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Anti-Infectives Exam 3 > Lecture 3 - Antiviral Agent 2 > Flashcards

Lecture 3 - Antiviral Agent 2 Flashcards

1
Q

Hep A

A

RNA virus
Transmission: Fecal oral, sexual
Risks: Endemic travel, MSM, daycare

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2
Q

Hep B

A

DNA virus
transmission: Parenteral, sexual, vertical
Risks: MSMS, IV drug user, Liver transplant, HC worker,

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3
Q

Hep C

A

RNA virus, most problematic

Transmission: Parenteral, sexual vertical

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4
Q

Which Hep can cause liver damage?

A

Hep B and C

Hep A goes away

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5
Q

Hep A treatment

A

Self limiting, symptomatic treatment

Prevention = hepA vaccine

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6
Q

Hep B treatment

A

Can be chronic, use chronic antiviral

Prevention = HepB vaccine

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7
Q

Tenofovir & Entecavir have….

A

rapid activity, relatively safety, clinical experience

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8
Q

Lamivudine is…

A

relatively safe but more resistance

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9
Q

IFN-alfa isn’t really used due to….

A

unacceptable safety profile

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10
Q

Adefovir isn’t used much due to…

A

more resistance and nephrotoxicity

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11
Q

Drugs with low resistance barrier

A

Lamivudine, Emtricitabine

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12
Q

Drugs with low potency

A

Adefovir

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13
Q

Lamivudine (A.K.A 3TC) MOA

A

inhibits HBV DNA polymerase

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14
Q

Lamivudine DI

A

None clinically significant

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15
Q

Lamivudine Dose adjustment

A

renal dose/interval adjustment required

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16
Q

Lamivudine ADRs

A

Headache, fatigue, anemia, nausea

Mitochondrial toxicity**
Lactic acidosis**
Pancreatitis**

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17
Q

Adefovir MOA

A

inhibits HBV DNA polymerase

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18
Q

Adefovir ADRS

A

Nephrotoxicity

Decreased carotene lvls

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19
Q

Adefovir Dose adjustment

A

Renal dose/interval adjustment required

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20
Q

Adefovir DI

A

no sig interactions

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21
Q

Entecavir (MOA)

