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Pharm exam 4 > Antivirals > Flashcards

Antivirals Flashcards

1
Q

what stage of herpes virus is suppressed by antivirals

A

lytic stage

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2
Q

antiviral treatments are indicated for what members of the herpesvirus family

A

VZV
HSV-1
HSV-2
CMV

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3
Q

Acyclovir MOA

A

requires initial phosphorylation by the viral thymidine kinase enzyme

competitive inhibitor of viral DNA polymerase

chain termination upon incorporation into the viral DNA

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4
Q

resistance to acyclovir

A

mutation of thymidine kinase gene

cross-resistance with other antivirals iwth similar mechanism

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5
Q

oral or IV administration of acyclovir:

  • severe/disseminated mucocutaneous disease
  • HSV encephalitis
  • varicella zoster
  • neonate infections
  • VZV in immunocompromised
  • genital herpes
A

Oral:

  • genital herpes
  • varicella zoster

IV:

  • severe/disseminated mucocutaneous disease
  • neonate infections
  • HSV encephalitis
  • VZV in immunocompromised patients
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6
Q

prodrug of acyclovir

acyclovir attached to a valine moiety. Metabolised into acyclovir in the liver and intestines

3-5x greater oral bioavailabiilty than acyclovir

A

Valacyclovir

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7
Q

therapeutic indications for valacyclovir

A

primary and recurrent genital herpes

varicella in older children and adults

zoster

oralabial herpes

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8
Q

how is foscarnet administered

A

IV

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9
Q

Analogue of pyrophosphate. Occupries site where pyrophosphate normally resides and blocks pyrophosphate release. Blocks catalytic cycle

**does not require prior phosphorylation by thymidine kinase in order to act

A

Foscarnet

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10
Q

therapeutic indications of foscarnet

A

HSV and VZV infections resistant to acyclovir

CMV retinitis, colitis, esophagitis

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11
Q

Ganciclovir requires initial phosphorylation by 1 (viral kinase enzyme). It is phosphorylated much more efficiently than acyclovir, therefore more active for 2 infections. It is also a competitive inhibitor of the viral 3. 4 termination upon incorporation into the viral DNA

A
  1. CMV UL97
  2. CMV
  3. DNA polymerase
  4. Chain
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12
Q

how is ganciclovir administered

A

IV
Oral
Intraocular routes

  • poor bioavailability
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13
Q

therapeutic indications for ganciclovir

A

IV

  • CMV retinitis (AIDs)
  • CMV colitis, pneumitis, esophagitis (foscarnet does colitis, esophagitis, and retinitis)

Intraocular injection or implant
- CMV retinitis

IV followed by oral
- transplant pts.

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14
Q

how can you reduce the risk of CMV in transplant patients

A

IV followed by oral ganciclovir

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15
Q

prodrug of ganciclovir with higher bioavailability and serum levels approach IV ganciclovir

A

valganciclovir

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16
Q

therapeutic indications for valganciclovir

A

CMV retinitis (AIDs)

prevention of CMV in pts with heart, kidne, kidney-pancreas transplants

17
Q

MOA of trifluridine

A
  • phosphorylated by cellular enzymes

- competitive inhibitor of thymidine and incoorporation into newly synthesized genomes

18
Q

therapuetic indication of trifluridine

A
  • low selectivity, does not allow for systemic administration
  • ocular administration to treat keratoconjunctivitis and recurrent epithelial keratitis due to HSV-1 and HSV-2
19
Q

when must antivirals be administered to have any impact on influenza virus

A

first 48 hours

20
Q

What influenzavirus antivirals inhibit neuraminidase

A

oseltamivir
zanamivir
peramivir

21
Q

how is oseltamivir administered

A

oral - 80% bioavailability

22
Q

therapeutic indications for oseltamivir:

for children 1 y/o. Effective for influenza 2. Given 3 for uncomplicated flu and can be given 4 for complicated influence. Can be used as 5 for influenza

A
  1. 1+
  2. A and B
  3. within first 48 hours
  4. chemoprophylaxis
23
Q

how is zanamivir administered

A

administered to oropharynx and lungs by inhalation

24
Q

how is therapeutic indication of zanamivir different from oseltamivir

A

same but approved for children 7+

25
Q

how is peramivir administered

A

IV

26
Q

therapeutic indications for peramivir

A

acute, uncomplicated and have not been symptomatic for more than 48 hours

27
Q

what anti-influenza drugs inhibit the activity of influenza A M2 protein - ion channel forming protein required for nucleocapsid release

A

Amantadine

Rimantadine

*readily absorbed with high bioavailability

28
Q

what is treatment of ribavirin indicated for

A

Respiratory syncytial virus (RSV)

indicated for severe LRT illness in:

  • premature infants
  • immunocompromised
  • pts with lung or heart congenital heart disease
29
Q

MOA of ribavirin

A

phosphorylated by cellular adenosine kinase

interferes with synthesis of guanasine triphosphate

inhibit viral mRNA capping

inhibits RdRp of RSV and HCV virus

30
Q

how is ribavirin administered

A
  • aerosol route for RSV

orally for combo therapy for HCV (w/ interferon+/-protease inhibitors)

31
Q

contraindications for ribavirin

A

pregnancy

anemia

ischemic vascular disease

severe renal disease

32
Q

general tx of HCV

A

combo therapy with direct acting antiviral - at least 2 from two different classes

oral

8-24 weeks

Tx depends on:

  • HCV genotype
  • +/- cirrhosis
  • tx naiive vs experienced
  • special populations
33
Q

MOA of HCV “-previr” drugs

A

protease inhibitors

inhibit NS3/4A protease

34
Q

MOA of HCV “-buvir” drugs

A

RNA polymerase inhibitor

inhibit NS5B enzyme

35
Q

MOA of HCV “-asvir” drugs

A

NS5a inhibitors - plays role in genome replciation and virion assembly

36
Q

In some patients with HCV, adding __1_ to the “previrs, buvirs, or asvirs” is indicated. This adds to the adverse effects and is contraindicated in 2

A
  1. ribavirin

2. pregnancy

37
Q

HBV is a DNA virus that uses ____

A

reverse transcriptase

38
Q

how would you treat HBV

A

pegylated interferon

reverse transcriptase inhibitiors

  • entecavir
  • tenofovir

Pharm exam 4 (15 decks)

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