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Flashcards in AntiViral-Table 1 Deck (62):
1

What are viruses hard to tx?

-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

2

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

Docosanol
Amantadine
Rimantadine
Oseltamivir
Zanamivir
Peramivir

3

What are the inhibitors of viral attachment?

Amantadine and Rimantadine

4

What is the MOA of the inhibitors of viral attachment?

¨Bind viral protein M2 and inhibit viral uncoating

5

How are the inhibitors of viral attachment used?

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

6

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

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

7

When is amantadine specifically used?

Parkinsons

8

How is amatadine excreted?

Majority Unchanged in the urine

9

How is RImantadine metabolized?

Liver

10

What are the neuroaminidase inhibitors?

Oseltamivir, Zanamivir, Peramivir

11

What is the MOA of the neuroaminidase inhibitors?

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

12

What are the neuroaminidase inhibitors used for?

¨Treatment of influenza A and B, duration 5 days
can be effective prophylactically before or after exposure to influenza A/B

13

How is oseltamivir administered?

Orally

14

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

N/V, take with food

15

How is Zanamivir administered?

Intranasal or inhaled dry powder

16

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

produce bronchospasms
careful in patients with asthma or COPD

17

How is Peramivir administered?

IV

18

What is an ADR of Peramivir ?

Diarrhea

19

What drug inhibits attachement?

DOcosanol- prevents viral attachment to human cell

20

How is Docosanol administered?

OTC creamw

21

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

Oral/genital herpes
Begin tx within 12 hrs of prodromal symptoms or lesion onset

22

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

Guanosine analog and Cytosine Analog

23

What are the above drug groups active against?

Herpes family

24

What are the guanosine analogs?

¨Acyclovir
¨Valacyclovir
¨Penciclovir
¨Famiciclovir
¨Ganciclovir
Valganciclovir

25

What are the cytosine analogs?

Cidfovir

26

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

Phosphorylated by viral thymidine kinase

27

What is the oral prodrug of acyclovir?

Valcyclovir

28

What are acyclovir and valcyclovir used for?

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

29

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

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

30

What is the DOC for HVS infections?

Val/acyc

31

What pts is acyclovir used prophylactically in?

Seropositive pts undergoing immunosuppressive therapy- prevent mucocutaneous HSV infections

32

When are penciclorvir and famciclovir used?

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

33

How are ganciclovir and valganciclovir phosphorylated?

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

34

What are ganciclovir and valganciclovir active against?

All herpes viruses

35

What are ganciclovir and valganciclovir used to tx specifically?

CMV in immunocompromised pts

36

What are some ADRs of ganciclovir and valganciclovir?

Neutropenia, thrombocytopenia, teratogenic

37

What is vitasert?

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

38

How is cidofovir phosphorylated?

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

39

What is the spectrum of activity for cidofovir?

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

40

What is cidofovir primarily used for?

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

41

What are the ADRs of cidofovir?

Neutropenia and nephrotoxicity

42

What are the nucleotide analogs?

Adefovir and tenofovir

43

What is adefovir used for?

treatment of chronic active infections HepB

44

Does adefovir need to be phosphorylated?

this drug does NOT require phosphorylation

45

How is tenofovir processed?

Hydrolysis then phosphorylation

46

What is tenofovir used for?

HIV and Hep B tx

47

What is foscarnet?

-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

48

Does foscarnet require phosphorylation?

Nope

49

What is foscarnet active against?

all herpes viruses, influenza, and HIV

50

What are the primary uses of foscarnet?

CMV infections, acyclovir resistant herpes simplex or varicella zoster

51

How is foscarnet administered?

Infusion in large volume of fluid

52

What are the ADRs of Foscarnet?

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

53

What is Ribavirin?

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

54

What is ribavirin aerosol used to tx?

RSV

55

What is ribavirin plus peginterferon used for?

Tx of Hep C

56

What are interferons?

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

57

What are the dose limiting toxicities of interferons?

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

58

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

Viral infection

59

What produces interferon Gamma?

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

60

What is interferon A used for?

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

61

What is interferon B used for?

Remitting MS

62

What is interferon Y(gamma) used for?

Chronic granulomatous disease