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237 Cards in this Set
- Front
- Back
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what are viruses
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submicroscopic infective agents/obligate intracellular parasites
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how do viruses reproduce
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by using the host's cell's metabolic pathways
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what are viruses composed of
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a protein coat surrounding a DNA or RNA core
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virused lack the metabolic machinery needed to generate what
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high energy phosphate bonds proteins carbs lipids
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where do DNA viruses replicate
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nucleus
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where do RNA viruses replicate
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cytoplasm
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what are retroviruses
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RNA viruses that reverse transcribe to DNA then replicate in the nucleus
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what is an example of a retrovirus
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HIV
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what are the processes that take place in viral replication
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1. absoprtion/penetration into host cell 2. uncoating of viral nucleic acid 3. syn. of :early regulatory proteins, DNA/RNA, late structural proteins 4. assembly of viral particles 5. release from cell
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what are some examples of DNA viruses belonging to the category of herpes viruses
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HSV, varicella, cytomegalovirus, EBV, mononucleosis
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varicella zoster is herpes virus type ?
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3
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type 1 herpes causes what
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fever blisters
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type 2 herpes causes what
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genital warts
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what are the drugs used for herpes infections
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nucleoside analogs
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what are the different nucleoside analogs
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acyclovir, cidofovir, famciclovir, ganciclovir, penciclovir, trifluridine, valacyclovir, vidarabine
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what are some other drugs for herpes infections
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foscarnet, fomivirsen
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what is acyclovir active against
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herpes and VZV
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what type of derivative os acyclovir
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guanosine
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what does acyclovir require for activation
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3 phosphorylation steps
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what is the first phosphorylation step of acyclovir
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converting to monophosphate derivative by virus specific thymidine kinase
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what are the 2nd and 3rd steps of phophorylation of acyclovir
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converting to di and tri compounds by host's cellular enzymes
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what type of oral bioavailability does acyclovir have
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poor
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what does acyclovir require for the initial phosphorylation step
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thymidine kinase
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true or false: acyclovir is not a selectively active
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false, it is selectively active
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when using acyclovir where does the active metabolite accumulate
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in the infected cells
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how is acyclovir available
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orally IV topical
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how is acyclovir cleared
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by glomerular filtration
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what is acyclovir used to treat
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primary and recurrent genital herpes
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IV acyclovir is the DOC for what
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herpes simplex encephalitis and neonatal HSV infections
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how is acyclovir tolerated
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well tolerated
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what are the side effects of acyclovir
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NVD, headache, possible renal damage
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what will prevent the renal damage when using acyclovir
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adequate hydration
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what are the interactions of acyclovir
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coadministration w/ probenecid will decrease renal clearance of acyclovir
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what are the contraindications of acyclovir
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allergy to drug
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what are the adverse effects of acyclovir
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nephrotoxicity
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what is valacyclovir
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a prodrug converted to acyclovir in the body
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when is valacyclovir converted
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after ingestion
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what are the serum levels of valacyclovir
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3-5 X those achieved w/ oral acyclovir (55% bioavailabilty)
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what is the dosing of valacyclovir like compared to acyclovir
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less frequent
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what is the mechanism of action of famciclovir
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synthetic of guanine derivative- prodrgu for penciclovir
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how is famciclovir activated
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by phosphorylation
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what is phosphorylation of famciclovir catalyzed by
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virus specific thymidine kinase in infected cells
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what does the latter part of phosphorylation of famciclovir consist of
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competitive inhibtion of the viral DNA polymerase to block DNA synthesis
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what are the indictation of famciclovir
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acute herpes zoster (shingles), Tx/supression of recurrent genital herpes, Tx of recurrent mucocutaneous herpes simplex in HIV pts
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what are the contraindications of famciclovir
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hypersensitivity
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what are the adverse effects of famciclovir
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headache, nausea, diarrhea
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what are the interactions of famciclovir
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probenecid will increase serum levels
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what is the mechanism of action of penciclovir
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guanosine analogue that is the active metabolite of famciclovir
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what are the indications of penciclovir
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topical Tx of recurrent herpes labialis (fever blisters)
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what are the contraindications of penciclovir
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hypersensitivity
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what are the adverse effects of penciclovir
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headache anesthesia at site of application
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what is the mech of action of trifluridine (viroptic)
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fluorinated pyrimidine nucleoside that inhibits viral DNA synthesis by being incorporated into viral DNA in place of thymidine
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what are the indications of trifluridine
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Tx of keratoconjunctivitis caused by herpes simplex types I and II
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what are the contraindications of trifluridine
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hypersensitivity
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what are the adverse effects of trifluridine
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local irritation of the eye
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what are the interactions of trifluridine
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none
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what is ganciclovir
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acyclic guanosine analog that requires triple phosphorylation for activation
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what is the initial phosphorylation of ganciclovir catalyzed by
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viral enzyme
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what is ganciclovir active against
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CMV, HSV, VZV, EBV, HHV-8 (Kaposi sarcoma associated herpes virus)
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how is ganciclovir available
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IV and orally
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what is ganciclovir indicated for (Rx)
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Rx of CMV retinitis in AIDS, and prevention of CMV disease in organ transplant recipients and AIDS
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if you see dendrite filaments in the eye under a blacklight it is an indication of what
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herpes in the eye
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what is oral ganciclovir indicated for
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prevention of end organ CMV dz in AIDS pt.
