PHARM: Viral Pneumonia

Question 1

What is the treatment for Influenza A and B viruses?

Answer 1

Oseltamivir (PO)

Zanamivir (inhaled)

Question 2

What is the treatment for Influenza A virus?

Answer 2

Amantadine (PO)

Rimantadine (PO)

Question 3

What is the treatment for RSV?

Answer 3

Ribavirin (inhalational or IV)

Question 4

What is the treatment for Adenovirus?

Answer 4

Cidofovir (IV)

Question 5

What is the treatment for Rhinovirus?

Answer 5

none

Question 6

What is the treatment for Enteroviruses?

Answer 6

none

Question 7

What is the treatment for human metapneumovirus?

Answer 7

Ribavirin (IV)

Question 8

What is the treatment for hantavirus?

Answer 8

Ribavirin (IV)

Question 9

What ist he reatment for varicella-zoster virus?

Answer 9

Acyclovir (IV)

Valacyclovir (PO)

Question 10

What is the MOA of acyclovir?

Answer 10

Inhibition of viral DNA synthesis (via polymerase inhibition)

Question 11

How is acyclovir metabolized?

Answer 11

viral cells transform it into its active triphosphate form.

Systemic elimination unchanged by glomerular filtration and tubular secretion

Question 12

What are the AEs of acyclovir?

Answer 12

Headache, nausea, elevated hepatic enzymes, nasopharyngitis, neutropenia, stay hydrated to prevent kidney problems

Question 13

What is the MOA of amantadine?

Answer 13

inhibition of viral entry or uncoating

Question 14

How is amantadine metabolized?

Answer 14

systemic elimination unchanged by glomerular filtration and tubular secretion

Question 15

What are the AEs of amantadine?

Answer 15

Multiple: neurologic, nausea, and orthostatic hypotension

Contraindicated in narrow angle glaucoma and with breastfeeding

Question 16

What is the MOA of cidofovir?

Answer 16

Inhibition of viral DNA synthesis (DNA polymerase inhibition)

Question 17

How is cidofovir metabolized?

Answer 17

Metabolized via pyrimidine nucleoside monophosphate kinase to mono- and then diphosphate analong and finally to the monophosphate-choline

Systemic elimination by globular filtration and tubular secretion

Question 18

What are the AEs of cidofovir?

Answer 18

BBW for renal impairment/toxicity

Also neurologic, hematologic, and tubular damage

Question 19

What is the MOA of oseltamavir?

Answer 19

inhibition of release of influenza virus from infected cell

Question 20

How is oseltamavir metabolized?

Answer 20

hepatic metabolism to the carboxylate active form of the drug

Systemic elimination by globular filtration and tubular secretion

Question 21

What are the AEs of oseltamavir?

Answer 21

Minimal: potential for fatal neuropsychiatric adverse effects
Serious skin reactions (rarely)

Question 22

What is the MOA of ribavirin?

Answer 22

inhibition of viral nucleic acid synthesis

Question 23

How is ribavirin metabolized?

Answer 23

Undergoes non-CYP metabolism in nucleated cells with systemic elimination of drug and products in the URINE

Question 24

What are the AEs of ribavirin?

Answer 24

BBW for hemolytic anemia and M/F teratogenicity

Others: fatigue, headache, myalia, nausea, fever

Question 25

What is the MOA of rimantadine?

Answer 25

Inhibition of viral entry/uncoating

Question 26

How is rimantadine metabolized?

Answer 26

Extensive hepatic metabolism with renal elimination of drug and metabolites

Question 27

What are the AEs of rimantadine?

Answer 27

minimal

Question 28

What is the MOA of valacyclovir?

Answer 28

Pro-drug for acyclovir

Question 29

How is valacyclovir metabolized?

Answer 29

converted to acyclovir (and L-valine) by first pass metabolism. Systemic elimination (acyclovir) by glomerular filtration and tubular secretion

Question 30

What are the AEs of valacyclovir?

Answer 30

same as with acyclovir

Question 31

What is the MOA of zanamivir?

Answer 31

inhibition of release of influenza virus from infected cell

Question 32

How is zanamivir metabolized?

Answer 32

renally eliminated unchanged

Question 33

What are the AEs of zanamivir?

Answer 33

Contraindicated with underlying pulmonary disease (can lead to fatal bronchospasm) Other: Headache, throat/tonsil pain, cough, viral infection