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Antivirals Flashcards

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1
Q

HSV/ VZV- correspond to what HHVs

A

1,2,3

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2
Q

First line Tx for HSV, VZV

A

Acylovir, Valacyclovir, Penciclovir, Famicilovir

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3
Q

Alternative Tx for HSV and VZV

A

Cidofovir, Foscarnet, Vidarabine

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4
Q

Acyclovir- Drug class

A

Nucleoside analog

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5
Q

Acyclovir- MOA

A

viral thymidine kinase converts Acyclovir to acylco GMP –> inhibits viral DNA pol, chain termination

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6
Q

Acyclovir- Features

A

High selectivity, poor solubility and oral availability

Topical, IV, Oral- not absorbed well orally

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7
Q

Acyclovir MOR

A

viral TK or viral DNA polymerase mutation

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8
Q

Acyclovir t1/2

A

3 hr- short half life

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9
Q

Acyclovir AE

A

Acyclovir has poor solubility, ensure adequate hydration to prevent crystalluria

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10
Q

Valcyclovir- Structure

A

Ester of Acyclovir

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11
Q

Valcyclovir advantages

A

Increased water solubility increases bioavailability

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12
Q

Penciclovir Advantage

A

increases oral bioavailability, prolonged intracellular half life

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13
Q

Pencilovir Chain termination

A

Not an obligate chain terminator

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14
Q

Famciclovir Structure

A

Ester of Penciclovir

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15
Q

Famcilovir Advantage

A

More water soluble & Inc half life

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16
Q

Cidofovir structure

A

Nuleotide analog of Cytidine Monophosphate

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17
Q

Cidofovir activation

A

independent of the virus

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18
Q

Cidofovir MOA

A

viral DNA polymerase inhibitor –> chain termination

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19
Q

CIdofovir- Admin

A

IV

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20
Q

Cidofovir- Uses

A

Resistant HHV1,2,3 and CMV (HHV5)

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21
Q

Cidofovir AE

A

dose limiting renal toxicity ensure is pre hydrated with IV saline

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22
Q

Cidofovir + Probenacid

A

Give probenacid to dec renal elimination of Cidofovir

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23
Q

Foscarnet Structure

A

Pyrophosphate analog

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24
Q

Foscarnet MOA

A

binds to pyrophosphate binding site of viral DNA pol –> inhibits it

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25
Foscarnet AE
renal toxicity, prevent via hydration
26
Foscarnet resistance
mutation in viral DNA polymerase
27
Vidarabine Structure
Adenosine analog
28
Vidarabine MOA
viral TK coverts it to Ara- MP --> Ara- ATP inhibits viral DNA pol BUT NOT A CHAIN TERMINATOR
29
VIdarabine MOR
mutation in viral DNA pol
30
Vidarabine uses
Topical treatment for herpes keratitis. Limited systemic value b/c of metabolic inactivation and high toxicity
31
Tx for CMV
Cidofovir, Ganciclovir, Valganciclovir
32
Ganciclovir structure
similar to acyclovir but altered to be an inhibitor of UL97
33
Ganciclovir Features
Poor oral bioavailability
34
Ganciclovir AE
myelosuppresion that is potentiated when given with Zidovudine (AZT)
35
Gancilovir Resistance
UL97 or DNA polymerase mutation
36
Valgancilovir structure
Ester of Ganciclovir
37
Valganciclovir advantages
Increased bioavailability compared to Ganciclovir
38
HBV Tx 1st line, 2nd line
1st line- Lamivudine, IFN alpha | 2nd line- Adefovir
39
Lamivudine structure
Cytidine analog
40
Lamivudine MOA
NRTI + chain terminator
41
Lamivudine AE
fairly non toxic
42
Lamivudine resistance
rapid and common
43
Adefovir Structure
AMP nucleotide
44
Adefovir MOA
nucletoide RTI
45
Adefovir use
alternative CMV tx if resistant to lamivudine
46
Adefovir resistance
None up to 1 yr
47
Adefovir AE
Dose limiting renal toxicity
48
IFN alpa MOA
immune cytokine that activates non selective immunity (macrophages and NK cells) and stops replication in virally infected cells
49
IFN alpha AE
Feel sick- fever, flu like, injection site reactions. Bone marrow suppression
50
IFN alpha CI
autoimmune disease, hepatic decompensation
51
HCV tx- 1st line, 2nd line
1st line- IFN alpha | 2nd line- add Ribavirin
52
IFN alpha in HCV
prophylaxis and chronic infection
53
Ribavirin use only with?
IFN alpha
54
Ribavirin structure
guanidine/ adenosine dual analog
55
Ribarvirin MOA
inserts itself into mRNA and causes hypermutation NOT A CHAIN TERMINATOR
56
Ribavirin admin
oral
57
Ribavirin elim
renal
58
Ribavirin AE
dose limiting renal toxicity b/c stored in RBC for entire 90 day life span
59
Ribavirin CI
Pregnancy
60
Influenza A tx- 1st line, 2nd line
1st line- Oseltamivir | 2nd line- zanamivir, amantadine, rimantadine
61
Amantadine MOA
M2 blocker
62
Amantadine uses
only prophylactic and treatment of suspected influenza A infection
63
Amantadine resistance
frequent but strain dependent
64
Amantadine AE
Crosses BBB and is dopaminergic- agitation, hallucination, cardiac arrhythmias, death if OD
65
Rimantadine MOA
M2 inhibitor
66
Rimantadine uses
prophylaxis and Tx and influenza A infection
67
Rimantadine AE
GI, but less BBB penetration than amantadine so less CNS side effects
68
Oseltamavir Name
Tamiflu
69
Oseltanavir MOA
Sialic acid analog that blocks neurominidase for prophylaxis and early tx
70
Oseltanavir resistance
high
71
Oseltanavir uses
Influenza A and B
72
Zanamavir MOA
sialic acid analog that blocks neuriminidase for propyxlaxis and early tx
73
Zanamavir admin
Nasal
74
Zanamavir AE
respiratory toxicity- bronchospasm
75
Zanamvir CI
Pulmonary disease
76
Influenza B tx
oseltamavir and zanamavir
77
Acylovir, Valacyclovir, Penciclovir, Famicilovir- MOA
Nucleoside activated by viral TYR kinase, inhibit viral DNA pol--> chain termination
78
Valganciclovir Toxicity
Same as Gancilovir- myelosuppression potentiated by Zidovudine
79
Lamivudine uses
Also used for HAART

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