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what are the side effects of ganciclovir
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myelosupression
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what are the interactions of ganciclovir
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coadministration w/ imipenem-cilistatin may cause seizures
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what are the contraindications of ganciclovir
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neutrocytopenia and thrombocytopenia
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what is valgancyclovir
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L-valyl ester prodrug of ganciclovir that exists as a mixture of diastereomers
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how is valganciclovir absorbed
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well absorbed and rapidly metabolized in intestinal wall and liver to ganciclovir- no other metabolites detected
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what has oral valgancicolvir replaced
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largely replaced oral ganciclovir b/c of lower pill burden
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what is foscarnet
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a phosphonoformic acid
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what is a phosphonoforic acid
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inorganic pyro-phosphate compound that inhibits viral DNA polymerase, RNA polymerase, and HIV reverse transcriptase without requiring activation by phosphorylation
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what are the indications of foscarnet
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CMV retinitis, colitis, and esophagitis, also acyclovir-resistant HSV and VZV infections
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what are the contraindications of foscarnet
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impaired renal function
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what are the interactions of fascarnet
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additive nephrotoxicity w/ cyclosporine, amphotericin B, and aminoglycosides
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what is cidofovir
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acyclic cytosine nucleotide analog
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what is cidofovir active against and how
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in vitro activity against CMV, HSV-1, HSV-2, VZV, EBV, HHV-6, HHV-8, adenovirus, poxviruses, polyomaviruses, and human papillomavirus
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what is the phosphorylation of cidofovir to the active diphosphate idependent of
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viral enzymes-activity is maintained against thymidine kinase-deficient or -altered strains of CMV or HSV: IN CONTRAST TO GANCICLOVIR
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IV cidofovir is effective for Tx of what
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CMV retinitis, used expeimentally to treat adenovirus infections
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what is the primary adverse effect of IV cidofovir
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dose-dependent proximal tubular nephrotoxicity
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how can nephrotoxicity after using cidofovir be reduced
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preyhdration using normal saline
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what are the antiretroviral agents
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Nucleoside/Nucleotide Reverse Transcriptase Inhibitors, Nonnucleoside Reverse Transcriptase Inhibitors, Protease Inhibitors,
Fusion inhibitors, CCR5 receptor antagonists, Integrase inhibitors |
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what are the Nucleoside/Nucleotide Reverse Transcriptase Inhibitors
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nucleoside analogs/nucleotide analogs
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what do Nonnucleoside Reverse Transcriptase Inhibitors do
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Bind directly to a site on the viral reverse transcriptase that is distinct from the nucleoside binding site
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what do protease inhibitors do
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Inhibit an enzyme that is needed for the production of mature virions
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what are fusion inhibitors
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Enfuvirtide- first in a new class
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what do fusion inhibitors interfere w/
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entry of HIV-I into cells by inhibiting the fusion of viral and cellular membranes
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how do fusion inhibitors bind
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to viral envelope
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fusion inhibitors are available by
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injection SQ bid
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what might fusion inhibitors cause
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diarrhea, nausea, aches, fatigue and other non-specific symptoms
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what are the different NRTI's
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abacavir, didanosine, emtricitbine, lamivudine, stavudine, tenofovir, zidovudine
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how do NRTI's act
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by competitive inhibition of HIV-1 reverse transcriptase
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what does incorporation of NRTI into growing viral DNA chain result in
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premature chain termination due to inhibition of binding with the incoming nucleotide
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what do NRTI's require
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intracytoplasmic activation via phosphorylation by cellular enzymes to the triphosphate form
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most NRTI's have activity against what
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HIV 1 and 2
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what types of toxicity are associated with NRTI's
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lactic acidemia and severe hepatomegaly with steatosis-liver becomes infiltrated w/ fat
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what is zidovudine also know as
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AZT
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zidovudine is an analog of what
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thymidine
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zidovudine requires what to work
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phosphorylation by host cell cell kinases
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how does zidovudine work
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forms a nucleotide that inhibits reverse transcriptase and causes chain termination in viral DNA
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when is resistance of zidovudine common
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in advanced AIDS pts
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how is zidovudine absorbed
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well absorbed orally, penetrated CNS well
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what type of metabolism is associated w/ zidovudine
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hepatic and renal
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what is zidovudine used for
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prophylaxis after needle sticks/ to prevent vertical transmission (pregnancy)
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what type of toxicity is seen in zidovudine
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Bone marrow suppression which is additive with other myelosuppressive drugs (specifically ganciclovir)
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drugs the undergo ______ may increase ________ levels
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glucuronidation; AZT
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metabolism of zidovudine is inhibited by what
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azoles and protease inhibitors
