Antivirals

Question 1

Influenza drugs

Answer 1

Amantadine
Oseltamivir
Zanamivir
Baloxavir marboxil

Question 2

Herpesvirus drugs

Answer 2

Acyclovir/valacyclovir
Ganciclovir/valganciclovir
Cidofovir (+ probenecid)
Foscarnet

Question 3

Hemagglutatin

Answer 3

Binds to sialic acid to initiate infection

Question 4

Neuramidiase

Answer 4

Cleaves/releases virions so other cells can be infected

Question 5

M2 protein

Answer 5

Influenze protein channel
Incoating and release of viral contents

Question 6

Chemotherapy

Answer 6

Not a substitute for vaccination
Must be stated within 48 hours for patients with high risk of influenza complications

Question 7

Amantidine (Adamatases) mechanism

Answer 7

blocks influenza A M2 channel proteins
does not work on influenza B

Question 8

amantadine resistant

Answer 8

nearly 100% due to mutations in M2 protein

Question 9

amantidine uses

Answer 9

parkinsons

Question 10

amantidine adverse effects

Answer 10

mild CNS effects (tremor, diziness, ataxia)

Question 11

neuramidase inhibitors (oseltamivir, zanamivir) mechanism

Answer 11

competitive inhibitor or viral neuramiinidase

Question 12

Oseltamivir pharmacokinetics

Answer 12

orally avaliable

Question 13

zanamivir pharmacokinetics

Answer 13

Given as dry powder for oral inhalation directly to side of infection

Question 14

Neuramidase inhibitor resistance

Answer 14

Very low

Question 15

Neuramidase inhibitor uses

Answer 15

Prophylaxis (pre and post exposure to influenza A or B in high-risk or unvaccinated patients)
Given within 48 hours of symptom onset

Question 16

Oseltamivir adverse effects

Answer 16

Mild nausea and vomiting

Question 17

Zanamivir adverse effects

Answer 17

Not for use in people with asthma/COPD due to risk of bronchospasm

Question 18

Cap dependent endonuclease inhibitors (baloxavir marboxil) mechanism

Answer 18

Inhibits cap dependent nucleus

Question 19

Cap dependent endonuclease inhibitors (baloxavir marboxil) pharmacokinetics

Answer 19

Reduced availability when taken with dairy products

Question 20

Cap dependent endonuclease inhibitors (baloxavir marboxil) uses

Answer 20

Alternative for oseltamivir for post expoure prophylaxis and treatment of influenza A and B (used within 48 hours)

Question 21

Cap dependent endonuclease inhibitors (baloxavir marboxil) adverse effects

Answer 21

Mild GI symptoms and headaches

Question 22

_ herpesvirus is not eradicated by antiviral drugs

Answer 22

Latent

Question 23

Nucleoside analogues for HSV and VZV (acyclovir, valacyclovir) uses

Answer 23

HSV»VZV
CMV is resistant

Question 24

Valacyclovir compared to acyclovir

Answer 24

Greater oral bioavaliability

Question 25

Nucleoside analogues for HSV and VZV (acyclovir, valacyclovir) mechanism

Answer 25

Convirted to acyclo-GMP by viral thymidine kinase in the cytosol of infected cells Host kinases convert mono to triphosphate which is transported to the nucleus and inhibits viral DNA polymerase or causes DNA chain termination

Question 26

Resistance to Nucleoside analogues for HSV and VZV

Answer 26

Viral TK defiencu

Question 27

Nucleoside analogues for HSV and VZV uses

Answer 27

Genital herpes Primary herpetic gingivostomatitis Mucocutaneous HSV HSV encephalitis VZV infections

Question 28

Nucleoside analogues for HSV and VZV adverse effects

Answer 28

Occur with IV use Renal dysfunction from crystalline neuropathy (Minimalized by hydration and slow IV infusion) Neurotoxicity

Question 29

Nucleoside analogues for CMV

Answer 29

Ganciclovir Valganciclovir

Question 30

Nucleoside analogues for CMV are used for

Answer 30

All herpesviruses but especially CMV

Question 31

Ganciclovir and calganciclovir mechanism

Answer 31

Same as acyclovir Converted to monophosphate by CMV UL97 kinase then die and try phosphorylated by host kinases anti-try phosphates inhibit CMV UL54 DNA polymerase and terminates DNA chain elongation

Question 32

Nucleoside analogues for CMV reistance

Answer 32

Mutations in UL97 kinase, UL54 DNA polymerase

Question 33

Valganciclovir compared to ganciclovir

Answer 33

Higher oral bioavaliability

Question 34

Valganciclovir and ganciclovir uses

Answer 34

Restricted due to toxicity HSV herpetic keratitis CMV retinitis Prophylaxis of CMV infection and organ transplant patients

Question 35

Valganciclovir and ganciclovir Adverse effects

Answer 35

Lower therapeutic index than acyclovir/valacyclovir Black box warning for myelosuppression Renal insufficiency

Question 36

Nucleotide analogs for CMV

Answer 36

Cidodovir (cytidine nucleotide analogs) Active against Kinase deficient herpes virus is because they don’t need to be phosphorylated by viral tyrosine kinase

Question 37

Cidofovir mechanism

Answer 37

Converted to active diphosphate by host kinesis Inhibits viral DNA polymerase and terminates DNA chain 

Question 38

Cidofovir pharmacokinetics

Answer 38

IV only Excreted by OAT1

Question 39

Cidofovir use

Answer 39

Black box warning only for use for CMV retinitis and HIV/AIDS patients Alternative to ganciclovir, foscarnet

Question 40

Cidofovir adverse effects

Answer 40

Black box warning for nephrotoxicity Given with probenecid Black box warning for neutropenia Black box warning for carcinogen and teratogen

Question 41

Non-nucleoside analog for drug resistant HSV and CMV

Answer 41

Foscarnet

Question 42

Foscarnet uses

Answer 42

All herpesvirures Hepatitis B HIV

Question 43

Foscarnet mechanism

Answer 43

Inhibits DNA polymerase and HIV reverse transcriptase (not used for HIV treatment

Question 44

Foscarnet use

Answer 44

Black box warning for appropriate use Ganciclivir-resistane CMV retinitis in HIV/AIDS patients or organ transplant recipients Acylovar-resistant HSV mucocutaneous infections

Question 45

Foscarnet adverse effects

Answer 45

Black box warning for nephrotoxicity Pronounced electrolyte disturbances- Symptomatic hypocalcemia Blackbox warning for seizures due to electrolyte imbalance