Antivirals

Question 1

What are the medications that can be used for treatment of Hepatitis B?

Answer 1

Entecavir, Adefovir, and Interferon Alfa (NRTIs)

Question 2

What are the medications that can be used to treat Hepatitis C?

Answer 2

Elbasavir/grazoprevir, Ledipasvir/sofosbuvir, Simeprevir, Daclastasvir, Sofosbuvir//velpatasvir, Ombitasvir, Paritaprevir, Ritonavir, Dasabuvir, Ribavirin, and Interferon Alpha

Question 3

Which medications can be used to treat both Hep B and Hep C?

Answer 3

Interferon Alpha and ribavirin

Question 4

As a MOA, what does Entecavir inhibit?

Answer 4

nucleoside analogue reverse transcriptase (can’t make DNA)

Question 5

Entecavir is more potent than what two medications?

Answer 5

Iamivudine and adefovir

Question 6

Entecavir should not be used for treatment of ___/___ confection when ___ treatment is deferred

Answer 6

HBV/HIV; HIV

Question 7

Entecavir is generally well tolerated, but can cause adverse drug reactions such as ___, ___, and ___–usually in patients with hepatotoxicity.

Answer 7

HA, NVD, and lactic acidosis

Question 8

Patients taking Entecavir should take the medication (with/without) food because ____

Answer 8

without, because food decreases bioavailability of the medication

Question 9

Entecavir has a (high/low) resistance rate in treatment naive patients

Answer 9

low

Question 10

___ and ___ are two Hep B medications that are only available orally.

Answer 10

Adefovir and Entecavir

Question 11

Adefovir’s MOA is …

Answer 11

phosphate nucleotide analog

Question 12

Adefovir is indicated for use in patients who have HBV that is …

Answer 12

resistant to lamivudine, entercavir, HIV, pox, and HSV

Question 13

Adefovir should not be given to patients who have both ___ and ___

Answer 13

HBV and HIV

Question 14

Generally, Adefovir is well tolerated, but some ADRs of this medication may include …

Answer 14

HA, diarrhea, abd pain, and asthenia (abnormal physical weakness/lack of energy)

Question 15

There are some strains of ___ that are resistant to Adefovir

Answer 15

Hep B

Question 16

Interferon Alfa (is/is not) directly virucidal or virustatic

Answer 16

not

Question 17

Interferon Alfa induces ___ activity to promote a(n) ___ state

Answer 17

enzymatic; antiviral

Question 18

Interferon Alfa can be used to treat ___ and ___

Answer 18

Hep B and Hep C

Question 19

Interferon Alfa is no longer first line, however, it is found naturally in the body and has ___, ___, and ___ effects

Answer 19

antiviral, immunomodulating, and anti proliferative effects

Question 20

When a patient is taking Interferon Alfa, we as providers have to ensure careful monitoring of ___ and ___ levels, while also watching for ___ concerns.

Answer 20

CBC and TSH; Autoimmune

Question 21

Some ADRs of Interferon Alfa include …

Answer 21

Flu like syndrome, neuropsychiatric disturbances, sz, and cardiotoxicity

Question 22

Elbasvir/grazoprevir inhibits ____ ___ replication with HCV protease inhibitor

Answer 22

HCV NS5A

Question 23

Which medications are indicated for first line treatment of genotype 1 Hep C?

Answer 23

Elbasvir/grazoprevir and Ledipasvir/sofobuvir

Question 24

A patient should not take Elbasvir/grazoprevir is they have ___ insufficiency or if they are taking medications for ___

Answer 24

hepatic; HIV

Question 25

Patients who take Elbasvir/grazoprevir may experience ADRs such as ___, ___, and ___

Answer 25

fatigue, HA, nausea

Question 26

Sofosbuvir will interact with ___ ___ and Ledipasvir will interact with ___

Answer 26

P450 inducers; amiodarone (bradycardia)

Question 27

Simeprevir should not be used ___ and can treat genotype ___ when taken with ___ or ___

Answer 27

alone/mono therapy; ribavirin or sofosbuvir

Question 28

If a patient is about to start taking Simeprevir, you as a provider should warn them against possible ___ ___

Answer 28

hepatic insufficiency

Question 29

Hep C medications that interact with P450 inducers include

Answer 29

Viekira Pak, Ledipasvir/sofosbuvir, Simeprevir, Daclatasvir, and Sofosbuvir/velpatasvir

Question 30

Which medication for Hep C was the first single tablet regimen for all genotypes?

