Systemic Antivirals

Question 1

Antiviral Drugs

Answer 1

Despite significant advances, ability to treat viral infections is limited.
Viruses mimic host processes to replicate and suppressing that without harming the host is real hard.
No strong efficacy or quick resolutions of viral infections

Question 2

Acyclovir

Answer 2

IND: HSV, VZV, first line. CMV is often resistant
MOA: Inhibit viral replication via inhibition of viral DNA polymerase
BOX: n/a
CON: n/a
ADR: Infusion site rxns. AKI. Neurotoxic

Question 3

Valacyclovir

Answer 3

IND: HSZ, VZV, Better dosing intervals than Acyclovir, making it first line
MOA: Pro-drug into acyclovir, better absorbed
BOX: n/a
CON: n/a
ADR: TTP/HUS in immunocompromised

Question 4

Foscarnet

Answer 4

IND: HSV, CMV
MOA: Inhibit RNA/DNA polymerase. 2/3 line, good spectrum of activity if acyclovir resistant
BOX: Renal impairment, watch SCr
Seizures from alterations in plasma minerals and electrolytes
CON: n/a
ADR: Hypokalemia, calcemia, magnesemia, phosphatemie. GI. Anermia. Renal insufficiency

Question 5

Famciclovir

Answer 5

IND: HSV, VZV
MOA: Inhibits viral DNA synthesis and replication
BOX: n/a
CON: n/a
ADR: HA. Nausea

Question 6

Ganciclovir

Answer 6

IND: CMV ONLY
MOA: Inhibits viral DNA synthesis
BOX: Hematologic toxicity.
Fertility impairment.
Fetal toxicity.
Mutagenesis and carcinogenesis
CON:
ADR: V/D, anorexia

Question 7

Cidofovir

Answer 7

IND: Last line CMV in pts with AIDS who failed Ganciclover and Foscarnet
MOA: Inhibits viral DNA synthesis
BOX: Neprhotoxic: acute renal failure resulting in dialysis within 1-2 doses.
Neutropenia
Carcinogenic/teratogenic
CON: High SCr, low CrCl, urine protein high, use within 7 days of nephrotoxic agents, direct intraocular injection
ADR: Decreased serum bicarb
Hypotony of the eye, iritis

Question 8

Osaeltamivir

Answer 8

IND: Prophylaxis and treatment of influenza A or B. Dosing must begin within 2 days of symptom onset. Has diminishing returns on symptom duration
MOA: Inhibits virus neuraminidase; prevents additional virsues being released
BOX: n/a
CON: n/a
ADR: GI

Question 9

Remdesevir

Answer 9

IND: COVID 19 hospitalized pts
MOA: Inhibits SARS CoV 2 RNA dependent RNA polymerase; stops viral replication
BOX: n/a
CON: n/a
ADR: Symptomatic bradycardia, potentially fatal. Increased AST/ALT. Infusion related rxns

Question 10

COVID 19 Monoclonal Antibodies

Answer 10

IND: Post exposure of COVID 19, treatment of mild-moderate COVID 19 to prevent hospitalization, one time dose
MOA: Recombinant monoclonal antibodies that target specific spike proteins on the SARS CoV 2 virus
BOX: n/a
CON: n/a
ADR: Infusion related rxns

Question 11

Nirmatrelvir-Ritonavir

Answer 11

Paxlovid
IND: Mild to moderate outpatient COVID 19 (EUA)
MOA: (N)Protease inhibitor of SARS CoV 2; inhibits viral replication
(R) Pharmacokinetic enhancer; inhibits CYP3A4 mediated metabolism of Nirmatrelvir
BOX: n/a
CON: n/a
ADR: n/a