1. Nephrotox -->electrolyte abn (+/- Ca+2, +/- Phosphate, hypokalemia, hypomagnesemia) 2. seizures (from electrolyte imbalance)

Nucleoside RT inhib. 1. Abacavir (ABC) 2. Didanosine (ddl) 3. Emtricitibine (FTC) 4. LamiVUDINE (3TC) 5. StaVUDINE (d4T) 6. Tenofovir (TDF) 7. ZidoVUDINE (ZDV) "haVE U DINED (VUDINE) with my NUCLEAR (NUCLEOSIDE) family?"

1. general prophylaxis 2. during pregnancy to decrease risk of fetal transmission

Antiviral Flashcards by Leah Stalnaker

Oseltamivir, Zanamivir:
MOA
Clinical Use
Administration

Inhib Flu Neuraminidase–>decrease release of progeny virus (DOESN’T KILL VIRUS)

Flu A&B treatment/prevention
* given within 48hrs of Symptoms (F/myalgias)

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Acyclovir, famciclovir, valacyclovir (prodrug):
MOA
MOResistance

Guanosine Analogs
RXN: Guanine –> Guanine-P –> Guanine-PPP
1. monophosphorylation occurs via HSV/VZV thymidine kinase
2. Triphosphate formed by cellular enzymes
3. preferentially inhib viral DNA polymerase by chain termination

phophorylation will only take place in uninfected cells–> few adverse cells

Resistance: Mutated viral thymidine kinase

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Acyclovir, famciclovir, valacyclovir (prodrug):
Clinical use(3)

Acute/reactivation HSV, VZV, EBV (weak)

HSV mucocutaneous/genital lesion
HSV encephalitis
Px: immunocompromised patients

NOT FOR LATENT FORMS OF HSV/VZV
Valacyclovir=prodrug–>better oral bioavailability

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Drug used to treat Herpes Zosters

famciclovir

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Acyclovir, famciclovir, valacyclovir (prodrug):
Adverse
How to avoid adverse?

obstructive crystalline nephropathy
Acute Renal Failure

Make sure patient stays HYDRATED

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Ganciclovir, Valganciclovir (prodrug):
MOA
MOResistance

Guanosine analog
Guanosine Analogs
RXN: Guanine –> Guanine-P –> Guanine-PPP
1. monophosphorylation occurs via CMV viral kinase
2. Triphosphate formed by cellular enzymes
3. preferentially inhib viral DNA polymerase by chain termination

Resistance: mutated viral kinase

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CMV types of infections in immunocompromised (3)

CMV colitis
CMV retinitis
CMV esophagitis

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Ganciclovir, Valganciclovir (prodrug):

Clinical Use

CMV, esp in immunocompromised patients

2. Valganciclovir=prodrug–> better oral bioavailability

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Ganciclovir, Valganciclovir (prodrug):
Adverse
Compare toxicity of ganciclovir w/ acyclovir

Bone Marrow Suppression (leukopenia, neutropenia, thrombocytopenia)
Renal tox

toxicity: ganciclovir > acyclovir

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CMV details:
Histo
Latent in which cells
infections
transmission:

Histo: owl’s eye inclusions
* latent in mononuclear cells

congenital infection (TORCH)
Mono (monospot -)
pneumonia
retinitis

-congenital, transfusion/transplant, sex, saliva, urine

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Foscarnet:
MOA
MOResistance

Pyrophosphate analog (“pyro’FOS’phate”)

->binds pyrophosphate-binding site of enzyme
1. viral DNA/RNA polymerase inhib
2. HIV reverse transcriptase inhib
does not require any kinase activation

Resistance: Mutated DNA polymerase

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Foscarnet:

Clinical use

2nd line for CMV/ HSV

CMV retinitis in immunocomp. pt. when ganciclovir fails
acyclovir-resistant HSV

*can be used when resistance develops to ganciclovir/acyclovir b/c Foscarnet doesn’t require any kinase activation

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Foscarnet:

Adverse

Nephrotox –>electrolyte abn (+/- Ca+2, +/- Phosphate, hypokalemia, hypomagnesemia)
seizures (from electrolyte imbalance)

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Which B-lactam Abx can cause seizures?

Carbapenems

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Drugs which induce seizures

“With seizures, I BItE my tongue”

Isoniazid (B6 def)
Buproprion
Imipenem/cilastatin
Enflurane
Foscarnet(from nephrotox)

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Cidofovir:
MOA
Half-life?

inhib viral DNA polymerase
-DOESN’T REQUIRE VIRAL KINASE PHOSPHORYLATION

-long half-life

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Cidofovir:
Clinical use (2)

CMV retinits in immunocompromised patients

2. acyclovir-resistant HSV

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Cidofovir:
Adverse
How to decrease toxicity?