Answer 30

Sofosbuvir/velpatasvir

Question 31

The Viekira Pak (Ombitasvir, paritaprevir, ritonavir, dasabuvir, ribavirin) is used for genotype ___ and can cause, most seriously, severe ___ injury in patients with ___

Answer 31

1; liver; cirrhosis

Question 32

Ribavirin is a purine nucleoside analog that inhibits viral ___ synthesis, is used against ___ and ___ viruses, and can cause ___ in patients taking this medication

Answer 32

RNA; RNA and DNA; Hemolytic anemia

Question 33

Antivirals used as treatment and prevention of influenza A and B are classified as ___ ___ and include medications such as ___, ___, and ___

Answer 33

Neuroaminidase inhibitors; Oseltamivir, Zanamivir, and Peramivir

Question 34

A patient should start taking Oseltamivir, Zanamivir, and Peramivir within ___ hours of onset of symptoms

Answer 34

48

Question 35

When prescribing a patient wither Oseltamivir, Zanamivir, or Peramivir, you should adjust the dose for ___ insufficiency, and ask patients about pregnancy as these medications are pregnancy category ___

Answer 35

renal; C

Question 36

Taking Oseltamivir, Zanamivir, and Peramivir can cause adverse reactions such as...

Answer 36

NVD, neuropsych, and HA

Question 37

You should not write a prescription for Zanamivir for patients who have comorbid ___

Answer 37

Asthma/COPD

Question 38

Acyclovir inhibits ___ synthesis and is the most commonly used antiviral in treatment of ___, ___, and possibly ___

Answer 38

HSV1 and 2, varicella zoster, and possibly EBV

Question 39

Acyclovir is a pregnancy category ___ as it crosses the BBB and enters the breast milk

Answer 39

B

Question 40

Acyclovir has a cross resistance to ___ and ___

Answer 40

famicyclovir and valcyclovir

Question 41

___, ___, and ___ are examples of anti viral pro drugs

Answer 41

Valacyclovir (metabolized to acyclovir), Famiciclovir (converted to penciclovir), and Valganciclovir

Question 42

Valacyclovir has (more/less) ADRs than acyclovir

Answer 42

less

Question 43

Famiciclovir has some cross resistance with ___ and has resistance to ___ due to point mutation.

Answer 43

acyclovir; HBV

Question 44

Ganiciclovir is a competitive inhibitor of DNA polymerases and can be used to treat ___, ___, ___, and ___

Answer 44

CMV, EBV, HSV/VZV, and human herpes virus 6

Question 45

Valganciclovir is 1st line treatment for ___ and is similar to ____

Answer 45

CMV retinitis; ganiciclovir

Question 46

Foscarnet is administered as ___ medication only, and can be used to treat various viruses, including ___. However, when taking Foscarnet, patients can develop ___ ___, which can be avoided by doing... and monitoring ...

Answer 46

IV; CMV; renal dysfunction; hydration, adjust dosage, avoid nephrotoxic medications, and monitor electrolytes, CBC, renal function weekly

Question 47

Cidofovir isa rarely used due to ___

Answer 47

nephrotoxicity

Question 48

Papillomavirus treatment medications include ___, ___, ___, and ___.

Answer 48

Imiquimod, podofilox, Sinecatechins, and Trichloroacetic acid

Question 49

Which medication is first line treatment for external and perianal genital warts? Which medication is the first line alternative to the previous medication? Why is the first line alternative medication not the first line medication?

Answer 49

Imiquimod; Podofilox--has more ADRs than Imiquimod

Question 50

Sinecatechins are used for treatment of ___ but can cause ____ in ____ males

Answer 50

anogenital warts; narrowing of foreskin; uncircumcised

Question 51

Trichloroacetic acid is not approved by FDA because it is a ________

Answer 51

caustic agent