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Flashcards in Antivirals Deck (79):
1

what are the DNA viruses

-adenovriuses
-herpesviruses
-papillonaviruses
-Varciella-Zoster

2

what are the RNA viruses

-ortho and paramyxoviruses, rubella, viruses and retroviruses

3

what is used to treat Herpes and Varicella-Zoster Infections

Acyclovir

4

what are the symptoms of Acyclovir toxicity

-nausea, headache, diarrhea and vomiting
-transient renal dysfunction at high doses and when given to dehydrated patients by IV

5

what is the therapeutic use of Ganciclovir

-treatment of CMV retinitis in immunocompromised pats
-prevention of CMV disease in transplant pts

6

what is the toxicity of Ganciclovir

dose-dependent neutropenia, CNS effects (headache, behavioural changes, convulsions, coma), carcinogenic

7

patients with Ganciclovir toxicity present with

-blurred vision
-floaters
-loss of central or peripheral vision

8

what is the plasma half life of acyclovir

2.5 hrs

9

what is the plasma half life of Ganciclovir

>24 hrs
Ganciclovir triphosphate [ ] are 10x of acyclovir

10

what is the therapeutic use of Foscarnet

-IV treatment for CMV retinitis in HIV-infected patients who are resistant to ganciclovir.
-Herpes patients who are resistant to acyclovir.

11

Toxicity of Foscarnet

Nephrotoxicity, anemia, nausea, fever, hypocalcemia and hypomagnesemia.

12

what is the therapeutic effect of Trifluridine

HSV keratoconjunctivitis and keratitis.
Replaced the drug Idoxuridine

13

what is the toxicity of Trifluridine

Inflammation of the cornea

14

what is the therapeutic effect of Fomivirsen

CMV retinitis in patients who do not respond to other drugs. Do not give to patients who have taken cidofovir in past month-may increase inflammation of the eye.

15

what is the toxicity of Fomivirsen

Iritis, increased intraocular pressure and vision changes.

16

see mnemonic on slide 13

see mnemonic on slide 13

17

what are the Neuraminidase Inhibitors

zanamivir, oseltamivir

18

what is the therapeutic use of Neuraminidase Inhibitors

-shortens the duration and may be used to prevent flu

19

what is the toxicity of Zanamivir

nasal and throat discomfort and headaches
-bronchospasm in asthma patients

20

what is the toxicity of oseltamivir (TAMIFLU)

-nausea, vomiting and headaches
-when taken with food there is less nausea

21

what can Zanamivir be used for

treatment of H1N1

22

what is Oseltamivir used for

Influenza A and B, H1N1

23

what are interferons

Interferons alpha and beta are made in response to viral infection

24

what is the MAO of interferons

IFNs bind to cellular receptors and activate the JAK-STAT signal transduction pathway
IFNs induce many proteins, including 2'-5'-oligoadenylate synthetase and a kinase, that inhibit protein synthesis.

25

what is the therapeutic use of interferons

genital warts, chronic hepatitis B and C, Kaposi's sarcoma in HIV-infected patients, multiple melanomas and multiple sclerosis.

26

Peg-interferon 2A with Ribavirin is the treatment of choice for

chronic hepatitis C

27

what is the toxicity of interferons

-IM or SC injection may produce flu-like symptoms
-High dose or chronic therapy may be limited due to bone marrow suppression, fatigue, increased susceptibility to bacterial infections, anorexia, diarrhea and psychiatric syndrome (depression and anxiety)

28

what is the MOA of Ribavirin

inhibits viral mRNA synthesis

29

what is the therapeutic use of Ribavirin

-Ribavirin with interferon is the standard treatment for hepatitis C
-Given to treat infants and young children with Respiratory Syncytial Virus infections that cause bronchiolitis and pneumonia.
-Influenza A and B, Parainfluenza, Paramyxovirus, Arenaviruses and HIV.

30

what is the toxicity of Ribavirin

Aerosol is well tolerated, but systemic doses may cause anemia
Teratogenic therefore do not give to pregnant women.

31

what does HAART stand for

Highly Active Anti-Retroviral Therapy

32

what are the possible side effects of HAART

liver problems
diabetes
lipodystrophy syndrome
high cholesterol
increased bleeding hemophiliacs
decreased bone density
skin rash

33

what is the therapeutic use of Zidovudine (AZT)

HIV patients, protects fetuses from becoming infected in HIV-infected pregnant women.

34

Zidovudine resistance

Mutated reverse transcriptase that has a lower affinity for the AZT-TP

35

what is the toxicity of Zidovudine

Bone marrow (anemia and leukopenia) and headaches

36

what drugs increase the toxicity of Zidovudine

Probenecid, Acetaminophen Lorazepam (benzodiazepine), Indomethacin (anti-inflammatory), and Cimetidine (H2-receptor antagonist)

"I am a PAL I Care"

37

what is the therapeutic use of Didanosine (ddI)

-patients with AZT-resistant HIV infections

38

what s the toxicity of Didanosine

-Pancreatitis that may be fatal, gastrointestinal disturbances and a dose-limiting peripheral neuropathy
-toxicity increases when combined with Stavudine

39

what is the therapeutic Zalcitabine (dec)

-Given in conjunction with AZT or alone for those who cannot tolerate AZT- treatment

40

what is the toxicity of Zalcitabine

Peripheral neuropathy, rash and stomatitis on initial treatments

41

what is the toxicity of Stavudine

peripheral neuropathy

42

what is the toxicity of both AZT and Stavudine treatment

Potentially fatal lactic acidosis, peripheral lipoatrophy, central fat accumulation and hyperlipidemia

43

what is the therapeutic use of Lamivudine (3CT) and Emtricitabine

Patients with HIV in combination with AZT (resistance to AZT develops more slowly when used in combination)
and hepatitis B patients.

