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Pharm I Test II 2016 > Antivirals > Flashcards

Antivirals Flashcards

1
Q

What are the two classes of antivirals for influenza?

A

Adamantanes and Neurominidase Inhibitors

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2
Q

Name two adamantanes and the influenza virus(es) they are active against.

A

Amantadine and Rimantadine. ONLY Influenza A.

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3
Q

Name two Neurominidase Inhibitors and the influenza virus(es) they are active against.

A

Oseltamivir and Zanamivir. Have activity against influenza A and B.

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4
Q

What is the MOA of Neurominidase Inhibitors, Oseltamivir and Zanamivir?

A
  • Block active site of neuraminidase
  • Reduce the amount of viral particles released from infected cells

Result in decreased shedding of influenza A and B viruses

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5
Q

Neuromindase Inhibitors main tx efficacy:

A

– Reduces duration of uncomplicated influenza A and B illness
– Reduction in viral shedding, fever, illness
– May reduce complications, death and shorten duration of hospitalizations
– Shortens symptoms by 1 or 2 days

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6
Q

Adverse effects of Oseltamivir?

A

– Nausea, vomiting (9-10%)
– Transient neuropsychiatric events (self-injury or delirium – majority in Japan
– Limited data in children

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7
Q

T or F: Oseltamivir is preferred in pregnancy

A

True

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8
Q

T or F: Oseltamivir is preferred in pregnancy

A

True

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9
Q

Route of administratin of Zanamivir (for influenza A, B)

A

Orally inhaled powder

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10
Q

Adverse effects of Zanamivir:

A

– Nausea, diarrhea
– Headache
– Cough
– BRONCHOSPASM in persons with pulmonary disease (not recommended in this population)

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11
Q

What are the antivirals used for HSV?

A
  • Acyclovir/ Zovirax
  • Famciclovir/ Famvir
  • Valacyclovir/Valtrex
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12
Q

Which antiviral is converted to acyclovir after oral administration?

A

Valacyclovir/Valtrex - it has better bioavailability

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13
Q

Which antiviral is converted to acyclovir after oral administration?

A

Valacyclovir/Valtrex - it has better bioavailability

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14
Q

MOA of Acyclovir?

A

Acyclovir is a guanosine analog that is incorporated into the virus DNA and inhibits further viral synthesis.

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15
Q

T or F: Acyclovir only works against viruses that are actively replicating and is ineffective against latent virus.

A

True

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16
Q

Which antiviral can actively cross the blood barrier and can thus be used to treat herpes meningitis and encephalitis?

A

Acyclovir/Zovirax

17
Q

Indications for Acyclovir/Zovirax?

A

– Genital Herpes (shortens sx by 2 days) – Herpes labialis (modestly beneficial)
– Varicella (HIGHER DOSES REQ)

18
Q

Adverse effects of Acyclovir/Zovirax?

A

– Oral: Headache, nausea and vomiting
– IV: Renal Toxicity (need proper hydration),
CNS side effects
– Topical: skin irritation

19
Q

Two treatments for Hep B?

A
  1. Immunomodulatory therapy (finite therapy)

2. Anti-viral agents acting on Hep B DNA polymerase (treatment may be indefinite)

20
Q

What is the immunomodulatory therapy and what is its duration and goal?

A

Pegylated interferon for 48 weeks

Goal: sustained suppression of viral replication after completion of treatment

21
Q

MOA of Peg-interferon alfa (Pegasys®)?

A

CYTOKINE that induces specific & nonspecific immune responses

22
Q

What is the only effective tx of Hep B with Hep D coinfection?

A

Peg-interferon alfa (Pegasys®)

23
Q

Adverse effect/toxicity of Peg-interferon alfa (Pegasys®)?

A 
– fatigue 
– flu-like rxn 
– anemia 
– panctyopenia 
– depression
– mood disturbances (20-30% of patients)
24
Q

Contraindications of Peg-interferon alfa (Pegasys®)?

A

– autoimmune disease
– uncontrolled psychiatric disease
– decompensated cirrhosis
– uncontrolled seizures

25
Q

What monitoring do you need to do with patients on Peg-interferon alfa (Pegasys®) and how often?

A

CBC
TSH

Every 3 months

26
Q

Ideal (necessary?) patient picture for treatment with Peg-interferon alfa (Pegasys®)?

A

– low HBV DNA levels
– high levels of ALT
– lack of advanced liver disease

27
Q

What are the 5 nucleoside or nucleotide analogs (anti-virals for Hep B)?

A 
– lamivudine
– adefovir
– telbivudine
– ENTECAVIR
– TENOFOVIR
28
Q

Duration of nucleoside or nucleotide analogs therapy is variable and influenced by (3 things):

A

– HBeAg status
– duration of HBV DNA suppression
– presence of cirrhosis/decompensations

29
Q

Which two nucleoside or nucleotide analogs are the only first line antivirals for treatment naïve patients with HBV?

A

– ENTECAVIR

– TENOFOVIR

30
Q

What is the class and MOA of Tenofovir (Viread®)?

A

NucleoTIDE analog

Inhibits hepatitis B REVERSE TRANSCRIPTASE (NRTI)

31
Q

Which nucleotide analog is the referred 1st line treatment for HBV and also recommended for lamivudine- resistance HBV infection?

A

Tenofovir (Viread®)

32
Q

Adverse reactions/side effects of Tenofovir (Viread®)?

A 
– asthenia (abnormal physical weakness or lack of energy)
– fatigue
– lactic acidosis
– acute renal failure
– hypophosphatemia
– osteoporosis
33
Q

What monitoring is needed for someone on Tenofovir (Viread®)?

A 
– ALT/AST
– total bilirubin
– BMP (basic metabolic)
– CrCl
– CBC with differential
34
Q

Class/MOA of Entecavir (Baraclude®)?

A

NucleoSIDE analog

Inhibits hepatitis B POLYMERASE.

35
Q

Which nucleoside analog is NOT recommended with previous Lamiduvine resistance?

A

Entecavir (Baraclude®)

36
Q

Which nucleoside analog is approved for children 2 years and older?

A

Entecavir (Baraclude®)

37
Q

Adverse/side effects of Entecavir (Baraclude®) ?

A 
– nausea
– dizziness
– ALT elevations
– lactic acidosis
– anaphylaxis
38
Q

Monitoring of patients on Entecavir (Baraclude®), and timeline?

A

– ALT/AST
– renal function
– hepatitis B virus DNA

During treatment and several months after completion

39
Q

Why is Entecavir (Baraclude®) not recommended in HIV/HBV co-infected patients not treated with highly active antiretroviral therapy?

A

The potential for the development of resistance

Pharm I Test II 2016 (6 decks)

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