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Pharmacology > Anti-Virals > Flashcards

Anti-Virals Flashcards

1
Q

There are _______ deaths in U.S. per year d/t Influenza

A

50,000

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2
Q

T/F: Admantanes (Amantadine, Rimantadine) are DOC for tx influenza

A

FALSE

**only active agains influenza A viruses and high a high rate of resistance so are not longer recommended…now recommendation if Neuraminidase inhibitors (Oseltamivir, Zanamivir)

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3
Q

Neraminidase inhibitors (Oseltamivir, Zanamivir) have activity against

A

influenza A and B

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4
Q

Oseltamivir and Zanamivir MOA

A

block active site of neuraminidase –> reduce amount of viral particles released from infected cells (i.e. decreased viral shedding)

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5
Q

Neuraminidase inhibitors greatest benefit is seen when __________

A

started w/in 48 hrs of illness onset

reduce duration of uncomplicated influ A and B illness

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6
Q

Oseltamivir ADRs

A
  • nausea, vomiting (9-10%)

- transient neuropsychiatric events

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7
Q

Which neuraminidase drug is preferred in pregnancy?

A

Oseltamivir

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8
Q

Zanamivir ADRs

A
  • nausea, diarrhea
  • HA
  • cough
  • **bronchospasm in persons with pulmonary dz
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9
Q

Zanamivir is C/I in

A

persons with pulmonary dz (can cz bronchospasm)

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10
Q

How is Zanamivir administered?

A

orally inhaled powder

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11
Q

What are DOC for HSV?

A

1 Acyclovir (Zovirax)

Can also use Valacyclovir (Valtrex)

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12
Q

Acyclovir (Zovirax) class

A

guanosine analog

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13
Q

Acyclovir (Zovirax) MOA

A

guanosine analog is incorporated into the virus DNA and inhibits further viral synthesis

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14
Q

Acyclovir (Zovirax) indications

A
  • HSV

- VZV (less potent so higher doses required)

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15
Q

T/F: Acyclovir (Zovirax) is effective against latent virus

A

FALSE

it only works against viruses that are actively replicating

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16
Q

topical ointment of ______ is used to tx HSV1

A

Acyclovir (Zovirax)

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17
Q

Acyclovir can actively cross the BBB thus is can tx

A

herpes meningitis and encephalitis

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18
Q

It’s important for pt. receiving IV Acyclovir (Zovirax) to be __________

A

properly hydrated (prevent renal toxicity)

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19
Q

What is the benefit of Valacyclovir (Valtrex) over Acyclovir (Zovirax)?

A

Acyclovir needs to be taken 3-5 times daily and Valacyclovir only needs to be given BID

Valacyclovir has greater bioavailability

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20
Q

Which hepatitis do we tx with antivirals?

A

Hepatitis B and Hepatitis C - these are the ones with potential to become chronic

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21
Q

What is the goal of Pegylated interferon tx?

A

sustained suppression of viral replication after completion of tx (48 wks)

tx is finite

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22
Q

What is the goal of anti-viral agents acting on Hep B DNA polymerase (i.e. nucleoside or nucleotide analogs)?

A

obtain rapid and LT viral suppression

*tx may be indefinite

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23
Q

Peg-interferon alfa (Pegasys) class

A

Cytokine (Antiviral)

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24
Q

Peg-interferon alfa (Pegasys) MOA

A

cytokine that induces specific and nonspecific immune responses to halt replication of the virus

25
Q

Peg-interferon alfa (Pegasys) indications

A
  • first-line tx of HSV
  • only effective tx with HDV coinfx

*would only use in pt. with less severe dz so they can tolerate it and pt. who want a 48-wk regimented plan

26
Q

Peg-interferon alfa (Pegasys) ADRs

A
  • fatigue
  • flu-like rxn
  • anemia
  • pancytopenia
  • depression
  • mood disturbances (20-30% pt.)
27
Q

Peg-interferon alfa (Pegasys) C/I

A
  • AI dz
  • uncontrolled psychiatric dz
  • decompensated cirrhosis
  • uncontrolled seizures
28
Q

Entecavir and Tenofovir class

A

Nucleoside or nucleotide analogs (antivirals)

29
Q

All nucleoside or nucleotide analogs require dose adjustment in person with _________

A

CrCl < 50 ml/minCrCl < 50 ml/min

30
Q

_________ are only first-line antivirals for tx of naive pt. with HBV

A

Entecavir and Tenofovir (nucleoside or nucleotide analogs)

31
Q

T/F: Entecavir (Baraclude) is not recommended in HIV/HBV co-infected patients no treated with highly active antiretroviral therapy

A

TRUE

d/t potential for the development of resistance

32
Q

What is the MC blood borne dz in the U.S.?

