically chelates Ca2+ (FosCA2+rnet)
Ganciclovir AEs
Anemia, pancytopenia or indiv cell line, teratogenic
Valacyclovir AEs
Same as acyclovir, neurotoxicity w/ seizure
Valganciclovir AEs
Same as ganciclovir, anemia, pancytopenia or indiv cell line, teratogenic
These two drugs are neurotoxic
(CR)ACYclovir & ValACYclovir
These two drugs cause anemia, pancytopenia, and are teratogens
Ganciclovir & Valganciclovir