antiviral therapy Flashcards Preview

Microbiology > antiviral therapy > Flashcards

Flashcards in antiviral therapy Deck (41):
1

Hepatitis C therapy - drugs

1. Interferons - α
2. ribavirin
3. Simeprevir
4. Sofosbuvir

2

Ribavirin - mechanism of action

inhibits synthesis of guanine nucleotides by competitively inhibiting inosine monophophate dehydrogenase

3

Ribavirin inhibits synthesis of .... by

- guanine nucleotides
- competitively inhibiting inosine monophophate dehydrogenase

4

Ribavirin - clinical use

1. Chronic HCV
2. RSV (palivizumab is preferred in children)

5

Ribavirin - toxicity

1. hemolytic anemia
2. severe teratogen

6

Simeprevir - mechanism of action

HCV protease inhibitor
prevents viral replication

7

Simeprevir - clinical use

Chronic HCV in combination with ledipasvir (NS5A inhibitor)
DO NOT USE AS MONOTHERPAY

8

Simeprevir - toxicity

1. photosensitivity reaction
2. rash

9

Sofosbuvir - mechanism of action

inhibitis HCV RNA-dependent RNA polymerase acting as a chain terminator

10

Sofosbuvir - clinical use

Chronic HCV in combination with ribavirin +/- peginterferon alfa
DO NOT USE AS MONOTHERAPY

11

Sofosbuvir - side effects

fatique
headache
nausea

12

HIV therpay regimen

Highly active antiretrovial therapy (HAART)

13

HIV therpay - groups of drugs

1. protease inhibitors
2. Nucleoside Reverse Transcriptase Inhibitor (NRTI)
3. Non-nucleoside reverse transcriptase inhibitors (NNRTI)
4. Integrase inhibitors
5. Fusion inhibitors

14

HAART - when to start

often initiated at the time of HIV diagnosis
strongeest indication for patients presenting with AIDS-defining illness, low CD4 (under 5 hundreds), or high viral load

15

HAART regimen consist of

2NRTIs (Nucleoside Reverse Transcriptase Inhibitor) and 1 of the following: NNRT1 (Non-nucleoside reverse transcriptase inhibitors) or protease inhibitor or integrase inhibitor

16

Protease inhibitors - drugs

-NAVIR

17

HIV-1 Protease in encoded by

pol gene

18

HIV-1 Protease - function

assembly of virions depend on HIV-1 protease, which cleaves the polypeptide products of HIV mrna into theri functional parts

19

HIV Protease inhibitors - mechanism of action

inhibit HIV-protease --> prevents maturation of new viruses

20

HIV Protease inhibitors - toxicity

1. hyperglycemia
2. GI tolerance (nausea, vomiting)
3. Lipodystrophy (Cushing-like syndrome)
4. Nephropathy (indinavir)
5. hematuria (indinavir)
6. inhibit cytochrome P-450 (ritonavir)

21

HIV protease inhibitors with antimycobacterial drugs

Rifampin (a potent CYP/UGT inducer) contraindicated with proteae inhibitors because it can decrease protease inhibitor concentration

22

Nucleoside Reverse Transcriptase Inhibitors (NRTIs) - mechansim of action

Competitively inhibit nucleotide binding to reverse transcriptase and terminate the DNA chain (Lack of OH group

23

Nucleoside Reverse Transcriptase Inhibitors (NRTIs) - drugs

1. Abacavir (ABC)
2. Didanosine (ddl)
3. Emtricitabine (FTC)
4. Lamivudine (3TC)
5. Stavudine (d4T)
6. Tenofovir (TDF)
7. Zidovudine (ZDV, formerly AZT)

24

Nucleoside Reverse Transcriptase Inhibitors (NRTIs) - structure

Tenofovir --> nucleotide
the others --> nucleosides and need to be phosphorylated to be active

25

Zidovudine - special clinical use

general prophylaxis and during pregnancy to decrease risk of fetal transmission

26

Nucleoside Reverse Transcriptase Inhibitors (NRTIs) - side effects

1. Bone marrow suppression
2. peripheral neuropathy
3. lactic acidosis (nucleosides)
4. anemia (ZDV)
5. pancreatitis (didanosine)

27

Nucleoside Reverse Transcriptase Inhibitors (NRTIs) - pancreatitis is caused by

didanosine

28

Nucleoside Reverse Transcriptase Inhibitors (NRTIs) - anemia is caused by

ZDV

29

Nucleoside Reverse Transcriptase Inhibitors (NRTIs) - lactic acidosis is caused by

nucleosides

30

Nucleoside Reverse Transcriptase Inhibitors (NRTIs) - how to prevent side effects

bone marrow suppression --> granulocyte colony stimulating factor (G-CSF) and erytrhopoietin)

31

Non-nucleoside reverse transcriptase inhibitors (NNRTI) - drugs

1. Delavirdine
2. Efavirenz
3. Nevirapine

32

Non-nucleoside reverse transcriptase inhibitors (NNRTI) - drugs and mechanism of action

1. Delavirdine 2. Efavirenz 3. Nevirapine
Bind to reverse transcriptase at site different from NRTIs. Do not require phosphorylation to be active or compete with nucleotide

33

Non-nucleoside reverse transcriptase inhibitors (NNRTI) - toxicity

1. rash
2. hepatotoxicity
3. vivid dreams (efavirenz)
4. CNS sympoms (efavirenz)
5. contraindicated in pregnancy (Delavirdine and efavirenz)

34

Non-nucleoside reverse transcriptase inhibitors (NNRTI) - which drugs are contraindicated in pregnancy

Delavirdine and efavirenz

35

HIV - integrase inhibitors - drugs?

1. raltegravir
2. Elvitegravir
3. Dolutegravir

36

integrase inhibitors - mechanism of action

inhibits HIV genone integration into host cell chromosome by REVERSIBLY inhibiting HIV integrase

37

integrase inhibitors - toxicity

increased creatine kinase

38

HIV - fusion inhibitors - drugs

1. Enfuvirtide
2. Maraviroc

39

HIV - fusion inhibitors - drugs and mechanism of action

1. Enfuvirtide --> Binds gp41, inhibiting viral entry
2. Maraviroc --> Binds CCR-5 on surface of T cells/monocytes, inhibiting interaction with gp120

40

HIV - fusion inhibitors - toxicity

skin reaction on injection sites (Enfuvirtide)

41

Abacavir - special characteristic of using

contraindicated if patients has HLA-B*5701 mutation