Pharm - Antivirals Flashcards by Anishya Idicula

Classes of antiviral medications

Nucleoside reverse transcriptase inhibitors (NRTIs)
Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
Integrase inhibitors
Protease inhibitors

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Recommended initial ART regimens for HIV

Integrase inhibitor
(dolutegravir/abacavir/lamivudine)

Integrase inhibitor (Dolutegavir) + NRTI
(tenovir/emtricitabine)

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Antiretroviral therapy for HIV is intended to be

polytherapy

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Tenofovir (disoproxil fumerate/TDF or alafenamide/TAF) class

NRTI

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Tenofovir adverse effects

Renal insufficiency, much improved with TAF

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Special considerations for tenofovir

Use with emtricitabin for pre-exposure prophylaxis and post exposure prophylaxis

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Name 2 combinations Tenofovir products

Emtricitabine + TDF (Truvada)
Emtricitabine + TAF (Descovy)

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Emtricitabine (Emtriva) class

NRTI

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Adverse effects of emtricitabine

Hyperpigmentation of palms
Skin discoloration

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Zidovudine (Retrovir) class

NRTI

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Adverse effects of Zidovudine

Bone marrow suppression, anemia

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Special considerations for Zidovudine (Retrovir)

Caution with Epivir HBV
Renal dose adjustments

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Efavirance (Sustiva) class

NNRTI

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When is efavirance (sustiva) taken?

At bed time

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Should efavirance (sustiva) be taken on a full or empty stomach

Empty stomach

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Adverse effects of efavirance

CNS effects (drowsiness, lucid dreams, nightmares)
Rash
Elevated LFTs
Teratogenic
False positive cannabinoid test

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Efavirance can be formulated with _______ and ________ (ATRIPLA)

Tenofovir DF, emtricitabine

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Rilpivirine (Edurant) dosing consideration

Not for use in high viral loads

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Rilpivirine drug interactions

Avoid use with PPIs

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Issues with the protease inhibitor class

Drug interactions
Metabolic syndrome
Hepatotoxicity
GI intolerance
Osteopenia/osteoporosis

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Atazanavir (Reyataz) class

Protease inhibitor

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Special considerations for atazanavir

Avoid with PPIs

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Adverse effects of Atazanavir

Indirect hyperbilirubinemia
Lack of effect on lipids

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Darunavir (Prezista) class

Protease inhibitor

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Special considerations with Darunavir

Caution with sulfa allergic patients

Adverse effects of Darunavir (Prezista)

Rash (7%) Hepatotoxicity

Dolutegravir (Tivicay) class

Integrase inhibitor

Special considerations for Dolutegravir

Increased creatine kinase Weight gain (particularly in women and AA/Hispanic populations)

Bictegravir class

Integrase inhibitor (newest)

Special considerations for Bictegravir

Drug interactions Increase CK (4%)

Recommended initial treatment for HIV

Integrase inhibitor + NRTI

Cabotegravir and Rilpivirine (Cabenuva) come in what formulation

Extended Release injectable suspension

Indication for Cabotegravir and Rilpivirine

Replace antiretroviral regimen in persons with HIV RNA <50 copies/ml (LOW VIRAL LOAD) On stable antiretroviral regimen No history of treatment failure No known or suspected resistance to Cabotegravir or Rilpivirine

Oral Cabotegravir and Rilpivirine used and dosed when

28 day oral lead-in phase prior to starting injections

HSV and VZV are ___________ viruses

DNA

Treatments for HSV and VZV are _____________

Virustatic Arrest DNA synthesis by inhibiting viral DNA pol

When must antiviral therapy be initiated in HSV and VZV?

Within 48-72 hours of rash onset

Acyclovir MOA

Inhibition of viral replication

Special considerations for acyclovir

Specific roles for topical vs IV therapy Patient expectations (not curative)

Valacyclovir (Valtrex) is considered a _________ drug

Prob

Special considerations for Valacyclovir dosing

Less frequent dosing than acyclovir Higher plasma concentrations than acyclovir

Famiciclovir (Famivir) MOA

Completely inhibits viral DNA pol

Topical agents for HSV/VZV

Penciclovir (Denavir) - oral herpes Docosonal (Abreva) Trifluridine (Viroptic)

For genital herpes, will a topical or oral antiviral agent be given?

