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BL and DD final > DD Antivirals > Flashcards

DD Antivirals Flashcards

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1
Q

List neuramidase inhibitors

which inhibits release of Progeny virus

A
  1. osteltamivir
  2. zanamivir
  3. paramivir
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2
Q

What do neuramidase inhibitors do?

A

inhibit NA → prevent cleavage of SA from host receptors → reduces viral intracellular translocation and budding → prevent release of progeny virus → reduces viral infectivity

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3
Q

Route of administration of:

  1. osteltamivir
  2. zanamivir
  3. paramivir
A
  1. osteltamivir - oral
  2. zanamivir - inhalation (poor oral)
  3. paramivir - IV
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4
Q

Dosing of:

  1. osteltamivir
  2. zanamivir
  3. paramivir
A
  1. osteltamivir - bid for 5 days
  2. zanamivir - bid for 5 days
  3. paramivir - single dose
    ______
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5
Q

half life of:

1. osteltamivir

A
  1. osteltamivir: 6-10 hours
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6
Q

Adverse drug rxn of:

  1. osteltamivir
  2. zanamivir
A
  1. osteltamivir:
    - Nausea and vomiting (better with food)
  2. zanamivir
    - Bronchospasm in patients with asthma or COPD
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7
Q

Which Neuramidase inhibitor is ONLY for the critically ill or immunocompromised?

A

Peramivir

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8
Q

Are NA inhibitors good prophylactics?

Are Uncoating inhibitors good prophylactics??

A

NA inhibitors: yes 80-90% effective prophylactic for both influenza A and B

Uncoating inhibitors: yes good prophylaxis but only for influenza A

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9
Q

Which drug that treats influenza A/B is excreted via hepatic elimination?

A

Rimantadine (flumadine)

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10
Q

How do amantadine and rimantadine inhibit uncoating?

A

Block M2 proteins (virally-encoded H+ ion channel), → prevents intracellular pH changes necessary for uncoating / release of ribonucleoprotein & genome for replication.

  • note: due to resistance, these two drugs are no longer recommended for use
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11
Q

What is special about amantadine and rimantadine’s route of elimination?

A

They can be excreted in breast milk - careful

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12
Q

Adverse drug rxn of oseltamivir

A

nausea, vomiting

better w/ food

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13
Q

Adverse drug rxn of zanamivir

A

bronchospasm in patients with asthma or COPD

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14
Q

Adverse drug rxn of Amantadine (Symmetrel)

A

insomnia,
concentration difficulty,
lighteadedness/dizziness,
headache

  • note rimantadine is better tolerated ;)
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15
Q

Where can amantadine and rimantadine accumulate?

A

in lungs (via oral route)

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16
Q

List the drugs that are Inhibitors of viral genome replication and can be used to treat herpes infxn:

A
  1. Acyclovir (Zovirax)
  2. Valacyclovir (Valtrex)
  3. Penciclovir (Denavir)
  4. Famciclovir (Famvir)
  5. Vidarabine & Trifluridine (Viroptic)
  6. Cidofovir (if acyclovir resistant)
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17
Q

MOA of acyclovir?

A

Acyclovir diffuses into cell → gets triphosphorylated (TP) by viral thymidine kinase → Acyclovir triphosphate inhibits viral DNA polymerase (Selective Toxicity) → Terminates replication and Viral DNA pol inactivation

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18
Q

how do viruses acquire resistance to inhibitors of viral genome replication to treat herpes infxn?

A

Mostly in immunosuppressed patients.

1) loss of viral thymidine kinase
2) ↓kinase specificity for drug as substrate
3) altered affinity of viral DNA polymerase

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19
Q

Which herpes medication is administered topically?

A

Acyclovir (Zovirax)

Penciclovir (Denavir)

Vidarabine & Trifluridine (Viroptic)

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20
Q

Which herpes medication is administered either orally, topically, or via IV?

A

Acyclovir

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21
Q

dosing of:

  1. Acyclovir (Zovirax)
  2. Valacyclovir (Valtrex)
A
  1. Acyclovir (Zovirax) - 5x a day

2. Valacyclovir (Valtrex) - qd

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22
Q

What is the prodrug of acyclovir? Penciclovir?

A

valacyclovir is prodrug of acyclovir

famciclovir is prodrug of penciclovir

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23
Q

Which herpes medication will have renal toxicity with IV use?

