Antivirals Flashcards by Sarah Sanchez

4 classes of RNA viruses?

orthomyxovirus
orthocoronavirus
retrovirus
flavivirus

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name the 3 orthomyxoviruses?

influenza A
influenza B
RSV

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name the retroviruses?

HIV-1
HIV-2

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name the falvivirus?

Hep C virus

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2 classes of DNA viruses?

herpes viruses
hepadnaviruses

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name the 4 herpes viruses?

HSV-1
HSV-2
varicella-zoster virus
CMV

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name the hepadnavirus?

hep B virus

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what is the challenge for antiviral therapy?

have no cell wall or cell membrane

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2 synthetic nucleoside analogs that are phosphorylated into nucleotides and taken up by viral DNA polymerase as “false substrates” during the acute phase of infection

acyclovir
valacyclovir (prodrug)

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3 uses for acyclovir and valacyclovir?

HSV-1
HSV-2
VZV

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topical ADR of acyclovir and valacyclovir? oral? IV? in patients with impaired renal function?

TOPICAL:
burning
stinging
mild pain

ORAL:
headache

IV:
phlebitis

IMPAIRED RENAL FUNCTION:
nephrotoxicity

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4 synthetic nucleoside analogs that get phosphorylated into monopotassium phosphate (PO4) by viral thymidine kinase in HSV or VZV-infected cells OR UL97 kinase in CMV-infected cells

penciclovir
famciclovir (prodrug)

ganciclovir
valganciclovir (prodrug)

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2 uses for penciclovir and famciclovir?

HSV
VZV

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3 ADR of penciclovir and famciclovir?

TOPICAL:
burning/pain

ORAL:
headache

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2 uses for ganciclovir and valganciclovir?

CMV
CMV retinitis in AIDS

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3 ADRs of ganciclovir and valganciclovir?

headache
allergic reaction
bone marrow suppression

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3 monophosphate nucleoside analogs that do not need the viral kinase to phosphorylate and can overcome viral resistance due to deficient or mutated thymidine kinase or UL 97 kinase

cidofovir (IV)
trifluridine (PO, eye)
vidarabine (PO, eye)

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2 uses for the monophosphate nucleoside analogs?

acyclovir-resistant HSV kerato-conjunctivitis
CMV retinitis

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anti-viral that directly inhibits viral DNA polymerase by targeting HIV reverse transcriptase (who converts viral RNA into viral DNA)

foscarnet (IV)

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2 uses for foscarnet?

acyclovir-resistant HSV
ganciclovir-resistant CMV

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4 ADRs of foscarnet?

“fast cars make me feel imbalanced (electrolytes), nephrotoxicity, hot (fever) and weak (anemia)

nephrotoxicity
electrolyte imbalance
fever
anemia

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why is foscarnet hardly used?

caused ARDS

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unsure MOA, possibly inhibits viral fusion; used OTC and started within 12 hours of symptoms

docosanol

(zilactin-B, blistex, erazaban)

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use for docosanol?

recurrent orolabial herpes

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2 ADRs of docosanol?

headache allergic rxn (rare)

target and bind to spike protein of COVID-19, block antigen from binding to cells or "mark" it for processing by immune cells

monoclonal antibodies

nucleoside triphosphate analogue that inhibits viral RNA polymerase and stops the inclusion of additional nucleosides

remdesivir (IV)

remdesivir use?

COVID-19

why does remdesivir have low efficacy, especially on ventilated patients?

infection spreads before patient has symptoms

what is the median incubation period of COVID-19? when should remdesivir be started?

4 days 8 hours - 2 days of infection

kinase inhibitor that interferes with the main protease enzyme of COVID-19

paxlovid (oral)

ADR of paxlovid?

rebound of symptoms after full course and viral clearance

2 paxlovid uses?

contain COVID-19 pandemic decrease hospitalizations and deaths

not yet approved for use but reserved for patients who cannot respond or tolerate paxlovid

molnupiravir

used as pre-exposure prophylaxis for COVID-19 infection in patients at risk for the infection and are allergic to the vaccine

evusheld (tixagevimab/cilgavimab)

4 ADRs of COVID-19 vaccine?

injection site reaction fatigue headache myalgia

what is considered the 1st line treatment for HIV?

NRTI's (nucleoside reverse transcriptase inhibitors)

what is the goal of HIV treatment?

slow or reverse the increase in viral RNA load that is associated with disease progression

what is the Highly Active Anti-Retroviral Therapy (HAART) regimen?

2 NRTIs + INSTI

what is the HAART alternative #1?

2 NRTIs + NNRTI or boosted protease inhibitor

what is the HAART alternative #2?

1 NRTI + INSTI

fusion inhibitor that blocks fusion between the virus and target cell membrane extracellularly

enfuvirtide (SQ)

-virtide

fusion inhibitor

enfuvirtide use?

HIV

2 entry inhibitors known as CXCR4 antagonists and CCR5 antagonists; the CXCR4 and CCR5 receptors help viruses bind

maraviroc ibalizumab

maraviroc and ibalizumab use?

HIV

ADRs of entry inhibitors?

hepatotoxicity

3 NNRTIs that directly bind to HIV's reverse transcriptase without needing phosphorylation

Rilpivirine Efavirenz Nevirapine

which NNRTI is used during childbirth to prevent transmission of HIV?

nevirapine *"Nevir let the baby get it"*

ADR specific to efavirenz?

vivid dreams

2 ADRs of NNRTIs?

rash elevated LFTs

NNRTIs have increased effects when used with _____

NRTIs

4 NRTIs that need activation/phosphorylation into a "false nucleotide" via intracellular kinases; inhibit conversion of viral RNA into viral DNA

Lamivudine Abacavir Tenofovir Emtricitabine

which HIV drugs have the least potential for D-D interaction?