ORAL (Acyclovir/Valacyclovir)

CMV is a _________ virus

DNA

CMV typically results from reactivation in ____________ patients

immunocompromised (HIV, transplant)

Adverse effects of Ganciclovir (Cytovene)

Black box warning: bone marrow toxicity (check CBC), cause marked neutropenia

Special considerations for Ganciclovir (Cytovene)

Aggressive hydration (can become dehydrated due to crystallization in renal tubules) Monitor renal function accordingly Avoid direct contact with skin (extremely alkaline)

Special considerations for Valganciclovir (Valcyte)

PO only Look/sounds like Valacyclovir - caution!

Drug of choice for Tx and Px of CMV retinitis

Valganciclovir (Valcyte)

Foscarnet (Foscavir) is has a broad spectrum of coverage, against

HSV, VZV CMV, influenza, HIV

Adverse effects of Foscarnet

Highly nephrotoxic

How do you combat the nephrotoxicity associated with Foscarnet

Infuse slowly over 1.5-2 hours (never IV bolus)

Agents utilized in Tx of HBV infection

PO -Tenofovir, entecavir SubQ -Interferon Alfa

Adverse effects of Entecavir (Baraclude)

Dizziness, fatigue

Lamivudine (Epivir HBV) used to treat

HBV

Special considerations for Lamivudine

Epivir HBV is dosage form However, resistance is COMMON

Adverse effects of Interferon alfa for HBV treatment

Flu-like prodrome (in almost 100% of people) -HA, myalgia, arthalgias, fatigue, malaise,fever,chills Improves as treatment continues

Contraindications to interferon for HBV infection

Hepatic decompensation Autoimmune disease History of arrhythmia Pregnancy

Is Hep C cureable?

Yes

Special considerations for Sofosbuvir (Sovaldi)

Pan geno-typic activity (Covers every stain of Hep C!) However, $$$$

Dosing for Sofosbuvir/Velpatasvir (Epclusa)

12 weeks for patients with or without compensated cirrhosis 12 weeks with Ribavirin in those with decompensated cirrhosis

Treatment duration for Glecaprevir/Pibrentasvir (Mavyret)

8 weeks (shorter)

Special considerations for Ribavirin

Pregnancy category X! Avoid in pregnant and 6 months after treatment!

Components of monitoring when building a treatment regimen

HCV RNA (viral load) every 4 weeks during treatment Check at 1 mo and 3 mo after completion to assess SVR

Influenza is a single strand ______ virus

RNA

Two surface antigens associated with influenza virus

Hemagglutinin (H1 to H16) Neuraminidase (N1 to N9)

Complications of influenza infection

Viral pneumonia Secondary bacterial pneumonia, sinusitis, otitis Exacerbation of other medical conditions

Best method of influenza prevention

Vaccination

Amantadine (symmetrel) used to treat

influenza

Adverse effects associated with Amantadine (symmetrel)

CNS toxicity (increased in elderly) Dry mouth, nausea, anorexia

Special considerations for Amantadine (symmetrel)

No longer recommended for influenza prophylaxis Used to treat Parkinson’s disease and drug induced EPS (extrapyramidal symptoms)

Rimantadine (Flumadine) adverse effects

Less CNS effects than amantadine

Important dosing note for oseltamivir (Tamiflu)

Must initiate treatment within 48 hours of symptom onset to decrease illness duration by 1-2 days

Oseltamivir (tamiflu) MOA

Neuraminidase inhibitor

Adverse effects of Zanamivir (Relenza)

Cough, bronchospasm (Caution in COPD/asthmatic patients)

Peramivir (Rapivab) dosing considerations

600 mg IV single dose (usually in ER setting) Only for acute (<2 days), uncomplicated influenza in adults

Baloxavir (Xofluza) dosing considerations

PO single dose 40 mg (40-80 kg) PO single dose 80 mg (>80 kg)

Special considerations for Baloxavir (Xofluza)

Avoid concomitant use with polyvalent cations