Antivirals Flashcards
(30 cards)
Acyclovir (Zovirax®)(B) (PO, IV, top)
inhibit viral replication, does not cure-only reduces the pain, severity & symptoms of the outbreak, shortens its duration and may prevent the overall number of recurrences.
ADRs - itching, hives, nephrotoxic - elevated BUN & creatinine, N,V,D, headache, paresthesias
valacyclovir (Valtrex®)(B) PO
famciclovir (Famvir®)(B) PO
ADRs: less than acyclovir, N,V, headache
bioavailability – less frequent dosing
ADRs: headache, fatigue, diarrhea
bioavailability – less frequent dosing
Both of these more effective than acyclovir for shingles
Penciclovir (Denavir®)(B) - topical
Docosanol (Abreva®) (B)
Active metabolite of famciclovir
Topical for herpes labialis
Potentially used for Epstein-Barr virus
ADRs – mild erythema, headache
First OTC topical for herpes labialis
Limited info available – may inhibit the fusion of the human host cell with the viral envelope
ADRs – local irritation, headache
NOT a nucleoside analog
Varivax – SC – Live vaccine
active immunization for the prevention of varicella in individuals 12 months of age and older
Administration – 0.5ml
Children (12 months to 12 years of age)
If a second dose is administered, there should be a minimum interval of 3 months between doses
Adolescents (≥13 years of age) and Adults
Two doses, to be administered a minimum of 4 weeks apart
CI
Primary or acquired immunodeficiency states, any febrile illness or active infection (including untreated Tuberculosis), pregnancy
ADR
Fever, injection site reactions, varicella like rash
Varizig
Postexposure prophylaxis in high risk individuals intended to reduce severity
immunocompromised children and adults
newborns of mothers with varicella shortly before or after delivery
premature infants
infants less than one year of age
adults without evidence of immunity
pregnant women
Zostavax SC injection
Indications: Prevention of herpes zoster (shingles) in pts > 50 years old
boost VZV-specific immune response
Live attenuated varicella zoster virus
More potent than chickenpox vaccine
Can reduce shingles cases by 50% and patients who get shingles will get milder cases. Also, in pts who get shingles - 1/3 less likely to develop postherpetic neuralgia.
Shingrix
Herpes Zoster
NOT live
ADRs
pain, redness, and swelling
myalgia, fatigue, headache, shivering, fever, and GI symptoms
vidarabine (Vira-A®)(C)
(ophth oint) – blocks vision, use HS
trifluridine (Viroptic®)(C)
(ophth sol.)
both used for keratoconjunctivitis and recurrent epithelial keratitis due to HSV I and II.
ADRs: burning, irritation, lacrimation
ganciclovir (Cytovene®) (C) (PO, IV, implant)
Used for treatment of CMV retinitis in immunocompromised patients and prevention of CMV diseases in HIV and transplant pts.
PO form has low bioavailability (use for long term suppression of CMV)
ADRs: bone marrow suppression (BMS), H/A, confusion, retinal detachment, liver and renal dysfunction, rash, fever, gi effects
Mutagenic, long term carcinogenic effects
valganciclovir (Valcyte®) (C) (PO)
cidofovir (Vistide®)(C) (IV)
For CMV
Same indication as ganciclovir, prodrug – can give less frequently
Same indications as ganciclovir
Reserved use for resistant viruses
Higher incidence of more serious adverse effects (nephrotoxicity, neutropenia, metabolic acidosis)
foscarnet (Foscavir®)(C) (IV) (NOT nucleoside)
Inhibits DNA polymerase
Tx of CMV retinitis in immunocompromised pts when ganciclovir alone has failed
Often given in combo with ganciclovir to reduce toxicity
Also used for acyclovir rst HSV infx and shingles
ADRs: fever, H/A, renal impairment, acute renal failure, N,V,D, hematologic deficiencies, seizures, cardiac arrhythmias, heart failure and pancreatitis
Letermovir (Prevymis)
prophylaxis of CMV infection and disease in adult CMV-seropositive recipients [R+] of an allogeneic hematopoietic stem cell transplant
CMV DNA terminase complex inhibitor
ADR - nausea, diarrhea, vomiting, peripheral edema, cough, headache, fatigue, and abdominal pain
Ganciclovir (Vitrasert) implant – CMV retinitis
Fomiversin (Vitravene) (C) inj – CMV retinitis
ocular antivirals for CMV
Flumist®
intranasal influenza vaccine
Live attenuated vaccine (LAIV)
About as effective as IM vaccine
2010 guidelines: can be used in healthy patients aged 2-49 years old.