NRTIs

2 ADRs of NRTIs?

lactic acidosis hepatomegaly

ADR of NRTI specific to abacavir?

hypersensitivity (esp if + HLA-B5701 gene carrier)

what disqualifies a patient from using abacavir?

HLA-B5701 gene carrier

which NRTI requires testing before considering the use of the drug and should NEVER be re-challenged?

abacavir

which NRTI has few S/E, good bioavailability and is in most HAART regimens?

emtricitabine

-tegravir

integrase inhibitors

prevent HIV from getting inserted into the host cell's DNA, which occurs after reverse transcription of viral RNA to viral DNA has occurred

integrase inhibitors

ADR of integrase inhibitors?

weight gain

-navir

protease inhibitors

stops maturation of viral DNA in HIV

protease inhibitors

6 ADRs of protease inhibitors?

hyperglycemia/insulin resistance central adiposity lipodystrophy syndrome increased LFTs prolonged QT hyperlipidemia

which protease inhibitor has oral absorption that depends on acidic environment?

atazanavir

which protease inhibitor has increased D-D interactions since it is a potent CYP3A4 inhibitor?

ritonavir

-savir

gP120 blocker (attachment inhibitor)

inhibits gP120, which would usually stop the drug from entering the viral cell of HIV

gP120 blocker (attachment inhibitor)

what is a key step needed for entry of HIV-1 into host cell?

binding of HIV-1 gP120 to co-receptors CCR5 or CXCR4

which 3 drug classes do not have CYP450 interaction?

NNRTI fusion inhibitor integrase inhibitor (INSTI)

which 2 drug classes are metabolized by CYP3A4?

protease inhibitor entry inhibitors

which 2 HIV drugs have acid-dependent oral absorption and will thus be affected by PPIs and other drugs that decrease acidity?

atazanavir rilpivirine

during which 2 trimesters have the highest transmission rate of HIV?

2nd 3rd

what can be given to pregnant patients with HIV who are and are not already being treated?

PrEP

which PrEP drug has the highest risk of hepatotoxicity with CD4 > 250?

nevirapine

available for HIV negative patients; take a once daily combination of 2 NRTIs before coming into contact with HIV to decrease infection risk. which 2 drugs can be used?

"PrEPare for ET" PrEP emtricitabine tenofovir

used for suppress local viral replication of HIV prior to dissemination to abort infection

PEP

when should PEP be started?

within 1-2 hours of exposure

what is the PEP regimen for a patient in low risk, with asymptomatic HIV, low HIV-RNA titer, and a high CD4 count?

zidovudine + lamivudine

what is the PEP regimen for a patient in high risk, with symptomatic HIV, high HIV-RNA titer, and a low CD4 count?

zidovudine + lamivudine + indinavir (protease inhibitor)

which protease inhibitor has no antiviral activity but it used to boost the systemic exposure of the active components being used to attack HIV?

ritonavir

-mivir

viral neuraminidase inhibitors

use of viral neuraminidase inhibitors?

influenza A influenza B

when should viral neuraminidase inhibitors be taken?

within 24-48 hours of symptom onset

ADRs of viral neuraminidase inhibitors (mivir)?

N/V nasal discomfort bronchospasms

in which medical condition should viral neuraminidase inhibitors be avoided?

COPD

inhibitor of CAP endonuclease (an essential subdomain of viral RNA polymerase within influenza A and B)

"CAP" associated with Bal..." baloxavir

baloxavir has a synergistic effect with which other antiviral?

oseltamivir

what should NOT be administered in any case of influenza infection d/t the risk of Reye syndrome (brain/liver damage)?

aspirin (pepto)

2 drugs that inhibit the 1st step in viral replication of influenza A and rubella viruses? are now used as anti-parkinsonism agents

amantadine rimantadine

2 previous uses for amantadine and rimantadine?

influenza A prophylaxis decreased symptom duration if taken within 48 hours of contact

antiviral that inhibits viral RNA polymerase

ribavirin

use of ribavirin? previous use?

severe RSV infection previously HCV

ADR of ribavirin?

human teratogen (CI in pregnancy!!!)

drug that stimulates synthesis of antiviral proteins that mimic host interferon; inhibiting viral life cycle at multiple steps

interferon alpha (IFN-alpha)

use for INF-alpha?

Hep B Hep C

4 ADRs of IFN-alpha?

flu-like symptoms confusion emotional disturbance dose-limiting bone marrow suppression

added to increase the activity IFN-alpha for Hep B and Hep C

polyethylene glycol

the drug combination of IFN-alpha OR polyethylene glycol IFN-alpha + ribavirin, requires what d/t being a teratogen?

pregnancy test and contraception

what is the current standard of care for chronic HCV?

oral direct-acting antivirals (DAA)

what is the length of treatment with DAA?

12 weeks

what drugs do DAAs have a high D-D interaction potential with?

anticoagulants: apixaban edoxaban rivaroxaban dabigatran

-previr

DAA protease inhibitors

-asvir

DAA NS5A inhibitors

-buvir

DAA nucleoside and non-nucleoside inhibitors

what is chronic HCV treatment dependent on?

genotype testing

Antivirals Flashcards

(107 cards)