Nephrotox

coadmin w/ Probenecid + IV saline

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Compare Foscarnet vs. Cidofovir:
MOA
Clinical Use
Adverse

Foscarnet: inhib both RNA/DNA pol & HIV RT
Cidofovir: inhib only DNA pol

both second line only
both cause Nephrotox

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What is HAART?
When does it begin
Describe regimen

“highly active antiretroviral therapy”

-often initiated at time of HIV diagnosis. Strongest indication for patients presenting with AIDS-defining illness, low CD4+ cell counts (

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NRTIs:

Name (7)

Nucleoside RT inhib.

Abacavir (ABC)
Didanosine (ddl)
Emtricitibine (FTC)
LamiVUDINE (3TC)
StaVUDINE (d4T)
Tenofovir (TDF)
ZidoVUDINE (ZDV)

“haVE U DINED (VUDINE) with my NUCLEAR (NUCLEOSIDE) family?”

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NRTIs:

MOA

Competitively inhib Nucleotide binding to RT and terminate the DNA chain (lack 3’OH group)

*Require Phosphorylation to be active!

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Unique characteristic of Tenofovir

‘T’enofovir is a nucleo’T’ide–> doesn’t require phosphorylation to become active

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2 uses Zidovudine

general prophylaxis

2. during pregnancy to decrease risk of fetal transmission

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Who is Abacavir contraindicated in?

pt with HLA-B*5701 mutation

NRTIs: Adverse How to decrease/overcome toxicity

1. Bone Marrow suppression (reverse w/ G-CSF or EPO) 2. peripheral neuropathy 3. lactic acidosis (nucleosides) 4. anemia (ZDV) 5. pancreatitis (didanosine)

NNRTIs: | Name 3

Non-nucleoside RT inhib 1. Delavirdine 2. Efavirenz 3. Nevirapine

NNRTIs: | MOA

Bind Reverse Transcriptase at different site than NRTI | *don't require phosphorylation to be active

NNRTIs: | Common adverse for all?

1. Rash | 2. Hepatotox (Allman taught not to start this class unless CD4 count was significantly low)

NNRTIs: | Which causes vivid dreams and CNS symptoms?

Efaviren'Z' *efaviren'z' gives you cra'z'y 'zzz's'

NNRTIs: | which are contraindicated in pregnancy? (2)

1. Delavirdine | 2. Efavirenz

Protease Inhibitors: | Name (7)

"-navir" --> "NAVIR (never) TEASE a PROTEASE" 1. Atazanavir 2. Darunavir 3. Fosamprenavir 4. Indinavir 5. Lopinavir 6. Ritonavir 7. Saquinavir

Protease Inhibitors: | MOA

Assembly of virons depends on HIV-1 protease (pol gene), which cleaves the polypeptide products of HIV mRNA into their functional parts. -->prevent maturation of new viruses

Protease Inhibitors: which can boost the other drug concentrations? How?

Ritonavir | - inhib P450

``` Protease Inhibitors: common Adverse(3) ```

1. hyperglycemia -->DM 2. GI intolerance (N/D) 3. Lipodystrophy -->Cushing-like syndrome

Protease Inhibitors: | Which causes Nephropathy/hematuria/ kidney stones?

Indinavir

Protease Inhibitors: | DD interaction

Rifampin | -potent CYP inducer (which would decrease protease inhib. concentration)

Integrase Inhibitors: | Name (3)

"-TEGRAvir" 1. Raltegravir 2. Elvitegravir 3. Dolutegravir

Integrase Inhibitors: MOA Adverse (1)

-inhib HIV genome INTEGRATION into host chromosome by reversibly inhib HIV integrate Adverse: increase creatine kinase

Fusion Inhibitors: Name 2 Adverse

1. Enfuvirtide 2. Maraviroc -Skin Rxn at injection site

Fusion Inhibitors: | MOA Enfuvirtide

binds gp41 --> inhibiting viral entry | "'E'arly in # for 'FU'sion"

Fusion Inhibitors: | MOA 'M'araviroc

Binds CCR-5 on surface of 'M'onocytes/Tcells--> inhib interaction with gp120

Which antiviral/class?: | screen HLA-B*5701?

Abacavir (NRTI)

Which antiviral/class?: | BM suppression

NRTI | Zidovudine also causes anemia

Which antiviral/class?: | pancreatitis

Didanosine (NRTI)

Which antiviral/class?: | Peripheral neuropathy

NRTI

Which antiviral/class?: | rash

NNRTI

Which antiviral/class?: | Lactic Acidosis

NRTIs

Which antiviral/class?: | Liver tox

NNRTI

Which antiviral/class?: | viral booster

Ritonavir

Which antiviral/class?: | Nephrolithiasis

Indinavir

Which antiviral/class?: | Insulin resistance/DM

Protease Inhib ('-navir')

Which antiviral/class?: | injection site rxn

Enfuvirtide/ maraviroc

Which antiviral/class?: | restricted to CCR5 tropic virus

Maraviroc

Interferons: MOA Adverse (4)

Glycoproteins normally synthesized by virus-infected cells, exhibiting a wide range of ANTIVIRAL & ANTITUMOR properties (paracrine signaling) 1. Flu-like sump 2. depression 3. Neutropenia 4. Myopathy

