Anti-virals

Question 1

What stage is suppressed by anti-virals with herpesviruses?

Answer 1

LYTIC STAGE

Question 2

Acyclovir MOA

Resistance?

Answer 2

PHOSPHORYLATED BY VIRAL DNA POLYMERASE

COMPETITIVE INHIBITION OF VIRAL DNA POLYMERASE - leads to chain termination

Mutation of thymidine kinase (prevents activation), cross-resistance

Question 3

Acyclovir routes of admin

Answer 3

Oral

IV for severe infections

Question 4

Acyclovir adverse

Answer 4

nausea
headache
diarrhea

REVERSIBLE CRYSTALLINE NEPHROTOXICITY - increased risk with dehydration

Question 5

Valacyclovir MOA

Answer 5

PRODRUG OF CYCLOVIR

Increased bioavailability

Same MOA as acyclovir once activated

Question 6

Foscarnet MOA

Administered?

Answer 6

DOES NOT REQUIRE PHOSPHORYLATION

PYROPHOSPHATE ANALOGUE - blocks catalytic cycle

IV admin

Question 7

Foscarnet typically used for?

Major adverse effect?

Answer 7

HSV AND VZV resistant to acyclovir
CMV infections

RENAL IMPAIRMENT - more so than acyclovir

Question 8

Ganciclovir MOA

resistance?

Answer 8

GUANOSINE ANALOGUE

REQUIRES PHOSPHORYLATION TO BE ACTIVATED

COMPETITIVELY INHIBITS VIRAL DNA POLYMERASE - leads to chain termination

UL97 MUTATIONS, cross-resistance

Question 9

Ganciclovir adverse effects?

Answer 9

MYELOSUPPRESSION

BONE MARROW AND CNS TOXICITY

Question 10

Valganciclovir MOA

Answer 10

PRODRUG OF GANCICLOVIR

BETTER ORAL BIOAVAILABILITY

Same MOA as ganciclovir

Question 11

Trifluridine MOA

Used for (2)?

Answer 11

FLUORINATED NUCLEOSIDE

INHIBITS THYMIDINE INCORPORATION INTO GENOME

LOW SELECTIVITY, Ocular diseases - HSV-1 and 2 keratoconjunctivitis

Question 12

Oseltamivir MOA

Resistance associated with?

Answer 12

sialic acid analogue - administered as prodrug

BINDS NEURAMINIDASE - inhibits migration of viral particles

mutations in neuraminidase and/or hemagglutinin

Question 13

Zanamivir MOA

Route of admin

Answer 13

Sialic acid analogue -

SAME MOA AS OSELTAMIVIR

INHALATION ADMIN

Question 14

Zanamivir therapeutic indications

Answer 14

CHILDREN 7 AND OLDER

Question 15

Peramivir MOA

Route of admin

Adverse effects?

Answer 15

SAME AS ZANAMIVIR AND OSELTAMIVIR

IV ADMINISTRATION

GI, rash, steven johnson, etc.

Question 16

Amantidine and Rimantadine MOA

Uses?

Problem with these drugs?

Answer 16

INHIBITS M2 PROTEIN

ONLY EFFECTIVE AGAINST INFLUENZA A

95 TO 100% RESISTANCE

Question 17

Ribavirin MOA

Answer 17

GUANOSINE ANALOGUE

PHOSPHORYLATED BY ADENOSINE KINASE

can interfere with GTP synthesis, viral mRNA capping, and RdRp of RSV and HCV

Question 18

Ribavirin administration?

Adverse effects?

Answer 18

AEROSOL FOR RSV
ORALLY FOR HCV

HEMOLYTIC ANEMIA

Question 19

Paritaprevir, Simprevir MOA

Answer 19

PROTEASE INHIBITORS

INHIBIT HCV NS3/4A proteolytic cleavage step

Question 20

Sofosbuvir MOA

Answer 20

RNA POLYMERASE INHIBITORS - NUCLEOTIDE ANALOGUE - incorporated into RNA -leads to premature chain termination

INHIBIT HCV RdRp (NS5B) - prevents formation of -ssRNA template from +ssRNA genome

Question 21

Ledipasvir, Ombitasvir MOA

Answer 21

HCV NS5A INHIBITORS - nucleotide analogue

Inhibit formation of -ssRNA template and inhibit VIRION ASSEMBLY

Question 22

Paritaprevir commonly used in combo with (2)?

Answer 22

ombitasvir

ritonavir

Question 23

Simeprivir treatment plan (3)

Answer 23

simeprivir
sofosbuvir or ribavirin
pegylated-IFN

Question 24

Simeprivir resistance

Answer 24

NS3 180K POLYMORPHISM - reduced response to treatment

Question 25

Ombitasvir treatment regimen (2 others)

Answer 25

Paritaprevir

Ritonavir

Question 26

Sofosbuvir shouldn’t be administered with what type of compounds

Answer 26

P450 INDUCERS

Question 27

Dasabuvir MOA

Answer 27

NON-NUCLEOSIDE INHIBITOR - RNA POLYMERASE INHIBITORS

targets palm domain of RdRp