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36 Cards in this Set
- Front
- Back
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Oseltamivir, Zanamivir, Peramivir
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MOA: block NA & prevent release of virions (Inf A&B) Oseltamivir: oral; Zanamivir: topical, inhaler Resistance: NA mutation Uses: Oseltamivir: Influenza A (H5N1), Prophylaxis, >3 months Zanamivir: Prophylaxis, >7 years |
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Acyclovir/Valcyclovir MOA
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MOA: nucleoside analogue of guanosine, activated by viral thymidine kinase, phosphorylation complete by host cellular kinases
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Against which viruses do acyclo & valcyclo have good activity?
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HSV & VZV; poor against CMV prophylaxis of VZV (immunocompromised); given orally (15-30%), IV, topical |
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Resistance of Acyclo/Valcyclo
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Mutations in viral TK/ viral DNA pol; genes - TK deficient |
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Adverse effects of Acyclo/Valcyclo; DI
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(1) GI (nausea, vomit, diarrhea) & (2) neurological; limit alcohol, pregnant use only if neccesary |
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Ganciclovir/Valganciclovir MOA
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analogue of 2-deoxyguanine; inhibits viral DNA pol incorporation of dGTP into viral DNA; Valganciclovir is a pro-drug of ganciclovir activated in gut
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Val/Ganciclovir have good activity against?
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CMV; given IV, oral (limited), intraocular
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Val/Ganciclovir resistance arises when
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Mutant DNA pol, reduced phosphorylation by CMV phosphor-transferase, UL97
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Val/Ganciclovir AE; DI
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(1) bone marrow depression (neutropenia, thrombocytopenia, anemia) & (2) neurological defects (seen in acyclo/valcyclo); extensive & very serious DI (zidovudine, abacavir, bacitracin...) |
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Cidofovir MOA, resistance causes & administration
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MOA: CTP analog that inhibits viral DNA pol Resistance: mutant viral DNA pol Admin: IV, intraocular |
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Cidofovir is given to which patients?
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acyclovir-resistant HSV infections (HIV +); CMV in solid organ transplant
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Cidofovir AE & DI
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AE: (1) nephrotoxic, nausea, vomit DI: nephrotoxic potential with nephrotoxic agents (aminoglycosides, amphotericin B) |
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Foscarnet MOA & resistance
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MOA: Similar to pyrophosphate anion, competes for pyrophpsphate binding site on viral DNA pol, preventing viral DNA synthesis Resistance: mutation in viral DNA pol |
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When is foscarnet given? Administration?
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2nd line CMV retinitis, acyclovir-resistant HSV, gangiclovir-resistant CMV (if resistance not due to pol) Admin: IV |
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Foscarnet AE & DI
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AE: (1) nephrotoxic, (2) CNS symptoms, (3) hypokalemia, (4) hypomagnesemia DI: nephrotoxic drugs |
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Ribavirin MOA & resistance
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MOA: guanosine analogue that inhibits capping of viral mRNA & stops viral RNA synthesis Resistance: mutations in Hep C |
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Spectrum of Ribavirin
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1. Hep C: Ribavirin + IFN-a-2b 2. RSV bronchiolitis (aerosol) 3. Hantavirus (IV) |
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Ribavirin AE & DI
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AE: (1) anemia (ribavirin-induced hemolysis (2) teratogenic |
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Ledipasvir/Sofosbuvir (Anti-Hep C) MOA
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Ledipasvir: inhibits NS5A protein (viral replication, assembly & release) Sofosbuvir: nucleotide analog incorporated in RNA pol that terminates viral chain |
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Resistance of Ledipasvir/Sofosbuvir (Anti-Hep C); administration
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resistance-associated substitutions; fixed dose 1 tablet daily |
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Ledipasvir/Sofosbuvir (Anti-Hep C) AE & DI
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AE: (1) fatigue, (2) headache DI: St. John's Wort, rifampin, amidoarone (reduced effect) |
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a, B Interferon MOA
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Enhance expression of MHC I & II; activate JAK/STAT pathway to increase antiviral RNase
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Spectrum of alpha, beta interferons
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a: chronic Hep B/C, papilloma virus warts, hairy cell leukemia, Kaposi sarcoma B: multiple sclerosis |
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Interferon resistance
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Virus blocks downstream signaling events after IFN binds receptor (Dengue T2, Hep C isolates)
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Interferon AE
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(1) Leukopenia, (2) Hepatotoxicity, (3) fever, chills, malaise
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Antiretroviral therapy should be INITIATED...
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in all patients with (1) AIDS-defining illness (2) CD4 < 350 c/mm3
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Initial ARVT is composed of (usually)
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2 NRTIs + PI/NNRTI/II
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Enfuvirtide (T20): what is it and what is its MOA?
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synthetic 36 AA peptide; prevents viral attachment and entry via gp41 resistance develops mutation in the envelope gene |
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Maraviroc MOA & AE
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Selectively binds CCR5 and prevents entry of HIV virus AE: (1) Hepatotoxic (preceded by pruritic rash, eosinophilia) (2) Dizziness/postural hypotension (3) MI, ischemic events |
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Zidovudine (Pyrimidine analog) MOA
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Thymine nucleoside analog phosphorylated to azidothymidine TTP via host thymidine kinase; inhibits viral RNA-dependent DNA pol (RT) by causing chain termination
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Zidovudine DI
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Enhanced by: acyclovir, interferon, gcmf, dideoxyadenosine Decreased by: thymidine, ribivarin |
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Zidovudine AE
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(1) Granulocytopenia and anemia (45%) (2) GI disturbance, abnormalities of liver function (3) Peripheral neuropathy (4) Pancreatitis in peadiatrics |
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Name the NNRTIs (3), name route of administration, compare resistance & side effects.
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Efavirenz, Nevirapine, Delaviridine bind directly to catalytic site of RT; given orally and have less serious side effects but resistance develops rapidly!
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Name protease inhibitors -avir's (6)
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1. saquinavir 2. ritonavir 3. lopinavir 4. indinavir 5. nelfinavir 6. ampernavir |
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Protease Inhibitors AE
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(1) Increased aminotransferase levels, (2) Hepatitis, (3) anemia, (4) GIT
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Raltegravir MOA, administration & AEs
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Targets viral integrase; is administered orally AE: muscle & joint ache, allergic reactions |
