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Spring 2025 Therapeutics V > Exam 4: Clinical Pharmacology and Therapeutics of Antivirals > Flashcards

Exam 4: Clinical Pharmacology and Therapeutics of Antivirals Flashcards

(61 cards)

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1
Q

What type of virus is Herpes Simplex Virus?

A

Double stranded DNA

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2
Q

Herpes virus can be in what 2 stages?

A

Active/lytic (producing new cells)

Latent (dormant)

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3
Q

Can HSV be cured?

A

No

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4
Q

Where does HSV1 infect?

A

Oral mucosa

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5
Q

Where does HSV2 infect?

A

Genital mucosa

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6
Q

What is the most common presentation of HSV1?

A

Cold sores

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7
Q

What is the most common presentation of HSV2?

A

Bumps, blisters, or ulcers around the genitals or anus

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8
Q

Which HSV viruses can enter the central nervous system?

A

Both HSV1 and HSV2

*HSV1 is the more common cause of encephalitis

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9
Q

What are the important facts about acyclovir?

A

Prodrug, needs to be triphosphorylated
Poor bioavailability, not affected by food
Renal elimination
Dose adjust in obesity

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10
Q

What is the main adverse effect of acyclovir?

A

Nephrotoxicity

IV form causes this

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11
Q

What is the dosing of acyclovir for Genital HSV?

A

Primary Infection:
400 mg po TID for 7-10 days
200 mg po q 4 hrs for 7-10 days

Recurrent:
800 mg po TID for 2 days
800 mg po BID for 5 days

Suppression:
400 mg po BID

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12
Q

What is the dosing of acyclovir for Oral HSV?

A

400 mg po TID for 5-10 days

*same for suppression

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13
Q

What is the dosing of acyclovir for HSV encephalitis?

A

10 mg/kg IV q8h for 14-21 days

*use adj bw

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14
Q

What are the main facts about Valacyclovir?

A

Prodrug of acyclovir

Better bioavailability than acyclovir

Not affected by food

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15
Q

What is the dosing of valacyclovir for oral herpes?

A

2g q12hr for 1 day

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16
Q

What is the dosing of valacyclovir for genital herpes?

A

Primary: 1g po BID x 7-10 days

Recurrent:
500mg po BID x 3 days
1g po daily x 5 days

Suppression:
500mg-1000mg po daily in immunocompetent patients
500mg po BID in HIV patients

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17
Q

What are the main facts about Famciclovir?

A

Prodrug of penciclovir, activated through triphosphorylation

Linear kinetics

Food slows absorption*

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18
Q

Famciclovir interacts with what drug?

A

Probenecid

-decreases renal clearance of famciclovir

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19
Q

What is the main side effect of famciclovir?

A

Acute renal failure (nephrotoxic)

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20
Q

What is the dosing of Famciclovir in oral herpes?

A

1.5 g single dose

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21
Q

What is the dosing of famciclovir in genital herpes?

A

Primary: 250 mg po TID x 7-10 days

Recurrent infection:
125mg po BID x 5 days
1 g po BID x 1 day
500 mg po x 1, then 250 mg po BID x 2 days

Suppression
250mg po BID

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22
Q

What type of virus is Varicella Zoster?

A

DNA virus

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23
Q

Varicela zoster virus is dormant where in the body after the initial infection?

A

Sensory nerve ganglia

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24
Q

What is the dosing of acyclovir for Varicella chicken pox?