A

guanosine analog, inhibits HBV DNA polymerase

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22
Q

Entecavir ADRs

A

lactic aidosis
nausea
headache
dizziness

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23
Q

Entecavir DI

A

No sig interactions

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24
Q

Entecavir Dose adjustment

A

Renal dose/interval adjustment required

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25
Emtricitabine FTC MOA
inhibits HBV DNA polymerase
26
Emtricitabine ADRs
hyperpigmentation of palms & soles** lactic acidosis headache dizziness
27
Emtricitabine DI
no sig interactions
28
Emtricitabine Dosage adjustments
renal dose/interval adjustment req
29
tenofovir MOA
inhibit HBV DNA polymerase
30
Tenofovir ADRs
Osteoporosis asthenia renal toxicity
31
Tenofovir DI
PGP inhibitors / inducers
32
Tenofovir dosage adjustment
renal dose/interval adjustment required more for TDF than TAF
33
TDF and TAF Tenofovir
``` TDF = Viread = 300mg QD TAF = Vemlidy = 25 mg QD ```
34
TAF doesn't need dose adjustment when....
CrCl > 15 mL/min
35
Interferon Alfa 2a (Pegasus) MOA
Stimulates HLA Class I protein (immune enhancer) longest 1/2 life
36
Interferon Alfa ADR
``` flue like lose hair CNS = depression, confused, sucidial Hematolgic Endocrine ```
37
Interferon Alfa dose adjustment
No recommended Renal insufficiency CrCl < 50ml/min
38
Interferon Alfa DI
``` Theophylline = inc Theo conc Zidovudine = inc myelosuppression ```
39
Mutation that will knock out lamivudine is...
YMDD mutation single point
40
What to do w/ LAM resistance?
Switch to TDF or TAF
41
What to do w/ ETV resistance
Switch to TDF or TAF
42
What to do w/ TDF+TAF resistance
Lam naive: Switch to ETV | LAM-R = Add ETV
43
What to do if MDR HBV?
Switch to ETV + (TDF or TAF) combo
44
Peginterferon alfa will work against which genotypes for HepC?
All of them
45
Interferon alfa dose is adjusted based on...
Hemoglobin and hematocrit also careful with depression ESRD req adjustment
46
Ribavirin MOA
1. enhances immune clearance 2. inhibition of IMPDH 3. Inhibition of HCV RdRp 4. RNA mutagenesis used in combo
47
Which genotypes can Ribavirin be used for?
all of them
48
Ribavirin DI
azathioprine increases cytopenias Abacavir, zidovudine = lactic acidosis
49
Ribavirin dose adjustment
req renal adjustment also adjust for cell count, if dec then dec dose
50
Ribavirin ADR
Shit load of side effects dont use men/women childbearing age
51
Where do Protease inhibitors work?
NS3
52
Protease inhibitors
``` Grazoprevir = GZR Voxilaprevir = VOX Glecaprevir = GLE ```
53
Where do Replication Complex inhibitors work
NS5A
54
Replication Complex Inhibitors
``` Elbasvir = EBR Ledipasvir = LDV Ombitasvir = OBV Velpatasvir = VEL Pibrentasvir = PIB ```
55
Where do NUC inhibitors work?
NS5B (Polymerase)
56
NUC inhibitors
Sofosbuvir = SOF
57
Where do Non-NUC inhibitors work?
NS5B (Polymerase)
58
Non-NUC inhibitors
Dasabuvir = DSV
59
-evir Drug Dose adjustments?
No dose adjustment
60
Elbasvir DI & Dose adjustment
No dose adjustment DI = 3A4 Substrate
61
Ledipasvir DI & Dose adjustment
Amiodarone***, Antacids, H2 blockers, PPI Dont use for CrCl < 30
62
Sofusbuvir DI & Dose adjustment
Use caution with CrCl < 30 ml/min***** Avoid Amiodarone + strong PGP inducers
63
Drugs active against all genotypes HepC
Sofosbuvir-Velpatasvir-Voxilaprevir (Vosevi) Sofosbuvir-Velpatasvir (Epclusa) Glecaprevir/Pibrentasvir (Mavyret)
64
Recommended drugs to avoid for severe liver dysfunction
GZR/EBV | IFN
65
-evir are substrates of....
3A4 Dependent on transport protein metabolism too potential inhibit and interact with plenty of other drug classes
66
-asvir interactions with....
3A4, transport proteins for metabolism too Ledipasvir doesn't req 3A4 adjustment but others do
67
Drugs that you dont want to give with doses of > 20mg of PPI
LDV/SOF Ledipasvir/Sofosbuvir
68
Drugs that you dont want to give with PPI at all
SOF/VEL Sofosbuvir/velpatasvir
69
NRTIs MOA
1. inhibit HIV RNA dependent DNA polymerase, inhibit viral replication 2. Incorporate into growing viral DNA chain-chain terminator
70
Shared NRTI's side effects?
General: N,V,D Mitochondiral toxicity Hypersensitivity = abacavir** Renal failure = tenofovir** Hyperpigmentation = emtricitabine** Anemia = Zidovudine***
71
NRTI Mitochondrial toxicity MOA
inhibition of mitochondrial DNA polymerase, impaired synthesis of mitchondrial enzymes, impaired ATP production ~50% mortality in most severe cases
72
Early signs for NRTI Mitochondrial toxicity
N, abdominal pain, weight loss/tachycardia, hyperventilation, weakness
73
Highest risk groups for NRTI Mitochondrial Toxicity
Combo of.... DDI + D4T DDI + hydroxyurea Prolonged duration of therapy Females Obese Pregnant patients
74
NRTIs effect on Lipids...
increase in Cholesterol potentially Older more effect than newer ones
75
Facial and extremity wasting with or without central adiposity associated with....
Stavudine Didanosine Zidovudine Also older age, higher TG at start of therapy, CD4 nadir < 200
76
Changing d4T to TDF can cause....
reversal in lipids and limb fats
77
Abacavir info
AKA ABC Early, w/I 6wks (Hypersensitivity syndrome (5-8%), fever,rsh, N,V,D) Late ( CVD)
78
Before pts on Abacavir, do a test for....
HLA-B*5701, correlates with susceptibility to hypersensitivity Dont give if positive Do not rechallenge
79
Advantages of ABC
1. coformulated with INSTI in 1st line regimen = Triumeq 2. Long hx of use 3. Not really cleared
80
Disadvantages of ABC
1. Hypersensitivity | 2. CVD
81
TAF is....
Alafenamide
82
TDF is....
Disoproxil Fumarate
83
Tenofovir ADE
Nephrotoxicity-AKI and Fanconi Syndrome Osteopenia
84
Benefits of TAF > TDF
1. less impact on BMD 2. Less impact on markers of renal tubular dysfunction 3. Low dose allows small tab coformulations
85
Benefits of TDF > TAF
1. used for longer 2. multiple coformulations 3. TAF has weight gain 4. recommended in pregnancy 5. available as generic with 3TC
86
NRTI that are really eliminated and dosed except....
Abacavir
87
NNRTI specific mutation
K103N
88
NRTI specific mutations
M184V = most common, Lamivudine + Emtricitabine resistance, increased activity to Tenofovir and ZDV K65R = resistance to most except ZDV
89
Abacavir DI
excessive Alcohol | Methadone
90
Didanosine DI
Allopurinol, consider reducing didanosine by 50% | Cidofovir
91
Stavudine DI
Zidovudine = Dont co admin
92
Tenofovir DI
Atazanavir = 300mg Atazanavir w/ 100mg ritonavir (booster) when used with tenofovir Didanosine = reduce didanosine to 250mg QD

Anti-Infectives Exam 3 (7 decks)

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