``` Interferon-alpha: Clinical use (6) ```

1. Hep B/C 2. Kaposi (HHV8) 3. Condyloma acuminatum (HPV 6, 11) 4. Renal cell carcinoma 5. Hairy cell leukemia 6. Melanoma

Interferon-beta Clinical use | Interferone-gamma clinical use

IFN-B: MS IFN-g: CGD (by increasing phagocyte release of Superoxide species to improve microbicidal properties-->decrease risk by 70% of serious infections)

Ribavirin: MOA Clinical Uses (2) Adverse (2)

Competitively inhibiting Inosine Monophosphate Dehydrogenase--> inhib synthesis of Guanine Nucleotides 1. Chronic Hep C 2. RSV(2nd line) Adverse: 1. hemolytic anemia 2. severe teratogen

What is the preferred for treatment for RSV in children?

Palivizumab

Sofosbuvir: MOA Clinical Use (combo of...) Adverse (3)

Inhib HCV RNA-dep-RNA-pol acting as a chain terminator 1. chronic HCV in combo w/ Ribavirin, +/- Peg IFN-a (Never a Monotherapy) Adverse: 1. Fatigue 2. HA 3. N

Simeprevir: MOA Clinical Use (combo of...) Adverse (2)

HCV protease inhibitor--> stop viral replication 1. chronic HCV in combo w/ Ledipasvir (NS5A inhib) (Never a Monotherapy) Adverse: 1. Photosensitivity 2. Rash

Infection control techniques: describe Autoclave Sporicidal?

pressurized steam at >120C | possibly sporicidal

Infection control techniques: describe Alcohols and Chlorhexidine Sporicidal?

``` denature proteins and disrupt cell membranes NOT Sporicidal (will kill bacteria and viruses) ```

Infection control techniques: describe Hydrogen peroxide Sporicidal?

Free radical oxidation | SPORICIDAL

Infection control techniques: describe Iodine and Iodophors Sporicidal?

Halogenation of DNA, RNA, and proteins | possibly sporicidal

differentiate btw Disinfecting and Sterilizing?

Disinfect- decrease pathogens | Sterilizing- destroy living things

C.diff is a common cause of hospital infections. What is the best way to eliminate it?

C.diff is spore forming | ``` #1= hydrogen peroxide followed by autoclave/ iodine&iodophors ```

Antimicrobials to Avoid in Pregnancy: | 8 drugs

"SAFe Children Take Really Good Care" 1. Sulfonamides 2. Aminoglycosides 3. Fluroquinolones 4. Clarithromycin 5. Tetracyclines 6. Ribavirin 7. Griseofulvin 8. Chloramphenicol

Antimicrobials to Avoid in Pregnancy: | Kernicterus causing

sulfonamides

Antimicrobials to Avoid in Pregnancy: | ototoxicity causing

aminoglycosides

Antimicrobials to Avoid in Pregnancy: | cartilage damage

fluoroquinolones

Antimicrobials to Avoid in Pregnancy: | embryotoxic

clarithromycin

Antimicrobials to Avoid in Pregnancy: | discolored teeth, inhib of bone growth

tetracyclines

Antimicrobials to Avoid in Pregnancy: | teratogenic (2)

1. Ribavirin | 2. Griseofulvin

Antimicrobials to Avoid in Pregnancy: | Gray baby syndrome

Chloramphenicol

Drugs which inhibit IMP dehydrogenase (2)

1. Ribavirin (used to treat Hep C | 2. Mycophenolate (used to prevent organ transplant)

What is the triple therapy for Hep C?

1. Ribovirin 2. Simeprevir 3. Peg IFN-a

Antiviral Flashcards

(77 cards)