Pharmacology Of Influenza and Anti-Viral (Fitz) Flashcards

1
Q

This drug blocks viral M2 ion (H+) channel; prevents uncoating and used for influenza A only

A

Amantadine

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2
Q

What is the anti viral spectrum of amantadine?

A

A

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3
Q

What is the antiviral spectrum of Oseltamivir and Zanamavir?

A

A and B

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4
Q

These drugs are neuraminidase inhibitors and target Influenza A and B

A

Oseltamivir and Zanamavir

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5
Q

List the neuraminidase inhibitors:

A

Oseltamivir and Zanamavir

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6
Q

This neuraminidase inhibitor is PO (suspension, capsule) and can cause nausea (20% incidence)

A

Oseltamivir

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7
Q

This neuraminidase inhibitor is inhaled and can cause bronchospasm in asthmatics (rare)

A

Zanamavir

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8
Q

Zanamivir is not recommended in these types of pts:

A

Asthma, COPD, resp disease

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9
Q

What age groups is Oseltamivir approved for? What about zanamavir?

A

Oseltamivir-tx and prevention in 1 yr and older

Zanamivir-tx=7 yrs and up; prevention=5 yrs and up

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10
Q

Which groups have the greatest burden of influenza?

A

Elderly

Persons with underlying medical conditions such as COPD, asthma, CHF, diabetes, pregnant women and young children

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11
Q

What is the MOA of Amantadine?

A

M2 ion channel inhibitors –> No H+ enters capsid

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12
Q

When is Amantadine not recommended?

A

Not recommended for antiviral tx or chemoprophylaxis of currently circulating Influenza A virus strains

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13
Q

Name the Acyclic nucleosides that act selectively on virus infected cells:

A

Acyclovir
Valacyclovir
Gancyclovir
Valganciclovir

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14
Q

Name the non-nucleoside anti-viral drugs:

A

Foscarnet

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15
Q

These anti-vitals work for HSV and Herpes zoster:

A

Acyclovir and valacyclovir

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16
Q

This drug works for acyclovir-resistant HSV and VSV

17
Q

These drugs are used for CMV infx:

A

Ganciclovir: IV (nucleoside)

Valganciclovir: PO, high bioavailability (ester of nucleoside)

Foscarnet: IV, topical (pyrophosphate)

18
Q

What type of analogs are Acyclovir and Ganciclovir?

19
Q

HSV and VSV activation of acyclovir involves this kinase:

A

Thymidine kinase

20
Q

CMV activation of gangiclovir involves this kinase:

A

UL97 kinase

21
Q

How do HSV, HZV, and CMV viruses acquire drug resistance?

A

By neutralizing viral dependent drug activating processes –> Kinases/phosphotransferases

Neutralizing drug targets –> DNA polymerases

22
Q

These drug types are pro-drugs with High ORAL bioavailability

A

Nucleoside esters

23
Q

This pro-drug (PO) gets converted to the activated Acyclovir

A

Valacyclovir

24
Q

How is Acyclovir administered, where is it distributed, how is it eliminated

A

IV, PO (low bioavailability)

Distributed into CNS and systemic

Renal elimination

25
At clinically achievable concentration, acyclovir is active against:
Best against: HSV-1, sort of against HSV-2 1/10 relative potency against VZV and EBV (NOT CMV)
26
What are acyclovir toxicities?
- well tolerated by most pts-Pregnancy category B - precipitation of acyclovir in renal tubules can lead to ACUTE RENAL FAILURE - NEUROLOGIC TOXICITY-particularly in pts with renal failure
27
What is the prodrug of Gancyclovir? How is it administered? How is distributed? Eliminated?
Valganciclovir IV Distributed into CNS and systemic Renal elimination
28
What is Ganciclovir most active against?
CMV Tx and suppress CMV retinitis in immunocompromised pts and prevention of CMV disease in transplant pts
29
What are toxicities/complications of Ganciclovir?
- associated with BM suppression (leukopenia) - need to monitor for hematologic and renal toxicity, especially pts taking nephrotoxic, immunosuppressive drugs cyclosporine
30
Does Foscarnet require activation? What is it used for clinically?
No activation required --> independent of viral or cell kinases Used for :CMV retinitis, Acyclovir-resistant HSV and VZV
31
How is Foscarnet administered? What is its toxicities? Where does it accumulate? What are consequence of it chelating Ca and Mg?
IV-low solubility and short t1/2 requires frequent injection Nephrotoxic Accumulates in bone matrix Hypocalcemia and hypomagnesemia