Sketchy Pharm: Ganciclovir, Valganciclovir, Foscarnet, and Cidofovir Flashcards

1
Q

All of the drugs in this sketch are used to treat _______________.

A

CMV, HSV, or VZV infections resistant to acyclovir and valacyclovir

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2
Q

What is a common indication for use of ganciclovir?

A

CMV reactivation in an AIDS patient (with CD4s less than 50)

Think of the woman with the pizza – representing HIV retinitis –in the line for customers with 50 items or LESS.

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3
Q

True or false: ganciclovir needs to be phosphorylated by viral kinases.

A

True! Like acyclovir, ganciclovir needs to be phosphorylated. However, it does so by a different enzyme: UL97 –an enzyme specific to CMV–accomplishes this.

(Think of the Mega-Lo employee putting the first P sticker on and then the kids, who are not Mega-Lo specific and represent cellular kinases, putting the second and third P’s on.)

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4
Q

The defective GTP made by ganciclovir ultimately disrupts ______________.

A

viral DNA polymerase

Think of the conveyor belt that splits into two getting jammed by ganciclovir.

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5
Q

What advantage does valganciclovir have?

A

Like valacyclovir, it has great bioavailability.

Think of the woman in the violet dress tossing the VALue snacks into her mouth.

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6
Q

Ganciclovir and valganciclovir are often used for _______________.

A

prophylaxis in organ transplant patients

Think of the organs in the back of the scene.

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7
Q

The biggest side effect of both ganciclovir and valganciclovir are ______________.

A

myelosuppression (particularly in patients receiving other myelotoxic agents like zidovudine)

(This is represented by the woman in the Z outfit next to the bone-shaped platter.)

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8
Q

Which antiviral drugs do not require phosphorylation?

A

Foscarnet and cidofovir

(Think of the FaSt CAR NET kid slamming directly into the checkout and CyD the clerk directly turning off the cash register conveyor belt.)

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9
Q

What side effects does foscarnet have?

A

Renal insufficiency (spilled barrel of kidney beans)
Hypocalcemia (spilled milk)
Hypomagnesemia (magnets knocked off cash register)
Hypokalemia (banana peels)

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10
Q

The central adverse effect of cidofovir is ____________.

A

nephrotoxicity with resultant metabolic acidosis)

Think of CyD knocking over the kidney-shaped bottles.

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11
Q

____________ must be administered with cidofovir to prevent negative side effects.

A

Probenecid (which prevents the renal excretion of cidofovir and thus limits its side effects)

(Think of CyD’s brother CID holding back the tumbling display of kidney-shaped bottles.)

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12
Q

Probenecid prevents ________________.

A

many drugs from entering the kidney

“It’s like a PROBation officer preventing your kidney from doing drugs.”

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