Study These Flashcards
A

Acyclovir

Vidarabine & Trifluridine (Viroptic)

24
Q

Minor adverse rxns of herpes medications:

Study These Flashcards
A 
Minor - 
reversible renal dysfunction,   
Pregnancy category B
headache, 
nausea, 
vomiting,
25
Influenza drugs that are teratogenic: | Herpes drugs that are teratogenic:
Influenza drugs: - amantadine - rimantadine Herpes drugs that are teratogenic: - Vidarabine & Trifluridine
26
Which herpes drug is more effective than topical acyclovir?
penciclovir
27
Which herpes medication is linked to IV encephalopathy?
acyclovir
28
Which herpes medication is linked to CNS deficiencies at high doses?
valacyclovir
29
Acyclovir comes in 3 routes of admin. Describe their diff clinical use:
Oral: - ↓ symptom duration during primary and recurrent genital herpes (NOT time to healing). - at higher doses can treat varicella or shingles, Topical (less effective) - Good for 2ndary prevention. IV: - best choice for HSV encephalitis, neonatal HSV, and serious HSV of VZV infections.
30
Why is valacyclovir a better option than acyclovir?
↑bioavailability, meaning ↑efficacy Greater compliance than acyclovir (qd) - qd vs 5x a day
31
Vidarabine & Trifluridine role in treatment
Limited to HSV keratoconjunctivitis and epithelial keratitis. Useful against acyclovir-resistant strains
32
MOA of docosanol (abreva)? How?
Inhibitors of viral penetration -Inhibits fusion between viral lipid envelope & host membrane
33
What happens if you give docosanol if it is administered too late?
fail to elicit therapeutic response (decreasing healing time by 1 day)
34
RSV drugs
Ribavirin (Copegus, Rebetol) Ribavirin (Virazole) Palivizumab (Synagis)
35
MOA of ribavirin
Converted to ribavirin-TP by cellular kinases. 1) Inhibits 5' capping of viral mRNA, ↓stability and translatability 2) ↑viral suicide
36
MOA of palivizumab
Humanized mab to RSV F glycoprotein | - prevents viral attachment/entry
37
Which ribavirin is administered orally? Via inhalation?
Oral - Ribavirin (Copegus, Rebetol) Inhalation - Ribavirin (Virazole)
38
What is the route of elimination for Ribavirin (Copegus, Rebetol)?
Hepatic metabolism and Renal excretion
39
adverse drug rxn of: Ribavirin in general Ribavirin (Copegus, Rebetol) Ribavirin (Virazole)
Teratogenic (category X)!!!!!! Ribavirin (Copegus, Rebetol): - Hemolytic anemia. When given with interferon, causes cough, rash and pruritus. Ribavirin (Virazole): - Conjuctival or bronchial irritation; not good for patients with bronchospastic lung disease
40
adverse drug rxn of: | Palivizumab (Synagis)
Rare hypersensitivity reactions:
41
Ribavirin (Copegus, Rebetol) - | Role of pharmacotherapy in treatment
RSV infxn in bone marrow transplant RSV infxn in immunocompromised, Hepatitis C when combined with interferon-α2a
42
Ribavirin (Virazole) | Role of pharmacotherapy in treatment
RSV and pneumonia in severe RSV and immunocompromised
43
Palivizumab (Synagis) | Role of pharmacotherapy in treatment
RSV Immunoprophylaxis in infants and young children with congenital heart disease. EXPENSIVE
44
CMV drugs
Ganciclovir (Cytovene) Valganciclovir (Valcyte) Foscarnet (Foscavir) Cidofovir (If immunocompromised or resistant to above drugs)
45
MOA of: Ganciclovir (Cytovene) Valganciclovir (Valcyte)
Phosphorylation of drug to TP by viral protein kinase UL97. → incorporates into replicating viral DNA→ inhibit viral DNA pol → slows and ceases chain elongation.
46
Routes of admin. for ganciclovir?
IV, Topica, Oral (poor)
47
Which CMV drug also treats HBV?
oral ganciclovir
48
Which CMV drug also treats HSV keratitis?
topical ganciclovir
49
Adverse drug rxns of CMV drugs
Myelosuppression w/ neutropenia and thrombocytopenia(reversible) Ganciclovir specifically: Rare CNS toxicity, abnormal liver fxn, GI disturbances and nausea
50
What has better bioavailability, ganciclovir or valganciclovir?
valganciclovir
51
Most of the CMV drugs are administered via which route?
IV
52
MOA of foscarnet?
Non-competitively binds RNA and DNA pol to inhibit cleavage of pyrophosphate. Block viral replication -Does not require cellular activation.
53
adverse drug rxns of foscarnet?
Nephrotoxicity and hypocalcemia. Some CNS abnormalities, rash, fever, nausea
54
What special Role of pharmacotherapy in treatment does foscarnet have?
Good against: - CMV retinitis - ganciclovir-resistant CMV - acyclovir-resistant HSV and VZV
55
Inhibitors of viral DNA Pol
1. Acyclovir, Valacyclovir, Penciclovir, Famciclovir, Vidarabine & Trifluridine 2. Ganciclovir, Valganciclovir. Cidofovir 3. Foscarnet
56
Route of administration of Cidofovir? How often?
IV - weekly/biweekly

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