A

800 mg po q 4 hrs (5x day) for 5-7 days

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25
What is the dosing of acyclovir for Zoster (shingles)?
800 mg po q 4hrs (5x day) for 7-10 days
26
What is the dosing of acyclovir for severe disseminated disease or VSV encephalitis?
10mg/kg IV q8hr for 14-21 days (use adjusted body weight)
27
What is the preferred drug for Varicella Zoster?
Valacyclovir (better dosing)
28
What is the dosing of Valacyclovir for Varicella (chicken pox)?
1 g po q8hr for 5-7 days and until lesions have crusted *start within 24 hours of symptom onset*
29
What is the dosing of Valacyclovir for Zoster (shingles)?
1 g po q8h for 7 days *preferred over PO acyclovir* *Start within 48-72 hr of rash onset
30
What is the preferred treatment for disseminated zoster?
Start with IV acyclovir (10mg/kg IV) for 10-14 days, then transition to valacyclovir once improved
31
What can famciclovir treat with regard to VZV?
Zoster (shingles) only
32
What is the dose of Famcyclovir for Zoster (shingles) treatment?
500 mg po TID for 7 days *begin within 72 hrs of rash onset*
33
Cytomegalovirus is an opportunistic infection, what does this mean?
Most healthy people's immune systems can keep the virus from causing illness -attacks people with weak immune systems
34
What is the moa of Ganciclovir?
HSV/VZV: Prodrug turned into active form by viral thymidine kinase CMV: Prodrug converted to active form (monophosphorylated) by a CMV-encoded protein kinase (UL97 gene), then to di- and triphosphate forms by cellular kinases Drug inhibits viral DNA polymerase and/or incorporation into viral DNA which inhibits viral replication
35
How does resistance occur against Ganciclovir?
UL97 gene mutation -leads to viral kinase deficiency or altered viral DNA polymerase
36
What are the important facts about Ganciclovir?
Low oral bioavailability, take with food to help absorption Adequate concentrations in CSF, brain, and eye
37
What drugs does ganciclovir interact with?
Other cytotoxic drugs with risk of bone marrow suppression Probenecid *avoid combination*
38
What is the main adverse effect of ganciclovir?
Bone marrow suppression
39
At what level of bone marrow suppression should ganciclovir be stopped?
ANC <500/mm^3 or Platelet <25,000/mm^3
40
What is the typical treatment duration of ganciclovir for CMV? (retinitis, esophagitis, colitis, pneumonitis, neurologic disease)
14-21 days
41
What is the duration of ganciclovir therapy in both prevention and treatment of bone marrow or organ transplant recipients?
5 mg/kg for 7-14 days then 5mg/kg once daily 7 days/week or 6 mg/kg once daily 6 days/week
42
What are the important facts about valganciclovir?
Prodrug of ganciclovir *Take with food (AUC can increase 30% when taken with a high fat meal) Used for CMV retinitis and CMV disease
43
What is the typical dosing/duration of Valganciclovir therapy?
900 mg 21 days
44
What is the MOA of letermovir?
Inhibits pUL56 subunit of viral terminase complex in CMV Prevents DNA cleavage, interfering with viral DNA processing and packaging into procapsids Result: Inhibits CMV replication and prevents CMV infection
45
What is the most important thing to remember about letermovir?
Lots of drug interactions
46
What are the SE of letermovir?
N/V/D Peripheral edema Cough Headache Fatigue Abdominal pain
47
What are the uses of letermovir?
CMV infection prophylaxis CMV positive adults who have received an allogenic hematopoietic stem cell transplant (HSCT)
48
What are the important facts about foscarnet?
Directly inhibits DNA polymerase *NOT A PRODRUG* Commonly last line Only IV
49
What is the major SE of Foscarnet?
Nephrotoxicity *patients need to be given hydration to prevent this
50
What are the 4 drugs used for influenza A/B?
Zanamivir Oseltamivir Peramivir Baloxavir Marboxil
51
What are the important facts about oseltamivir?
Capsules and Powder for oral suspension Food delays absorption
52
Who can receive oseltamivir?
Influenza patients >/= 2 weeks old who have been symptomatic for no more than 2 days
53
What are the important facts about zanamivir for influenza A/B?
Inhaled *SE: bronchospasm
54
Who can receive Zanamivir for influenza?
Patients >/= 7 years old who have been symptomatic for no more than 2 days
55
Who should not receive Zanamivir?
Patients with underlying respiratory disease
56
What are the important facts to remember about Peramivir for influenza?
*Only IV med Not approved for severe influenza requiring hospitalization
57
Who can receive Peramivir?
Acute uncomplicated influenza patients 18 or older who have been symptomatic no more than 2 days
58
What is important to remember about Peramivir dosing?
Single dose
59
What is the MOA of baloxavir marboxil?
Inhibits polymerase acidic (PA) endonuclease (an influenza specific enzyme in the viral DNA polymerase complex that is required for viral gene transcription) Leads to inhibition of mRNA synthesis and viral replication
60
what are the important points about Baloxavir marboxil?
Prodrug **Avoid co-administration with dairy products** Do not administer with live attenuated vaccine (this goes for all influenza drugs)
61
Who can receive Baloxavir Marboxil treatment?
Uncomplicated influenza patients >/= 12 years old who have been symptomatic for no more then 2 days

Spring 2025 Therapeutics V (41 decks)

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