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Didactic Year > Pharm - Antivirals > Flashcards

Pharm - Antivirals Flashcards

1
Q

Classes of antiviral medications

A

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

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2
Q

Recommended initial ART regimens for HIV

A

Integrase inhibitor
(dolutegravir/abacavir/lamivudine)

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

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3
Q

Antiretroviral therapy for HIV is intended to be

A

polytherapy

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4
Q

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

A

NRTI

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5
Q

Tenofovir adverse effects

A

Renal insufficiency, much improved with TAF

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6
Q

Special considerations for tenofovir

A

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

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7
Q

Name 2 combinations Tenofovir products

A

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

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8
Q

Emtricitabine (Emtriva) class

A

NRTI

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9
Q

Adverse effects of emtricitabine

A

Hyperpigmentation of palms
Skin discoloration

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10
Q

Zidovudine (Retrovir) class

A

NRTI

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11
Q

Adverse effects of Zidovudine

A

Bone marrow suppression, anemia

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12
Q

Special considerations for Zidovudine (Retrovir)

A

Caution with Epivir HBV
Renal dose adjustments

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13
Q

Efavirance (Sustiva) class

A

NNRTI

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14
Q

When is efavirance (sustiva) taken?

A

At bed time

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15
Q

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

A

Empty stomach

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16
Q

Adverse effects of efavirance

A

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

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17
Q

Efavirance can be formulated with _______ and ________ (ATRIPLA)

A

Tenofovir DF, emtricitabine

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18
Q

Rilpivirine (Edurant) dosing consideration

A

Not for use in high viral loads

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19
Q

Rilpivirine drug interactions

A

Avoid use with PPIs

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20
Q

Issues with the protease inhibitor class

A

Drug interactions
Metabolic syndrome
Hepatotoxicity
GI intolerance
Osteopenia/osteoporosis

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21
Q

Atazanavir (Reyataz) class

A

Protease inhibitor

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22
Q

Special considerations for atazanavir

A

Avoid with PPIs

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23
Q

Adverse effects of Atazanavir

A

Indirect hyperbilirubinemia
Lack of effect on lipids

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24
Q

Darunavir (Prezista) class

A

Protease inhibitor

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25
Q

Special considerations with Darunavir

A

Caution with sulfa allergic patients

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26
Q

Adverse effects of Darunavir (Prezista)

A

Rash (7%)
Hepatotoxicity

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27
Q

Dolutegravir (Tivicay) class

A

Integrase inhibitor

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28
Q

Special considerations for Dolutegravir

A

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

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29
Q

Bictegravir class

A

Integrase inhibitor (newest)

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30
Q

Special considerations for Bictegravir

A

Drug interactions
Increase CK (4%)

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31
Q

Recommended initial treatment for HIV

A

Integrase inhibitor + NRTI

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32
Q

Cabotegravir and Rilpivirine (Cabenuva) come in what formulation

A

Extended Release injectable suspension

33
Q

Indication for Cabotegravir and Rilpivirine

A

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

34
Q

Oral Cabotegravir and Rilpivirine used and dosed when

A

28 day oral lead-in phase prior to starting injections

35
Q

HSV and VZV are ___________ viruses

A

DNA

36
Q

Treatments for HSV and VZV are _____________

A

Virustatic
Arrest DNA synthesis by inhibiting viral DNA pol

37
Q

When must antiviral therapy be initiated in HSV and VZV?

A

Within 48-72 hours of rash onset

38
Q

Acyclovir MOA

A

Inhibition of viral replication

39
Q

Special considerations for acyclovir

A

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

40
Q

Valacyclovir (Valtrex) is considered a _________ drug

A

Prob

41
Q

Special considerations for Valacyclovir dosing

A

Less frequent dosing than acyclovir
Higher plasma concentrations than acyclovir

42
Q

Famiciclovir (Famivir) MOA

A

Completely inhibits viral DNA pol

43
Q

Topical agents for HSV/VZV

A

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

44
Q

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

A

ORAL (Acyclovir/Valacyclovir)

45
Q

CMV is a _________ virus

A

DNA

46
Q

CMV typically results from reactivation in ____________ patients

A

immunocompromised (HIV, transplant)

47
Q

Adverse effects of Ganciclovir (Cytovene)

A

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

48
Q

Special considerations for Ganciclovir (Cytovene)

A

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

49
Q

Special considerations for Valganciclovir (Valcyte)

A

PO only
Look/sounds like Valacyclovir - caution!

50
Q

Drug of choice for Tx and Px of CMV retinitis

A

Valganciclovir (Valcyte)

51
Q

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

A

HSV, VZV
CMV, influenza, HIV

52
Q

Adverse effects of Foscarnet

A

Highly nephrotoxic

53
Q

How do you combat the nephrotoxicity associated with Foscarnet

A

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

54
Q

Agents utilized in Tx of HBV infection

A

PO
-Tenofovir, entecavir

SubQ
-Interferon Alfa

55
Q

Adverse effects of Entecavir (Baraclude)

A

Dizziness, fatigue

56
Q

Lamivudine (Epivir HBV) used to treat

A

HBV

57
Q

Special considerations for Lamivudine

A

Epivir HBV is dosage form
However, resistance is COMMON

58
Q

Adverse effects of Interferon alfa for HBV treatment

A

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

Improves as treatment continues

59
Q

Contraindications to interferon for HBV infection

A

Hepatic decompensation
Autoimmune disease
History of arrhythmia
Pregnancy

60
Q

Is Hep C cureable?

A

Yes

61
Q

Special considerations for Sofosbuvir (Sovaldi)

A

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

However, $$$$

62
Q

Dosing for Sofosbuvir/Velpatasvir (Epclusa)

A

12 weeks for patients with or without compensated cirrhosis

12 weeks with Ribavirin in those with decompensated cirrhosis

63
Q

Treatment duration for Glecaprevir/Pibrentasvir (Mavyret)

A

8 weeks (shorter)

64
Q

Special considerations for Ribavirin

A

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

65
Q

Components of monitoring when building a treatment regimen

A

HCV RNA (viral load) every 4 weeks during treatment

Check at 1 mo and 3 mo after completion to assess SVR

66
Q

Influenza is a single strand ______ virus

A

RNA

67
Q

Two surface antigens associated with influenza virus

A

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

68
Q

Complications of influenza infection

A

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

69
Q

Best method of influenza prevention

A

Vaccination

70
Q

Amantadine (symmetrel) used to treat

A

influenza

71
Q

Adverse effects associated with Amantadine (symmetrel)

A

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

72
Q

Special considerations for Amantadine
(symmetrel)

A

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

73
Q

Rimantadine (Flumadine) adverse effects

A

Less CNS effects than amantadine

74
Q

Important dosing note for oseltamivir (Tamiflu)

A

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

75
Q

Oseltamivir (tamiflu) MOA

A

Neuraminidase inhibitor

76
Q

Adverse effects of Zanamivir (Relenza)

A

Cough, bronchospasm
(Caution in COPD/asthmatic patients)

77
Q

Peramivir (Rapivab) dosing considerations

A

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

78
Q

Baloxavir (Xofluza) dosing considerations

A

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

79
Q

Special considerations for Baloxavir (Xofluza)

A

Avoid concomitant use with polyvalent cations

Didactic Year (24 decks)

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