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Anti-Virals Flashcards

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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

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A

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

25
Peg-interferon alfa (Pegasys) indications
- 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
Peg-interferon alfa (Pegasys) ADRs
- fatigue - flu-like rxn - anemia - pancytopenia - depression - mood disturbances (20-30% pt.)
27
Peg-interferon alfa (Pegasys) C/I
- AI dz - uncontrolled psychiatric dz - decompensated cirrhosis - uncontrolled seizures
28
Entecavir and Tenofovir class
Nucleoside or nucleotide analogs (antivirals)
29
All nucleoside or nucleotide analogs require dose adjustment in person with _________
CrCl < 50 ml/minCrCl < 50 ml/min
30
_________ are only first-line antivirals for tx of naive pt. with HBV
Entecavir and Tenofovir (nucleoside or nucleotide analogs)
31
T/F: Entecavir (Baraclude) is not recommended in HIV/HBV co-infected patients no treated with highly active antiretroviral therapy
TRUE d/t potential for the development of resistance
32
What is the MC blood borne dz in the U.S.?
Hepatitis C
33
Which direct-acting antivirals act on all hepatitis C genotypes?
1) Nucleotide Polymerase Inhibitors (NS5B) | 2) NS5A inhibitors
34
Which HCV direct-activing antiviral has highest barrier to resistance?
Nucleotide Polymerase Inhibitors (NS5B) - e.g. Sofosbuvir
35
Protease Inhibitors (NS3/4A) ADRs
**hepatic decompensation anemia, pruritis, dysguesia, rash, photosensitivity
36
Polymerase Inhibitors (NS5B) ADRs
fatigue, HA, nausea
37
NS5A Inhibitors ADRs
fatigue, HA, nausea
38
Which specific HCV drugs covers all genotypes (GT1-6)
Epclusa (Sofosubvir and Velptasvir)
39
Which HCV Genotypes does the drug Harvoni (Ledipasvir and Sofosbuvir) cover?
GT 1, 4, 5, 6
40
What is a consideration with HCV drugs containing ritonavir?
many drug drug interactions | ritonavir is a component in Viekira Pak and Technivie
41
Which HCV direct acting antiviral can be used in end stage renal disease?
Zepatier (Elbasvir and Grazoprevir)
42
When should you initiate HIV tx?
antiretroviral tx is recommended for ALL HIV-infected individuals, regardless of CD4 count
43
What are the main categories of drugs used as tx or prophylaxis agains HIV?
- Reverse transcriptase inhibitors (RTIs), including Nucleoside/nucleotide (NRTIs) and Non-nuncleoside (NNRTIs) - Protease inhibitors (PIs)
44
Current tx for HIV infection consists of __________
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
What are the main nucleoside reverse transcriptase inhibitors (NRTIs) used to tx HIV?
- Abacavir - Tenofovir** - Emtricitabine** - Lamivudine
46
What is the main protease inhibitor (PI) used in HIV tx?
Darunavir
47
What are the main integrase inhibitors (InSTI) used in HIV tx?
- Dolutegravir - Elvitegravir - Raltegravir
48
What are the pharmacokinetic "Boosters" used in HIV therapy?
- Cobicistat | - Ritonavir (also a protease inhibitor)
49
What is a major issue with Nucleoside Reverse Transcriptase Inhibitors (NRTIs)?
Lactic acidosis | stavudine > didanosine, zidovudine
50
What are the preferred NRTI drugs in pregnancy?
- Lamivudine - Emtricitabine - Tenofovir - Abacavir
51
What is a major s/e in Tenofovir?
nephrotoxicity
52
Protease inhibitors (PIs) MOA
inhibit protease cleaving of gag and gag-pol viral proteins --> inhibit viral replication
53
What are class wide effects to consider with Protease Inhibitors (PIs)?
- hyperlipidemia and hypertriglyceridemia | - insulin resistance
54
Which protease inhibitors are preferred in pregnancy?
- Atazanavir + ritonavir - Darunavir + ritonavir - Lopinavir + ritonavir ritonavir = booster **increase dosage in 3rd trimester
55
Classwide issues seen in Integrase Inhibitors
interactions with divalent/polyvalent cations, therefore need to take 2 hrs away from magnesium containing antacids
56
Which Integrase Inhibitor has the lowest-risk for interactions?
Raltegravir
57
What is the suffix for integrase inhibitors?
-gravir
58
What is the preferred Integrase Inhibitor in pregnancy?
Raltegravir
59
T/F: You should never give live vaccines to someone with HIV
False-ish You should give with caution, but NEVER give when CD4 count is < 200 cells/mm3

Pharmacology (14 decks)

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