Antivirals

Question 1

Inhibitors of Viral Attachment, Uncoating or Release (list)

Answer 1

Pleconaril
Docosanol
Amantadine
Rimantadine
Osteltamivir
Zanamivir

Question 2

Name 2 inhibitors of viral attachment (inhibit viral uncoating)

Answer 2

Amantadine

Rimantadine

Question 3

What are Amantadine and Rimantadine used for?

Answer 3

Used for treatment and prophylaxis of *influenza type A, no effect on type B-lack M2
Amantadine also used in Parkinson’s disease

Question 4

Name 2 Neuraminidase Inhibitors

Answer 4

Oseltamivir and Zanamivir

Question 5

What are Oseltamivir and Zanamivir used for?

Answer 5

Treatment of influenza A and B, duration 5 days. Also effective for prophylaxis.

Question 6

Name one precaution for Zanamivir

Answer 6

inhalation of dry powder

May produce bronchospasms, careful in patients with asthma or COPD

Question 7

What 2 drugs inhibit attachment?

Answer 7

Pleconaril

Docosanol (Abreva)

Question 8

Pleconaril

Answer 8

Prevents attachment of the virus to the human cell
Prevents viral uncoating within the cell
Effective against picornavirus (common cold)
Not FDA approved—not used here, used in other countries

Question 9

Docosanol (Abreva)

Answer 9

Prevents attachment of the virus to the human cell
OTC cream : recurrent oral/genital herpes
Begin treatment within 12 hours of prodromal symptoms or lesion onset

Question 10

Drugs that Block DNA Synthesis from Viral DNA: Guanosine analogs

Answer 10

Acyclovir
Valacyclovir
Penciclovir
Famiciclovir
Ganciclovir

Question 11

Drugs that Block DNA Synthesis from Viral DNA: adenosine analog

Answer 11

Vidarabine

Question 12

Drugs that Block DNA Synthesis from Viral DNA: Cytosine analog

Answer 12

Cidfovir (used in CMV in HIV/AIDS patients)

Question 13

Acyclovir and Valacyclovir

Answer 13

Treatment and Prophylaxis of:
Herpes simplex (type I and II) and zoster
Drug of choice for treatment of HSV infections
Acyclovir used prophylactically to prevent mucocutaneous HSV infection in seropositive patients undergoing immunosuppressive therapy

Genital herpes: Decrease viral shedding, systemic symptoms, and time to resolution
Varicella zoster- treatment
Used within 24hours of rash onset decreases symptoms by ~ 1 day- use in high risk patients

Question 14

Penciclovir and Famciclovir (oral prodrug of Penciclovir)

Answer 14

Both used to treat Herpes Zoster, Herpes simplex type II, topical treatment of oral/labial herpes simplex virus

Question 15

Which 2 antivirals are Category B in pregnancy?

Answer 15

Acyclovir and Penciclovir

Question 16

Ganciclovir and Valganciclovir (Oral prodrug)

Answer 16

Phosphorylated by viral protein kinase in cytomegalovirus and by viral thymidine kinase in herpes simplex virus then further phosphorylated by host enzymes

Active against all herpes viruses
Treatment of CMV in immunocompromised patients
Neutropenia, thrombocytopenia, teratogenic –Cat C
Vitasert- an intraocular sustained release implant for CMV retinitis

Question 17

Which 2 antiviral are category C in pregnancy?

Answer 17

Ganciclovir and Valganciclovir (Oral prodrug)

Question 18

Vidarabine

Answer 18

Phosphorylated by host enzymes
Treatment of viral thymidine kinase resistance
Broad spectrum antiviral activity- herpes, pox viruses, rhabdoviruses, hepadenaviruses, some RNA tumor viruses

Primarily used for keratitis, keratoconjunctivitis due to HSV, life threatening herpes simplex virus, varicella zoster infections
N/V, bone marrow suppression, neurotoxicity, peripheral neuropathy

Question 19

Cidofovir

Answer 19

Phosphorylated by host enzymes- so useful when viral thymidine kinase resistance has developed
Broad spectrum antiviral activity; herpes and pox viruses, adenoviruses, papilloma viruses, and hepadenavirus

Primary use for treatment of cytomegalovirus in AIDS patients who are intolerant, relapsed, or nonresponsive to ganciclovir or foscarnet
Acyclovir resistant mucocutaneous HSV infection
Neutropenia and nephrotoxicity

Question 20

Thymidine analog

Answer 20

Idoxuridine- Topical- for HSV types 1 and 2 keratoconjunctivitis and recurrent epithelial keratitis

Question 21

Nucleotide analog

Answer 21

Adefovir- does not require phophorylation

FDA approved for treatment of chronic active infections HepB

Question 22

Foscarnet (method of action)

Answer 22

an inorganic phosphate analog
Directly inhibits DNA and RNA polymerases and reverse transcriptases- 100 x greater effect on viral vs human DNA polymerase.
Does not require phosphorylation- broad spectrum

Question 23

Foscarnet (uses)

Answer 23

Active against all herpes viruses, influenza, and HIV

Primary uses: CMV infections, acyclovir resistant herpes simplex or varicella zoster

Question 24

Ribavirin

Answer 24

purine nucleoside analog
Phosphorylated intracellularly by host cell enzymes
Ribavirin aerosol- treatment of RSV
Ribavirin plus peginterferon – for Hepatitis C

Question 25

Interferons

Answer 25

immunomodulatory (affect our own cells too) and antiviral.

Question 26

Dose limiting toxicities of Interferons

Answer 26

Neutropenia and anemia-want to check pts for this. Check baseline blood cell count
“Flu like syndrome”- fever, fatigue, myalgia

Question 27

Interferon alpha and beta

Answer 27

produced by nearly all cells in response to viral infection

Question 28

Interferon gamma

Answer 28

is produced by T-cells and NK cells in response to antigens and cytokines

Question 29

Main action of interferons

Answer 29

Interferons mainly act to prevent translation of viral proteins