antivirals

Question 1

MOA oseltamivir/zanamivir?

Answer 1

neuraminidase inhib

prevent release of progeny virus

Question 2

oseltamivir/zanamivir use?

Answer 2

flu!

w/in 48 hrs of sx onset

Question 3

a/fam/valacyclovir MOA?

Answer 3

guanosine analogs
P-lated by HSV/VZV thymidine kinase
preferentially inhibit viral DNA polym

Question 4

a/fam/valacyclovir uses?

Answer 4

HSV and VZV
no effect on latent forms
valacyclovir = better oral availability
famciclovir for zoster

Question 5

a/fam/valacyclovir toxicity?

Answer 5

obstructive crystalline nephropathy and acute renal failure

HYDRATE

Question 6

ganciclovir MOA?

Answer 6

5’monoP, guanosine analog.

preferentially inhibits viral DNA polym

Question 7

ganciclovir uses?

Answer 7

CMV!

valganciclovir = better oral availability

Question 8

ganciclovir toxicity?

Answer 8

leukopenia
neutropenia
TCP
renal toxicity

Question 9

foscarnet MOA?

Answer 9

viral DNA/RNA polym inhib
HIV reverse transcriptase inhib
does not need activation by viral kinase

Question 10

foascarnet uses?

Answer 10

CMV retinitis with ganciclovir failure

acyclovir-resistant HSV

Question 11

foscarnet toxicity?

Answer 11

nephrotoxicity (reversible)
electrolyte abnormalities
lowered sz threshold (2/2 electrolytes?)

Question 12

cidofovir MOA?

Answer 12

preferentially inhibits viral DNA polym

does not need activation by viral kinase

Question 13

cidofovir uses?

Answer 13

CMV retinitis

acyclovir-resistant HSV

Question 14

cidofovir toxicity?

Answer 14

nephrotoxicity - give with probenecid and saline

Question 15

what kinds of drugs make up HAART?

Answer 15

2 NRTIs and 1 of NNRTI/protease inhib/integrase inhib

Question 16

how do you recognize the protease inhibitors?

Answer 16

end in “-navir”

e.g. indinavir

Question 17

NRTI MOA?

Answer 17

competitive inhib of nucleotide binding to RT
terminate DNA chain
Tenofovir = nucleotide analogue; all others nucleoside (need to be phosphorylated)

Question 18

NRTI toxicity?

Answer 18

bone marrow suppression: reverse with G-CSF and EPO
peripheral neuropathy
lactic acidosis
anemia (ZDV)
pancreatitis (didanosine)

Question 19

protease toxicity?

Answer 19

hyperglycemia
GI intolerance
lipodystrophy
indinavir: nephropathy, hematuria
RIFAMPIN CONTRAINDICATED (decreases protease concentration)

Question 20

NNRTI MOA?

Answer 20

bind RT at different site than NRTI

do not compete with nucleotides

Question 21

NNRTI toxicity?

Answer 21

rash
hepatotoxicity
efavirenz: vivid dreams, CNS symptoms

Question 22

what kind of HIV mx is raltegravir?

Answer 22

integrase inhibitor

Question 23

what kind of HIV mx is enfuvirtide?

Answer 23

fusion inhibitor

binds gp41 - prevents viral entry

Question 24

what kind of HIV mx is maraviroc?

Answer 24

fusion inhibitor

binds CCR5

Question 25

what can you use IFN-alpha for?

Answer 25

``` chronic HBV/HCV Kaposi hairy cell condyloma acuminatum renal cell carcinoma malignant melanoma ```

Question 26

what can you use IFN-beta for?

Answer 26

MS

Question 27

what can you use IFN-gamma for?

Answer 27

chronic granulomatous disease

Question 28

IFN toxicity?

Answer 28

neutropenia | myopathy

Question 29

ribavirin MOA?

Answer 29

inhibits guanine nucleotide synthesis

Question 30

ribavirin uses?

Answer 30

``` chronic HCV (with peg-IFN-a) RSV (palivizumab preferred in children) ```

Question 31

ribavirin toxicity?

Answer 31

hemolytic anemia | TERATOGEN

Question 32

what are some newer HCV mx?

Answer 32

simeprevir, sofosbuvir, boceprevir, telaprevir not for monotherapy - use with peg-IFN-a and ribavirin

Question 33

how does sterilization with alcohol work?

Answer 33

protein denaturing cell membrane disruption spores NOT killed

Question 34

how does sterilization with chlorhexidine work?

Answer 34

protein denaturing cell membrane disruption spores NOT killed

Question 35

how does sterilization with hydrogen peroxide work?

Answer 35

free radical oxidation | SPORICIDAL

Question 36

how does sterilization with iodine work?

Answer 36

halogenation! | maybe sporicidal?

Question 37

what ABx/antivirals should preggos avoid?

Answer 37

``` SAFe Children Take Really Good Care sulfonamides (kernicterus) aminoglycosides (ototoxic) fluoroquinolones (cartilage) clarithromycin (embryotoxic) tetracyclines (teeth, bone) ribavirin (teratogen) griseofulvin (teratogen) chloramphenicol (gray baby) ```