AntiViral-Table 1

Question 1

What are viruses hard to tx?

Answer 1

• Effective treatment requires that the drug must enter the host cell
• Most antivirals agents inhibit single steps in viral replication and are virustatic- need competent host immune system

Question 2

What are the inhibitors of viral attachment (uncoating or release)?

Answer 2

Docosanol
Amantadine
Rimantadine
Oseltamivir
Zanamivir
Peramivir

Question 3

What are the inhibitors of viral attachment?

Answer 3

Amantadine and Rimantadine

Question 4

What is the MOA of the inhibitors of viral attachment?

Answer 4

¨Bind viral protein M2 and inhibit viral uncoating

Question 5

How are the inhibitors of viral attachment used?

Answer 5

for treatment and prophylaxis of influenza type A, no effect on type B-lack M2

Question 6

Do the inhibitors of viral attachment have a wide or narrow therapeutic index? Why is this important to know?

Answer 6

Narrow therapeutic index
(therapeutic 0.5-0.8mcg/mL, CNS toxic >1-5 mcg/mL)
this is important bc of the cns toxic effects- seizure, coma, delirium

Question 7

When is amantadine specifically used?

Answer 7

Parkinsons

Question 8

How is amatadine excreted?

Answer 8

Majority Unchanged in the urine

Question 9

How is RImantadine metabolized?

Answer 9

Liver

Question 10

What are the neuroaminidase inhibitors?

Answer 10

Oseltamivir, Zanamivir, Peramivir

Question 11

What is the MOA of the neuroaminidase inhibitors?

Answer 11

Selective inhibitors of viral neuraminidases which are essential for release of virus from the infected cell

Question 12

What are the neuroaminidase inhibitors used for?

Answer 12

¨Treatment of influenza A and B, duration 5 days

can be effective prophylactically before or after exposure to influenza A/B

Question 13

How is oseltamivir administered?

Answer 13

Orally

Question 14

What are some ADRs of oseltamivir? How can you diminish these?

Answer 14

N/V, take with food

Question 15

How is Zanamivir administered?

Answer 15

Intranasal or inhaled dry powder

Question 16

What can be an ADR of Zanamivir? Which pts should you prescribe this with caution in?

Answer 16

produce bronchospasms

careful in patients with asthma or COPD

Question 17

How is Peramivir administered?

Answer 17

IV

Question 18

What is an ADR of Peramivir ?

Answer 18

Diarrhea

Question 19

What drug inhibits attachement?

Answer 19

DOcosanol- prevents viral attachment to human cell

Question 20

How is Docosanol administered?

Answer 20

OTC creamw

Question 21

What is docosanol used for and when should it be started?

Answer 21

Oral/genital herpes

Begin tx within 12 hrs of prodromal symptoms or lesion onset

Question 22

What are the drug categories that block DNA synthesis from viral DNA?

Answer 22

Guanosine analog and Cytosine Analog

Question 23

What are the above drug groups active against?

Answer 23

Herpes family

Question 24

What are the guanosine analogs?

Answer 24

¨Acyclovir
¨Valacyclovir
¨Penciclovir
¨Famiciclovir
¨Ganciclovir
Valganciclovir

Question 25

What are the cytosine analogs?

Answer 25

Cidfovir

Question 26

What is the mechanism of viral resistance in nAcyclovir, Valacyclovir, Penciclovir, Ganciclovir, Valganciclovir?

Answer 26

Phosphorylated by viral thymidine kinase

Question 27

What is the oral prodrug of acyclovir?

Answer 27

Valcyclovir

Question 28

What are acyclovir and valcyclovir used for?

Answer 28

-Treatment and Prophylaxis of: Herpes simplex (type I and II) and zoster Varicella zoster- treatment

Question 29

When do val/acyc need to be administered to a pt with varicella zoster?

Answer 29

w/I 24hrs of rash onset to decrease symptoms by day 1

Question 30

What is the DOC for HVS infections?

Answer 30

Val/acyc

Question 31

What pts is acyclovir used prophylactically in?