A

Hepatitis C

33
Q

Which direct-acting antivirals act on all hepatitis C genotypes?

A

1) Nucleotide Polymerase Inhibitors (NS5B)

2) NS5A inhibitors

34
Q

Which HCV direct-activing antiviral has highest barrier to resistance?

A

Nucleotide Polymerase Inhibitors (NS5B) - e.g. Sofosbuvir

35
Q

Protease Inhibitors (NS3/4A) ADRs

A

**hepatic decompensation

anemia, pruritis, dysguesia, rash, photosensitivity

36
Q

Polymerase Inhibitors (NS5B) ADRs

A

fatigue, HA, nausea

37
Q

NS5A Inhibitors ADRs

A

fatigue, HA, nausea

38
Q

Which specific HCV drugs covers all genotypes (GT1-6)

A

Epclusa (Sofosubvir and Velptasvir)

39
Q

Which HCV Genotypes does the drug Harvoni (Ledipasvir and Sofosbuvir) cover?

A

GT 1, 4, 5, 6

40
Q

What is a consideration with HCV drugs containing ritonavir?

A

many drug drug interactions

ritonavir is a component in Viekira Pak and Technivie

41
Q

Which HCV direct acting antiviral can be used in end stage renal disease?

A

Zepatier (Elbasvir and Grazoprevir)

42
Q

When should you initiate HIV tx?

A

antiretroviral tx is recommended for ALL HIV-infected individuals, regardless of CD4 count

43
Q

What are the main categories of drugs used as tx or prophylaxis agains HIV?

A
  • Reverse transcriptase inhibitors (RTIs), including Nucleoside/nucleotide (NRTIs) and Non-nuncleoside (NNRTIs)
  • Protease inhibitors (PIs)
44
Q

Current tx for HIV infection consists of __________

A

HAART (highly active antiretroviral therapy)

two nucleoside reverse transcriptase inhibitors (NRTIs) + a non-nucleoside reverse transcriptase inhibitor (NNRTI) or a protease inhibitor (PI) or an integrase inhibitor

45
Q

What are the main nucleoside reverse transcriptase inhibitors (NRTIs) used to tx HIV?

A
  • Abacavir
  • Tenofovir**
  • Emtricitabine**
  • Lamivudine
46
Q

What is the main protease inhibitor (PI) used in HIV tx?

A

Darunavir

47
Q

What are the main integrase inhibitors (InSTI) used in HIV tx?

A
  • Dolutegravir
  • Elvitegravir
  • Raltegravir
48
Q

What are the pharmacokinetic “Boosters” used in HIV therapy?

A
  • Cobicistat

- Ritonavir (also a protease inhibitor)

49
Q

What is a major issue with Nucleoside Reverse Transcriptase Inhibitors (NRTIs)?

A

Lactic acidosis

stavudine > didanosine, zidovudine

50
Q

What are the preferred NRTI drugs in pregnancy?

A
  • Lamivudine
  • Emtricitabine
  • Tenofovir
  • Abacavir
51
Q

What is a major s/e in Tenofovir?

A

nephrotoxicity

52
Q

Protease inhibitors (PIs) MOA

A

inhibit protease cleaving of gag and gag-pol viral proteins –> inhibit viral replication

53
Q

What are class wide effects to consider with Protease Inhibitors (PIs)?

A
  • hyperlipidemia and hypertriglyceridemia

- insulin resistance

54
Q

Which protease inhibitors are preferred in pregnancy?

A
  • Atazanavir + ritonavir
  • Darunavir + ritonavir
  • Lopinavir + ritonavir

ritonavir = booster

**increase dosage in 3rd trimester

55
Q

Classwide issues seen in Integrase Inhibitors

A

interactions with divalent/polyvalent cations, therefore need to take 2 hrs away from magnesium containing antacids

56
Q

Which Integrase Inhibitor has the lowest-risk for interactions?

A

Raltegravir

57
Q

What is the suffix for integrase inhibitors?

A

-gravir

58
Q

What is the preferred Integrase Inhibitor in pregnancy?

A

Raltegravir

59
Q

T/F: You should never give live vaccines to someone with HIV

A

False-ish

You should give with caution, but NEVER give when CD4 count is < 200 cells/mm3

Pharmacology (14 decks)

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