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what increases clearance of AZT
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rifampin
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what is zidovudine usually combined with
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lamivudine, didanosine
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what is zidovudine not used with and why
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stavudine because the combo is antagonistic
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what are the contraindications of zidovudine
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hypersensitivity
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what is tenofovir
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- an NTRI - An acyclic nucleoside phosphonate (nucleotide) analog of adenosine
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how does tenofovir work
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Competitively inhibits HIV reverse transcriptase and causes chain termination after being incorporated into DNA
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what are the indications of tenofovir
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Tx of HIV
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what are the contraindications of tenofovir
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hypersensitivty
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what are the adverse affects of tenofovir
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renal impairment, headache, NVD
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what are the interactions of tenofovir
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Competes with other drugs that are actively secreted by the kidney such as acyclovir, and ganciclovir
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what is the preferred dual regimen involving tenofovir
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Tenofovir/Emtricitabine (coformulated)
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what are the NNRTI's
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efavirenz, nevirapine
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do NNRTI's require phophorylation
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no, they do not compete with nucleoside triphosphates
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what do NNRTI's directly inhibit
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reverse transcriptase
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true or false: NNRTI's have cross resistance w/ NRTI's
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false, they not have cross resistance
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should you use NNRTI's alone or w/ another drug
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not alone/ develops resistance
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how are NNRTI's given
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orally/good bioavailability
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what types of metabolism and excretion are seen with NNTRI's
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hepatic metabolism, renal/fecal excretion
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how do NNRTI's act
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synergistically w/ NRTI's and protease inhibitors against HIV
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what are the most common side effects of NNRTI's
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skin rashes
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what type of availabilty does nevirapine have
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excellent oral bioavailability
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how is nevirapine used
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in comb. therapy w/ 2 NRTI's
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what dosage is is effective in the prevention of vertical transmission when given at the onset of labor and followed by a 2mg/kg dose given to the neonate within 3 days of birth
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200 mg
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what toxicities are associated with nevirapine
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Stevens-Johnson syndrome and toxic epidermal necrolysis, fulminant hepatitis
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what does nevirapine induce
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CYP3A drug metabolism
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what does the induction of CYP3A4 drug metabolism by nevirapine cause
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metabolism-decreased levels of indinavir, ritonavir, saquinavir, and oral contraceptives
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what should nevirapine not be given with
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ketoconazole
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what is the preferred NNRTI
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efavirenz
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when is efavirenz contraindicated
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pregnancy
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what adverse effects are associated w/ efavirenz
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CNS effects such as abnormal dreams and depression, neural tube defects if given in the first trimester of pregnancy
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what are the protease inhibitors
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atazanavir, darunavir, fosamprenavir, lopinavir, nelfinavir, ritonavir
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what does protease cleave
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precursor molecules to produce the final structural proteins of the mature virion core
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what happens as a result of protease inhibitors producing the proteins of the viron core
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prevent new waves of infection (metabolic syndrome)
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what are the adverse effects of protease inhibitors
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Syndrome of altered fat distribution, insulin resistance, and hyperlipidemia
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how are protease inhibitors usually given
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orally
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what are protease inhibitors metabolized by
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cytochrome P450 enzymes before renal and fecal excretion
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true or false: protease inhibitors usually combined with two NRTI’s
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true
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what are multiple interactions of protease inhibitors due to
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inhibition of cytochrome P450
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how is absorption of protease inhibitor- nelfinavir- increased
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by food
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dosing of nelfinavir is limited by what
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diarrhea and flatulence
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what are the multiple drugs associated w/ nelfinavir
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Midazolam, amiodarone quinidine are all potentiated
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what are the contraindications of nelfinavir
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hypersensitivity
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what type of effect does ritonavir have on cytochrome P450 3A4 isoenzyme
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potent
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the effect of ritonavir on cytochrome P450 3A4 isoenzyme has allowed what
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the addition of low dose ritonavir to other PI's (w/ exception of nelfinavir) as a pharmacokinetic booster to increase/prolong plasma half lives of active PI
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what are the preferred PI regimens
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atazanavir + ritonavir- once daily darunavir + ritonavir o.d. fosamprenavir + ritonavir t. d. liponavir/ritonavir conformaulated once or twice d.
