3 - Antiviral Medications

Question 1

What are the 3 mechanisms of antivirals?

Answer 1

1. Alter uncoating of virus
2. Polymerase inhibitors
3. Inhibit viral protein synthesis

Question 2

What are the indications for amantadine (Symmetril) and rimantidine (Flumadine)?

Answer 2

Influenza A

Question 3

What are the indications for oseltamivir (Tamiflu)?

Answer 3

Influenza A or B

Question 4

What is the mechanism of oseltamivir (Tamiflu)?

Answer 4

Neuraminidase inhibitor - cleaves the budding viral progeny from its cellular envelope attachment point just prior to release.

Classic Prodrug

Question 5

What antiviral treats respiratory syncytial virus (RSV)?

Answer 5

ribavirin (Rebetol, Virazole)

Question 6

What are the side effects of ribavirin (Rebetol, Virazole)?

Answer 6

• mutagenic
• teratogenic
• carcinogenic

Question 7

What anti-viral is used to treat herpes simplex keratitis (in eye)?

Answer 7

trifluridine (Viroptic)

Question 8

What is the drug of choice for HSV encephalitis?

Answer 8

acyclovir (Zovirax)

Question 9

What drug is used to treat primary and recurrent herpes in immunocompromised patients?

Answer 9

acyclovir (Zorivax)

Question 10

What antiviral is used to treat CMV (and CMV retinitis)?

Answer 10

ganciclovir (Cytovene)

Question 11

Which antiviral is used to treat recurrent genital herpes?

Answer 11

famciclovir and valacyclovir

Question 12

famciclovir and valacyclovir are prodrugs that form into what as they pass through the intestine?

Answer 12

penciclovir and acyclovir respectively

Question 13

What are interferons?

Answer 13

A family of naturally occuring, inducible glycoproteins that interfere with the ability of viruses to infect cells

Question 14

What are the 3 types of interferons and how are they administered?

Answer 14

• Alpha
• Beta
• Gamma
• Administered - intralesionally, subcutaneously, or IV

Question 15

Whats the basic mechanism of interferons?

Answer 15

Inhibit viral RNA translation, ultimately leading to the degradation of viral mRNA and tRNA

Question 16

What are the most common indications for use of interferons?

Answer 16

• Hepatitis B and C
• Mutliple Sclerosis

Question 17

What are some adverse effects of interferons?

Answer 17

• Flu-like symptoms
• Bone marrow suppression
• Neurotoxicity
• CNS effects
• Severe fatigue
• Severe weight loss
• Autoimmune disorders
• Cardiovascular
• Oral

Question 18

What often alter the viral replication processes and are often toxic to host cells?

Answer 18

Anti-retrovirals

Question 19

What is the mechanism for anti-retrovirals?

Answer 19

• Inhibits viral attachment and entry
• Polymerase inhibitor
• Antibodies against viral envelope proteins

Question 20

What is the first HIV agent that inhibits viral entry into host cells?

Answer 20

enfuvirtide (Fuzeon)

Question 21

What is the target of anti-retrovirals?

Answer 21

Reverse Transcriptase

Question 22

When a DNA segment is permanently incorporated into the host cell DNA within a nucleus it is termed?

Answer 22

Integration

Question 23

What does treatment of HIV infection require?

Answer 23

Combination therapy =

HAART

“Highly Active Anti-Retroviral Therapy”

“cocktails”

Question 24

What are the side effects of anti-retrovirals?

Answer 24

• Anemia
• Leukopenia and granulocytopenia
• Hepatotoxicity
• Peripheral neuropathy
• Pancreatitis

Question 25

What is another goal while treating patients with anti-retrovirals?

Answer 25

Prevent opportunistic infections

Question 26

What is used to treat pneumocystis carinii?

Answer 26

A sulfa drug - oral trimethoprim-sulfamethoxazole (Bactrim)

Question 27

What is a characteristic of nucleoside reverse transcriptase inhibitors?

Answer 27

Must be biotransformed/bioactivated to work - then they inhibit the viral enzyme reverse transcriptase

Question 28

Nucleoside reverse transcriptase inhibitors dont work on what kind of cell?

Answer 28

The cells that already contain HIV

Question 29

What are the common nucleoside reverse transcriptase inhibitors?

Answer 29

* **didanosine** (Videx) * **zidovudine** (Retrovir) - "AZT" * abacavir (Ziagen)

Question 30

What drug inhibits HIV synthesis and reduces morbidity/mortality from AIDS and AIDS-related complex?

Answer 30

zidovudine (Retrovir) "AZT"

Question 31

Do non-nucleoside reverse transcriptase inhibitors require bioactivation?

Answer 31

No! But resistance quickly develops if used alone

Question 32

What's so different about the protease inhibitor drugs?

Answer 32

They interfere with the action of HIV-infected cells

Question 33

What are the common protease inhibitors?

Answer 33

* indinavir (Crixivan) * nelfinavir (Viracept) * saquinavir (Invirase)

Question 34

What kind of drug is tenofovir (Viread)?

Answer 34

A nucleotide reverse transcriptase inhibitor - inhibits viral replication

Question 35

What kind of drug is raltegravir (Isentress)?

Answer 35

**Integrase Inhibitor** - inhibits integrase, the enzyme that helps insert the viral cDNA strand from reverse transcriptase into the human genome

Question 36

If someone has "linear gingiva erythema" what do you suspect?

Answer 36

HIV