Not approved in pts > 50 y.o or pts with chronic illness
ADRs: runny nose, nasal congestion, fever, cough, vomiting, sore throat
Drugs for Flu A
amantadine (Symmetrel) (C) PO
rimantadine (Flumadine) (C) PO - has lower incidence of ADRs and no dose adjustment in renal dysfunction
MOA: inhibits the replication of the Influenza A virus ONLY by blocking the viral membrane matrix protein (M2)
ADRs: GI effects, CNS side effects:
Drugs for Flu A and B
oseltamivir (Tamiflu ®)(PO) (for pts >1 y.o)
zanamivir (Relenza ®)(INH) (for pts> 7 y.o.)
Tablet that must be crushed into a powder
Peramivir (Rapivab) IV
single dose within 2 days of onset of influenza symptoms
MOA: blocks neuraminidase, an enzyme needed for viral release from infected cell.
ADRs -N, V, D, abdominal pain, dizziness, headache
ribavirin (Virazole ®) (Inhalational) (X):
Indications: aerosol for severe lower respiratory infections due to Respiratory Syncytial Virus (RSV) in children. It reduces duration of disease, allows children to be removed from ventilator sooner, improves arterial oxygenation
MOA: Prevents mRNA capping and blocks RNA-dependent polymerase
ADRs serious pulmonary and cardiovascular effects – (apnea, pneumothorax, worsening of resp status and cardiac arrest), conjunctivitis, rash.
palivizumab (Synagis) (IM) (C)
Recombinant drug – monoclonal antibody
New drug for prevention of serious lower respiratory tract infections caused by RSV in infants and children < 2 y.o.
ADRs – nervousness, fever, fungal dermatitis, eczema, N/V/D, anemia, otitis media, cough, wheezing
Interferons
Recombinant DNA technology drug with immunomodulating and antiproliferative effects
Forms – alfa 2a, alfa 2b, pegylated alfa 2a
Can be used in Tx of hepatitis B & C (all forms)
Can also be used in Tx of certain cancers (all forms) and in Tx of anogenital warts (alfa 2a) and
ADRs: hematological toxicity, cardiac arrhythmias, changes in BP, CNS dysfunction, gi distress, chills, fatigue, H/A, myalgia, alopecia
Ribaviran (Rebetol ®, Copegus ®)(X) (PO)
Given in combo with interferon alpha 2b for the treatment of chronic hepatitis C in pts with compensated liver disease
ADRs: CNS side effects (dizziness, H/A, fatigue), alopecia, rash, pruritis, gi effects, bone marrow suppression (all observed when given w/ interferon alfa 2b)
may cause birth defects and fetal death
Drugs for Hep B
Nucleotides: (some may also be used for HIV infection)
Lamivudine (Epivir)
Adefovir (Hepsera)
Entecavir (Baraclude)
Telbivudine (Tyzeka)
tenofovir alafenamide (Vemlidy)
HEPLISAV-B
Hep B vaccine
adults 18 years of age and older
Administer two doses (0.5 mL each) of HEPLISAV-B intramuscularly one month apart
Hep C protease inhibitor MOA ADR
MOA - inhibitor of the HCV NS3/4A serine protease, necessary for the proteolytic cleavage of the HCV encoded polyprotein essential for viral replication
Indication - combination with peginterferon alfa and ribavirin (must not be used as monotherapy), chronic hepatitis C in adult patients who are treatment-naïve or who have been previously treated with interferon-based treatment, including prior null responders, partial responders, and relapsers
ADR-rash, pruritus, anemia, nausea, hemorrhoids, diarrhea, anorectal discomfort, dysgeusia, fatigue, vomiting, anemia, neutropenia and anal pruritus
Hep C protease inhibitor drugs
Telaprevir (Incivek) PO tab
BBW – serious skin reactions (including SJS), fatal cases have been reported, D/C immediately
Boceprevir (Victrelis) PO cap
Simeprevir (Olysio) PO cap
not recommended in patients with moderate or severe hepatic impairment
serious symptomatic bradycardia when co-administered with sofosbuvir and amiodarone, Photosensitivity
Glecaprevir
Paritaprevir – PO tab
Available in combination with ombitasvir, ritonavir and dasabuvir (Viekira Pak) -May use with ribavirin
Available in combination w/ ombitasvir, paritaprevir and ritonavir (Technivie) – may use with ribavirin
Hepatic Decompensation and Hepatic Failure in Patient with Cirrhosis and ALT Elevations
Grazoprevir (Zepatier -combo w/elbasvir) –PO tab
W/ or w/o ribavirin
CI w/ Patients with moderate or severe hepatic impairment and strong CYP3A inducers, and efavirenz