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what is the process of HIV1 entry into host cell like
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complex; each step forms potential target for inhibition
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what class is enfuvirtide
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a fusion inhibitor
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how does enfuvirtide work
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blocks entry of HIV into cell
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what are the indications of enfuvirtide
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Tx of HIV in comb. w/ other antiretroviral agents
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what are the contraindications of enfuvirtide
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hypersensitivity
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what are the adverse effects of enfuvirtide
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local injection site reactions common
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what are the interactions of enfuvirtide
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none
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what is maraviroc
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a CCR5 receptor antagonist
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what is maraviroc used for
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in adults w/ CCR5 tropic (R5) HIV 1 infections experiencing virologic failure due to resistance to other antiretroviral agents
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what is integrase
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a viral enzyme essential to replication of HIV1 and 2
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what is Raltegravir
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a pyrimidinone analog that binds integrase- integrase inhibitor
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what do intergrase inhibitors do
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inhibit strand transfer, the 3rd and final step of provirus integration= interfering w/ integration of reverse transcribed HIV DNA into chromosomes of host cell
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what is raltegravir licensed for
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treatment in experienced adult pt. infected w/ strains of HIV 1 resistant to multiple agents
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what are the goals of treatment w/ integrase inhibitors
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reduce morbidity w/ HIv, prolong survival, improve pt. quality of life, restoe/maintain immune fx, supress viral load, prevent vertical trasnmission
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according to dept. of human health ser. panel on antiretroviral guidelines for adults/adolescents ART should be initiated in who
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pt w/ history of AIDS defining illness or CD4 T cell count below 350 cells per cubic mm
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ART therapy should be started in who regarding CD4 tcell count
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pt w/ high viral load(100000copies/mm), rapid CD4 tcell count decline (1--/cubic mm/yr), pregnant women, HIV associated neuropathy, coinfected w/ HBV when Tx is indicated
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true or false: antiretroviral agents may be considered in some pt w/ CD4 tcell counts above 350/cubic mm
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true
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what are the potential benefits of early antiretroviral Tx
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decreased risk HIV associated complications (NHL, Kaposi's sarcoma, TB), nonopportunistic conditions, HIV transmission associated w/ early Tx
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what are the potential harms of early Tx w/ antiretroviral agents
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increased risk of drug related adverse events/ drug resistance increased time on meds
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what is the preferred regimen of Tx when using NRTI, NNRTI, protease inhibitors
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comb of 2 NRTI's and either a NNRTI of ritonavir-boosted protease inhibitor- both lead to suppression of HIV RNA levels and CD4 tcell increase in most pt
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true or false: interms of convenience NNRTI based regimens are among the most complicated to take
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false- simplest, particularly w/ confomulated tablet of tenofovir,emtricitabine, efavirenz- once daily w/ single pill
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all preferred PI based regimens include ____, may be dosed ____ and generally require ____ pills in the regimen
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ritonavir, 1 or 2 daily, more
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drug-drug interactions are important w/ both kinds of regimens but more clinically significant interactions w/
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ritonavir boosted regimens
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what are the antihep agents
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lamivudine, adefovir, interferon alfa, pegylated interferon alfa, ribavirin
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lamivudine is also used as a what
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age drug
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what is lamivudine classified as
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nucleoside reverse transcriptase inhibitor NRTI, a cytosine analog
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what are the indications of lamivudine
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HIV, HBV
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what are the contraindications of lamivudine
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hypersensitivity
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what are the adverse effects of lamivudine
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headache, insomnia, fatigue, elevated liver function test LFT
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what are the interactions of lamivudine
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lamivudine auc area under the curve (bioavailability) increases when coadministered w/ TMP-SMZ
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what mech of action does adefovir have
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analog of adenosine monophosphate (nucleotide analog) which is phosphorylated by cellular kinases and competitively inhibits HBV DNA polymerase/ results in chain termination
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what are the indications of adefovir
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hep B
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what are the contrandications of adefovir
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hypersensitivity to drug
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what are the adverse effects of aedfovir
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nephrotoxicity, lactic acidosis, hepatomegaly, steatosis
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what are the interactions of adefovir
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when given w/ ibufrofen AUC is increased
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what is the mech of action of interferon alfa
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synthesis of RNA and protein
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what is interferon alfa
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endogenous protein that exerts antiviral effects through cellular metabolic processes
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what are the indications of interferon alfa
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hep b and c
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what are the contraindiction of interferon alfa
