Week 3 Pearls

Question 1

Anitvirals must either block

Answer 1

entry into the cells or be active inside the host cells

Question 2

Steps of viral replication

Answer 2

1. adsorption
2. uncoating of the viral nucleic acid
3. synthesis of early, regulatory proteins
4. synthesis of RNA or DNA
5. Synthesis of structural proteins
6. Assembly of viral particles
7. Release from the cell

Question 3

Most antivirals work on step

Answer 3

4. synthesis of RNA or DNA

Question 4

Antivirals: Nucleoside Analogues examples

Answer 4

Acyclovir and Valacyclovir
Famciclovir
Ganciclovir

Question 5

Benefit of valacyclovir

Answer 5

less doses required

Question 6

Antivirals: Nucleoside Analogues pharmacodynamis

Answer 6

Antiviral drugs must either block entry into the cells or be active inside host cells to be effective.

Question 7

Acyclovir: active against

Answer 7

herpes simplex viruses 1 and 2 (HSV-1 and HSV-2); varicella-zoster virus (VZV); Epstein-Barr virus (EBV), cytomegalovirus (CMV), and herpes virus 6

Question 8

Valacyclovir is converted

Answer 8

into acyclovir after oral administration and is active against the same virus

Question 9

Famciclovir: active against

Answer 9

HSV-1 and HSV-2, HSV-1 and HSV-2, VZV, EBV, and hepatitis B virus

Question 10

Ganciclovir active against

Answer 10

CMV

Question 11

ADR Acyclovir/valacyclovir

Answer 11

few ADRs when given orally

Question 12

Valacyclovir ADR:

Answer 12

may cause thrombocytopenia purpura, hemolytic uremic syndrome in immunocompromised patients

Question 13

Famciclovir ADR

Answer 13

headach

Question 14

Granciclovir ADR

Answer 14

granulocytopenia, anemia, and thrombocytopenia

may be carcinogenic**

Question 15

Nucleoside drug interactions

Answer 15

few

Question 16

Clincial use and dosing for Antivirals Nucleoside

Answer 16

Herpes simplex: genital herpes, both initial outbreak and suppression therapy 
Herpes zoster (shingles): start therapy within 3 days of outbreak 

Varicella (chickenpox): start within 24 hours of outbreak
Gingivostomatitis in children
Bell’s palsy

Question 17

When do you start antivirals with Herpes zoster

Answer 17

within three days of the outbreak. Same with simplex

Question 18

Rational drug selection for antivirals nucleoside

Answer 18

cost and convenience

Question 19

acyclovir is taken

Answer 19

5 times a day but is inexpensive.

Question 20

Antivirals: Nucleoside Analogues

Monitoring

Answer 20

Rash for resolution
Temperature
Blood urea nitrogen and creatinine in high-risk patients

Question 21

Antivirals: Nucleoside Analogues

Patient education

Answer 21

**Drug started at earliest sign of infection
Good hydration
Symptoms of renal failure, encephalopathic changes, blood dyscrasias

Question 22

Antiviral guidelines for treatment for Hep C

Answer 22

Joint guidelines for treatment by American Association for the Study of Liver Diseases (AASLD) and the Infectious Diseases Society of America (ISDA)

Question 23

Treatment of Hep C (HCV) infection based on

Answer 23

the genotype and stage of the disease

Question 24

Antivirals for Hepatitis C Pharmacodynamics

Answer 24

most of HCV antivirals formatted as a fixed-dose combination of two antivirals

Question 25

Antivirals for Hepatitis C Pharmacokinetics

Answer 25

administered orally and widely distributed

Question 26

Antivirals for Hepatitis C Contraindications

Answer 26

Black Box warning regarding HBV reactivation and to test before starting HCV treatment

Question 27

Anivirals for Hep C ADR

Answer 27

headache, fatigue, and nausea are the most frequent ADRs for all

Question 28

Antivirals for Hep C Drug interactions

Answer 28

co-administration of ledipasvir and sofosbuvir (Harvoni) and amiodarone may cause serious symptomatic bradycardia Multiple drug interactions

Question 29

What should you really know about antivirals for Hep C

Answer 29

you will be seen by a specialist and they are given based on genotype and stage of the disease

Question 30

Antivirals for Hepatitis C | Clinical use and dosing

Answer 30

dependent on the genotype of the HCV virus, renal and hepatic function

Question 31

Antivirals for Hepatitis C | Monitoring

Answer 31

bilirubin, liver enzymes, and serum creatinine levels

Question 32

Antivirals for Hepatitis C | Patient education

Answer 32

taking medication daily, ADRs, drug interactions

Question 33

Antivirals for influenza names

Answer 33

Oseltamivir (Tamiflu), peramivir (Rapivab), zanamivir (Relenza) are used to treat influenza A and B.

Question 34

Anitvirals for influenza Pharmacodynamics

Answer 34

Sensitivity varies by year. | Resistance to amantadine and rimantadine is common, so these drugs are no longer recommended for influenza.

Question 35

Oseltamivir is

Answer 35

is well absorbed after oral administration.

Question 36

Zanamivir is

Answer 36

inhaled; 4% to 17% is absorbed

Question 37

Peramivir is administered

Answer 37

IV

Question 38

What will change the evfectiveness of oseltamivir

Answer 38

variences of viruses annually

Question 39

Osetamir and Zanamivir ADR

Answer 39

Ostemivir - GI upset Zanamivir - brhonchitis and SOB

Question 40

Oseltamivir, zanamivir: approved for

Answer 40

the prophylaxis and treatment of influenza type A and B

Question 41

Peramivir is approved

Answer 41

Peramivir is approved

Question 42

Antivirals for Influenza Monitoring

Answer 42

Monitoring Renal function in older and debilitated patients Older patients: evaluate for confusion, hallucinations, and cognitive impairment

Question 43

Anitvirals for Influenza Patient Education

Answer 43

Patient education Taking full course of therapy ADRs Annual influenza vaccination

Question 44

Where do you refer for prescribing guidelines for antivirals

Answer 44

CDC

Question 45

Systemic Azoles and Other Antifungals | Polyene macrolides:

Answer 45

amphotericin B and nystatin

Question 46

Systemic Azoles and Other Antifungals | Azoles with broad-spectrum activity

Answer 46

butoconazole, clotrimazole, ketoconazole, minonazole, terconazole, tioconazole, fluconazole, itraconazole

Question 47

Systemic Azoles and Other Antifungals | Allylamines active against yeast and dermatophytes

Answer 47

naftifine, terbinafine

Question 48

Systemic Azoles and Other Antifungals | Nuclear acid synthesis inhibitors

Answer 48

flucytosine | Griseofulvin

Question 49

Absorption of itraconazole is enhanced

Answer 49

food

Question 50

Absorption of griseofulvin is enhanced by

Answer 50

fat

Question 51

Fluconazole is an inhibitor of

Answer 51

cytochrome 3A4 (CYP3A4) and CYP2C9.

Question 52

Itraconazole is an inhibitor of

Answer 52

3A4 (CYP3A4) and CYP2C9

Question 53

Ketoconazole is an inhibitor of

Answer 53

is an inhibitor of CYP3A4.

Question 54

Systemic Azoles and Other Antifungals | ADRs

Answer 54

All of the azoles and terbinafine have been associated with hepatotoxicity.