Anti-virals

Question 1

Viruses replicate _____________. Just like the _________ bacteria.

Answer 1

Intracellularly

Atypical

Question 2

Viruses are more/less difficult to manage than bacterial infections, and anti-virals are more/less toxic to humans.

Answer 2

More difficult

more toxic

Question 3

3 concerns for anti-virals

Answer 3

1. Drug delivery
2. Drug concentrations
3. Resistant

Question 4

Most anti-virals target at least one sequence in the ______________ of a virus with little effects on _______ viruses.

Answer 4

replication cycle

latent viruses – they must be actively replicating for the drug to work

Question 5

Acyclovir coverts what 5 viruses?

Answer 5

HSV 1/2, VZ, CMV, EBV

Question 6

Acyclovir is converted to its active form ______________ by the enzyme ________________, which then attaches the to end of the viral DNA chain and terminates ______________.

Answer 6

acyclovir triphosphate (AT)
Viral thymidine kinase (TK)
replication

Question 7

T or F. Resistance to acyclovir is common.

Answer 7

T

Question 8

T or F. Acyclovir has many AEs that prevent it from being used often.

Answer 8

F - few AEs, most are CNS related and rare

Question 9

What is the difference between acyclovir and valacyclovir?

Answer 9

Val is a prodrug that rapidly delivers the drug, allows serum drug levels to reach that of IV acyclovir WHEN GIVEN PO, and has a simpler dosing regimen (QD, BID).
$$$$

Question 10

Explain why you wouldn’t use Penciclovir.

Answer 10

Poor oral bioavailability so have to use topically every 2h.

Question 11

Famciclovir competes with _________, by producing high drug levels. It is also a __________.

Answer 11

Valacyclovir

Prodrug

Question 12

What is the name-ending of the anti-virals used to suppress/treat herpes?

Answer 12

“cyclovir”

Question 13

Which drug sounds like the anti-virals that treats Herpes, but doesn’t…

Answer 13

Gancyclovir.

Question 14

What is the primary indication for Gancyclovir?

PO vs IV?

Answer 14

CMV
PO - suppresion
IV - treatment

Question 15

Valacyclovir: Acyclovir as __________: Gancyclovir

Answer 15

Valgancyclovir - prodrug that achieves IV-like drug levels for PO treatment of CMV

Question 16

Foscarnet is ____ line treatment for CMV. It also treats _____ and ______.

Answer 16

2nd line

HSV 1, 2

Question 17

Foscarnet is highly __________ due to what significant AE?

Answer 17

Intolerable

renal toxicity

Question 18

Foscarnet is only available ____ and _________ with ___ is essential to prevent renal toxicity.

Answer 18

IV

pre-hydration with NS

Question 19

If your patient already has renal damage, which anti-viral should you prescribe for the tx of CMV?….What is the major AE that you must then monitor?

Answer 19

Gancyclovir

AE - neutropenia - check ANC count,

Question 20

CMV likes to attach what part of the body?

Answer 20

retina - watch for visual disturbances

Question 21

What is 3rd line for CMV? …also treats HSV-1,2, VZ, EBV, CMV

Answer 21

Cidofivir

Question 22

Prior to administration of Cidofivir, make sure you ________ and possible consider oral doses of ___________ just prior to administration.

Answer 22

pre-hydrate

probenecid - prevents secretion from efferent arteriole to renal tubules, thus reducing nephrotoxicity.

Question 23

Does probenecid increase or decrease half life?

Answer 23

increase it by bypassing secretion into the urine

Question 24

Name the 2 first generation anti-virals for Hep C. GIve 3 characteristics of them.

Answer 24

Ribavirin and Interferon

1. Toxic
2. Non-curative
3. Hard to take

Question 25

Ribavirin is administered ____.
Is it safe with for women who are pregnant or could get pregnant?
Name the possible AEs.

Answer 25

PO
Not safe - teratogenic.embyogenic
Anemia - lethargy, malaise, increased HR, HA

Question 26

Interferon is administered _____.

Name AEs.

Answer 26

IM, SubQ

“flu-like symptoms”, depression, suicidal ideations

Question 27

How do you reduce daily dosing and increase half life of drugs?

Answer 27

Pegylation - they did this with interferon so that it could be once per week

Question 28

Name the 3 characteristics of 2nd generation Hep C drugs.

What are they called?

Answer 28

1. Well-tolerated
2. Curative
3. Expensive
   DIrect Acting Agents - DAAs

Question 29

What is the catch with Hep C anti-virals?

Answer 29

Each strain requires different meds, so you can be re-infected with a different strain multiple times despite being cured of a previous strain.

Question 30

Influenza A was once treated by Amantidine. What was this drug actually indicated for? What was created from Amantidine to treat the flu specifically?

Answer 30

Parkinsons.

Rimantidine - less CNS AE, $$$

Question 31

Name the derivatives of Amantidine that are used to treat influenza A and B. (3)

Answer 31

Viral neuraminidase inhibitors
Zanamivir
Oseltamivir
Peramivir

Question 32

Zanamivir is an ________ that cannot be used in those with _________ disease, so it is never used.

Answer 32

inhaler

pulmonary

Question 33

Oseltamivir (Tamiflu) is _____ and used first line.

Answer 33

PO

Question 34

Peramivir is _____ and used second line if Tamiflu cannot be given.

Answer 34

IV

Question 35

What are the cons of getting the flu shot?

Answer 35

just the injection itself

Question 36

What is antigenic drift?

Answer 36

Strains of bacteria/viruses that change a little from year to year. We create vaccines by predicting what strains will infect Americans.