Answer 31

Seropositive pts undergoing immunosuppressive therapy- prevent mucocutaneous HSV infections

Question 32

When are penciclorvir and famciclovir used?

Answer 32

to treat Herpes Zoster, Herpes simplex type II, topical treatment of oral/labial herpes simplex virus

Question 33

How are ganciclovir and valganciclovir phosphorylated?

Answer 33

by viral protein kinase in cytomegalovirus and by viral thymidine kinase in herpes simplex virus then further phosphorylated by host enzymes

Question 34

What are ganciclovir and valganciclovir active against?

Answer 34

All herpes viruses

Question 35

What are ganciclovir and valganciclovir used to tx specifically?

Answer 35

CMV in immunocompromised pts

Question 36

What are some ADRs of ganciclovir and valganciclovir?

Answer 36

Neutropenia, thrombocytopenia, teratogenic

Question 37

What is vitasert?

Answer 37

an intraocular sustained release implant for CMV retinitis (ganciclovir and valganciclovir?)

Question 38

How is cidofovir phosphorylated?

Answer 38

by host enzymes- males this useful when viral thymidine kinase resistance has developed

Question 39

What is the spectrum of activity for cidofovir?

Answer 39

Broad spectrum: herpes and pox viruses, adenoviruses, papilloma viruses, and hepadenavirus

Question 40

What is cidofovir primarily used for?

Answer 40

treatment of cytomegalovirus in AIDS patients who are intolerant, relapsed, or nonresponsive to ganciclovir or foscarnet AND
Acyclovir resistant mucocutaneous HSV infection

Question 41

What are the ADRs of cidofovir?

Answer 41

Neutropenia and nephrotoxicity

Question 42

What are the nucleotide analogs?

Answer 42

Adefovir and tenofovir

Question 43

What is adefovir used for?

Answer 43

treatment of chronic active infections HepB

Question 44

Does adefovir need to be phosphorylated?

Answer 44

this drug does NOT require phosphorylation

Question 45

How is tenofovir processed?

Answer 45

Hydrolysis then phosphorylation

Question 46

What is tenofovir used for?

Answer 46

HIV and Hep B tx

Question 47

What is foscarnet?

Answer 47

-an inorganic phosphate analog that acts by directly inhibiting DNA and RNA polymerases and reverse transcriptases- 100 x greater effect on viral vs human DNA polymerase

Question 48

Does foscarnet require phosphorylation?

Answer 48

Nope

Question 49

What is foscarnet active against?

Answer 49

all herpes viruses, influenza, and HIV

Question 50

What are the primary uses of foscarnet?

Answer 50

CMV infections, acyclovir resistant herpes simplex or varicella zoster

Question 51

How is foscarnet administered?

Answer 51

Infusion in large volume of fluid

Question 52

What are the ADRs of Foscarnet?

Answer 52

-Nephrotoxicity- dose limiting in 10-25% of patients | ¨Increased risk with amphotericin B and aminoglycosides

Question 53

What is Ribavirin?

Answer 53

A purine nucleoside analog that is phosphorylated intracellularly by host cell enzymes

Question 54

What is ribavirin aerosol used to tx?

Answer 54

RSV

Question 55

What is ribavirin plus peginterferon used for?

Answer 55

Tx of Hep C

Question 56

What are interferons?

Answer 56

Immunomodulatory and antiviral drugs that are non-specific inhibitors of RNA and protein synthesis- basically it prevents translation of viral proteins

Question 57

What are the dose limiting toxicities of interferons?

Answer 57

- Neutropenia and anemia | - Flu like syndrome”- fever, fatigue, myalgia

Question 58

Interferon A/B are produced by almost all cells in response to what?

Answer 58

Viral infection

Question 59

What produces interferon Gamma?

Answer 59

T-cells and NK cells in response to antigens and cytokines

Question 60

What is interferon A used for?

Answer 60

Chronic Hep C/B Genital warts from papilloma virus Hariy cell leukemia Kaposis sarcoma

Question 61

What is interferon B used for?

Answer 61

Remitting MS

Question 62

What is interferon Y(gamma) used for?

Answer 62

Chronic granulomatous disease