AntiviralSH1 Flashcards
Antivirals
Herpes: Acyclovir, Famciclovir, Valacyclovir
Influenza: Amantadine, rimantadine, Oseltamivir, Zanamavir,
-Peramivir ( Rapivab ) -IV
CMV: Ganciclovir( recall carbopenum causes seizures and so do ganiclovir), Valganciclovir, Cidofovir, Foscarnet
ZANAMIVIR Ralenza : comes as inhaled formulation. Can’t give to asthmatics and COPD patients
Herpes
•Acyclovir ( Zovirax) : ( K/B ) k means renal system B means pregnancy category B
Oral/topical/ IV
Up to 5 times a day ( why not give valacyclovir ? Bc its cheaper to use to acyclovir )
Renal
•Valacyclovir ( Valtrex)
BID ( higher bioavailability than acyclovir )
Renal
• Famciclovir ( Famvir ) ( K/B) : PO
-converted to penciclovir in the intestine and liver
Tx of influenza A and B
sooner you tx the more effective. Ideally within 2 days of signs and symptoms
Neuraminidase inhibitors:
•oseltamivir ( tamiflu ) :
•Zenamavir: relenza diskhaler )( caution in asthma/ COPD ) ( recall afreeza : inhaled insulin cant give asthmatics or COPD )
•Peramivir ( rapivab ) : indicated greater than 18 y/o / IV / renal
Endonuclease inhibitor : ( inhibits viral replication. Different than tamiflu ). (guideline update : now approved for tx and prophx
• Baloxavir. ( Xofluza ) : single oral dose.
SE: GI ( NVD)
Amantadine and rimantadine no longer recommended for influenza
T bc doesn’t cover both A and B
CMV retinitis
1) Ganciclovir ( DHPG ) IV (RENAL )and opthalmic gel ( SEIZURE, BMS, NEPHROTOX)
Monitor CBC/ seizure. Bone marrow suppression ( make IV in vertical flow ) / Seizures*
2) Valganciclovir ( Valcyte ) : PO renal : SEIZURE, BMS, NEPHROTOX
3) Cidofovir ( Vistide ) IV only (( RENAL ***** so bad you have to give probenacid before and after. Recall probenacid was given with PCN to increase PCN, in this case for kidney protection —- renal BMS and eye pressure
4) Foscarnet ( Foscavir )
SE: bone marrow suppression, seizures. Renal
With all of these we worry about bone marrow suppression.
Hepatitis B ( know your brand and generics )
PO nucleosides / tide analogs- all QD
Interferons ( SC ) : interferon for hep are interferon alpha for hep b. Interferon beta for MS
Oral antivirals are better tolerated. In treatment - naive patients can start with Tenofovir or entecavir
Hep C
Dx test: HCV ab testing. If + HCV rna test—-> if + what genotype. ( meds to tx that specific genotype )
1945 to 1965 born: get tested. Did you get a blood product before 1987
Hep C is blood borne pathogens
Different drugs target steps in HCV life cycle:
DIRECT acting antivirals
NS3/4A protease inhibitors( PIs) : Paritaprevir/ Grazoprevir
NS5B nucleoside polymerase inhbitors ( NPIs) : Sofosbuvir ( Vivaldi ) ** DDI amiodarone and sofosbuvir
NS5B non-nucleoside polymerase inhibitors ( NNPIs)
NS5A inhibitors: 1) ledipasvir, 2) ombitasvir 3) elbasvir
DDI Sofosbuvir and
Amiodarone. Never give together. Severe bradycardia
Harvoni: ledipasvir + sofosbuvir
Epclusa: Velpatsivir + sofosbuvir
All HCV drugs not good with statins except you can give sofosbuvir with statin
HCV drugs to know
eplusa cant give with
Amiodarone
Velpatsavir and sofosbuvir ( severe bradycardia )
Harvoni ddi with
Amiodarone
Ledipasvir + sofosbuvir ( severe bradycardia )
Pneumonic PORD
P- paritaprevir
O- ombitasvir
R- Ritonavir ( HIV medication ) - Ritonavir is a major cyp inhibitor so DDI **
D- dasabuvir
Viekira Pak has 4 medications in it. PORD. Bid 12 weeks
Mavyret
Glecaprevir + pibrentasvir
Only HCV tx for 8 weeks
Everything else is 12 weeks
Ribavarin:
Rabetrol
Oral HCV tx.
RSV infection ( off label use )
Pregnancy category X. Teratogen with half life. Dont get pregnant 6 months after starting this medication.
SE: hemolytic anemia. Can worsen cardiac disease
Genotype 1 most important in US