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psychosis, severe depression, neutropenia, uncontrolled seizures
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what are the adverse effects of interferon alfa
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flu like symptoms, elevated LFT depression
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what are the interactions of interferon alfa
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clearance of theophylline reduced
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what are the indications of pegylated interferon alfa
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chronic hep c
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what causes reduced clearance and sustained apsortion when using pegylated interferon alfa
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a polythylene glycol (PEG) moiety is attached to interferon- caused steadier drug concentrations and allows for less frequent dosing
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what is the mech of action of ribavirin
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unknown
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what is ribavirin active against
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influenza A and B, parainfluenza, RSV, paramyxoviruses, HCV, and HIV 1
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if a pt has severe RSV how should ribavrin be given
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as an aerosol
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if a pt has chronic hep c how should ribavirin be given
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orally
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what type of toxicity is seen w/ ribavirin
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Dpn, myelosuppression- won't get unless taking it orally for hep
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what are the contraindications of ribavirin
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anemia, end stage renal failure, severe heart dz, pregnancy
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what are the interactions of ribavirin
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antagonizes anitviral activity of zidovudine
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what are the antiflu agents
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amantadine, rimantadine, zanamivir, oseltamivir
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how are amantadine and rimantadine similar
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both useful for influenza A
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how are zanamivir and oseltamivir similar
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both useful for influenza Aand B
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what mechanism of action does amantadine have
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inhibit uncoating of viral RNA influenza A within infected cells
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what are the indications of amantadine
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prophylaxis and Tx of influenza infections
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what are the contraindications of amantadine
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hypersensitivity
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what are the adverse affects of amantadine
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GI intolerance, nervousness, lightheadedness
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what are the interactions of amantadine
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cimetidine inhibits the metabolism of this drug, additive anti cholinergic effects w/ other anticholinergic drugs
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what do amantadine and rimantadine work to do
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inhibit uncoating of viral RNA influenza A w/in infected cells
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what % efficacy do amantadine and rimantadine have against influenze A
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80%
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which drug has more pronounced CNS side effects- amantadine or rimantadine
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amantadine b/c it is more lipophillic
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what are zanamivir and oseltamivir
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Neuraminidase inhibitors
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what are neuraminidase inhibitors
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viral enzymes tha cleave sialic acid residues from viral proteins and surface proteins of infected cells
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true or false: neuraminidase inhibitors impede viral spread
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true
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what are zanamivir and oseltamivir active against
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influenza A and B
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is zanamivir intra or extranasal
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intranasal
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oseltamivir is also known as what
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tamaflu
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how is oseltamivir given
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orally
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what are the indications of zanamivir
|
Tx of influenza A and B
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what are the contraindications to zanamivir
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hypersensitivity
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what are the adverse effects of zanamivir
|
Nasal and throat discomfort, bronchospasm
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what are the interactions of zanamivir
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none
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what are the indications of oseltamivir
|
prevention and Tx of influenza A and B
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|
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what are the contraindications of oseltamivir
|
hypersensitivity
|
|
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what are the adverse effects of oseltamivir
|
GI upset, CNS agitation
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|
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what are the interactions of oseltamivir
|
probenecid increases serum levels
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|
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what is Palivizumab
|
Humanized monoclonal antibody directed against the F glycoprotein on the surface of RSV
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|
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what are the indications for palivizumab
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Prevention of RSV in high-risk infants and children
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what are the contraindications of palivizumab
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hypersensitivity
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what are the interactions of palivizumab
|
none
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what are the adverse effects of palivizumab
|
Injection site reaction, elevated LFT’s
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what is imiquimod
|
Immune response modifier
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|
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what are the indications for imiquimod
|
Topical treatment of external genital and perianal warts
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|
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what are the contraindications of imiquimod
|
hypersensitivity
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|
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what are the adverse effects of imiquimod
|
local skin irritaion
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what are the interactions of imiquimid
|
none
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