44

what is the toxicity of Lamivudine

Pancreatitis often develops in pediatric patients

45

what is the therapeutic use of Abacavir

: HIV infected adults and children in combination with AZT and Lamivudine or a protease inhibitor

46

what is the toxicity of Abacavir

Hypersensitivity resulting in fever, gastrointestinal distress, malaise and rash

47

what is the MOA of Tenofovir

Inhibits reverse transcriptase and terminates DNA chain elongation.

48

what is the therapeutic use of Tenofovir

HIV infected patients and chronic hepatitis B infections.

49

see slide 32

see slide 32

50

what is the toxicity of Tenofovir

-well tolerated except for flatulence, some renal toxicity
-do not give as didanosine, lamivudin or abacavir combo

51

see mnemonic on slide 33

see mnemonic on slide 33

52

what is the MOA of Efavirenz

alters the conformation of reverse transcriptase

53

what the therapeutic use of Efavirenz

Used in combination with AZT and Lamivudine

54

what is the toxicity of Efavirenz

Dizziness, headache, insomnia, rash

55

what is the drug interactions of Efavirenz

Efavirenz decreases concentration of Phenobarbital, Phenytoin, Carbamazepine, Methadone and Rifabutin.

Co-administration of Rifampin will reduce levels of Efavirenz

56

what is the MOA of Nevirapine

alters the conformation of reverse transcriptase

57

what is the therapeutic use of Nevirapine

used in combo with Didanosine or Stavudine

58

what is the toxicity of Nevirapine

Rash, fever, nausea, severe dermatologic effects and fatal hepatotoxicity

59

what are the drug interactions of Nevirapine

Must warn patients not to take St. John's Wort which lowers the concentration of Nevirapine.

Nevirapine induces CYP3A4 and therefore it may lower the concentration of drugs metabolized by this enzyme.

Nevirapine lowers plasma concentrations of Ethinyl estradiol and therefore patients should be given alternate methods of birth control

60

what is the MOA of Delavirdine

binds and inhibits reverse transcriptase

61

what is the therapeutic effect of Delavirdine

Used in combination with Zidovudine and Didanosine, least potent NNRTI

62

what are the drug interactions of Delavirdine

Delavirdine inhibits CYP3A4 and may thus alter the metabolism of Rifampin, Rifabutin, Ergot derivatives, Triazolam, Midazolam and Cisapride.

Delavirdine also inhibits CYP2C9.

Drugs that induce CYP3A4, such as Carbamazepine, Penobarbital, Phenytoin, Rifabutin and Rifampin, may decrease Delavirdine levels.

63

see mnemonic on slide 37

see mnemonic on slide 37

64

what are the protease inhibitors

Atazanavir
Indinavir
Ritonavir
Lopinavir
Nelfinavir
Amprenavir
Saquinavir

65

see mnemonic on slide 39

see mnemonic on slide 39

66

what is the therapeutic use of protease inhibitors

HIV patients must take the drugs continuously in combination with AZT and Lamivudine or other nucleoside reverse transcriptase inhibitors.

67

what is the toxicity of protease inhibitors

Well tolerated
Sometime- nausea, vomiting, diarrhea, lipodystrophy and hyperglycemia

68

what is the resistance of protease inhibitors

Cross-resistance often occurs among the protease inhibitors, but the HIV strains may still be susceptible to Amprenavir.

69

what are the pharmacokinetics of Lopinavir/Ritonavir

is metabolized by CYP3A. Ritonavir is an inhibitor of CYP3A4 activity and, therefore, raises the Lopinavir plasma levels

70

what is the therapeutic use of Lopinavir/Ritonavir

The combination of drugs is used to treat HIV strains that are resistant to multiple protease inhibitors

71

what is the toxicity of Lopinavir/Ritonavir

Well tolerated.
Diarrhea, nausea, fatigue, headache, hyperlipidemia, hyperglycemia, and altered body fat

72

what are the drug interactions of Lopinavir/Ritonavir

Inhibit the activity of CYP3A4 and CYP2D6 and therefore may increase or prolong the therapeutic or adverse effects of drugs metabolized by these pathways

73

what the Fusion Inhibitor

Enfuvirtide
Macaviroc

74

what is the therapeutic use of Enfuvirtide

Injected twice daily in HIV patients. Used with other drugs

75

what is the toxicity of Enfuvirtide

Pain, redness, nodules and cysts formation at the site of injection

76

what is the therapeutic use of Maraviroc

HIV patients

77

what is the MOA of Maraviroc

The drug blocks the CCR5 chemokine receptor. HIV uses CCR5 as a co-receptor to bind and enter macrophages

78

what is the toxicity of Maraviroc

-most common are cough, fever, dizziness, headache, lowered blood pressure, nausea, and bladder irritation
-May cause liver problems and cardiac events, an increased risk for some infections, and a slight increase in cholesterol levels

79

see slide 47

see slide 47