Antivirals (Non-Hiv)

Front 1

Cidofovir indication

Back 1

CMV

Front 2

MOA of Cidofovir

Back 2

Inhibits viral DNA polymerase

Front 3

t 1/2 of Cidofovir

Back 3

17-65 hr (very long!) Active metabolite is choline adduct with t ½ of 82 hrs

Front 4

Cidofovir is synergistic with what drugs?

Back 4

ganciclovir and/or foscarnet

Front 5

SE of Cidofovir

Back 5

a. Nephrotoxicity
b. Neuropenia
c. Metabolic acidosis
d. Decreases IOP
e. Uveitis

Front 6

What can treat Mucocutaneous HSV infections especially those resistant to acyclovir, (anogenital warts)?

Back 6

Cidofovir as a topical gel

Front 7

Acyclovir indications

Back 7

a. HSV 1
b. HSV 2
c. HS encephalitis
d. Neonatal HSV
e. VZ
f. Off label: prophylaxis of CMV

Front 8

What drug is best for HS encephalitis?

Back 8

Acyclovir (crosses BBB the best)

Front 9

Valacyclovir indications?

Back 9

a. Herpes labialis (cold sores, but doesn’t work once the cold sore is visible)
b. Genital herpes (preferred over acyclovir because better absorbed)
c. VZ
d. Chicken pox

Front 10

Preferred over acyclovir for genital herpes because better absorbed

Back 10

Valacyclovir

Front 11

What are Gancyclovir and Valgancyclovir indications?

Back 11

a. CMV
b. Gancyclovir ophthal Gel second choice agent for HSV Keratitis

Front 12

Maribavir indication

Back 12

For CMV infections in transplant patients

Front 13

MOA of maribavir

Back 13

Benzimidaole riboside; inhibits CMV assembly and egress from nucleid capsule of infected cells..

Front 14

Why is Famcyclovir called a “pre pre prodrug?”

Back 14

(three steps before becomes active)
a. Two acetyl groups removed then oxidation or
b. Oxidation then two acetyl groups removed
c. Eith pathway result in pencyclovir
Pencyclovir then must be phosphorylated 3 times

Front 15

What is pencycolvir used for?

Back 15

Only used topically for cold sores

Front 16

Famcyclovir indication

Back 16

PO agent for Shingles

Front 17

Famcyclovir SE

Back 17

GIT upset, bone marrow suppression

Front 18

Pencyclovir (and Famcyclovir) MOA

Back 18

Blocks thymidine which ultimate blocks incorporation of doxyguaosinne triphosphate inhibition of viral DNA synthesis

Front 19

Entacavir (Baraclude) indication

Back 19

Selective activity against HBV

Front 20

What are SE of entecavir (baraclude)?

Back 20

Somnolence: 2%, HA, dizziness, fatigue

Front 21

What should you keep in mind about Entecavir (Baraclude) dosing?

Back 21

a. PO
b. Adjust dose based on renal parameters
c. Food delays abs and AUC
d. No P450 interaction
e. CI: <16yo

Front 22

Can HIV/HBV patients receive Entecavir?

Back 22

Therapy with entecavir is not recommended for HIV/HBV co-infected patients who are not also receiving highly active antiretroviral therapy (HAART).1

Front 23

What can happen if Entacavir (Baraclude) is discontinued?

Back 23

Severe acute exacerbations of hepatitis B have been reported in patients who have discontinued antihepatitis B therapy, including entecavir.

Front 24

What is one Black Box Warning of Entecavir (Baraclude)?

Back 24

Lactic acidosis and severe hepatomegaly with steatosis, including fatal cases, have been reported with the use of nucleoside analogs alone or in combination with antiretrovirals.

Front 25

MOA or Entecavir (Baraclude)

Back 25

guanosine nucleoside analog with activity against HBV polymerase, and is efficiently phosphorylated to the active triphosphate form, which has an intracellular half-life of 15 hours

Front 26

Tyzeka (Telbivudine) indication

Back 26

Thymidien analog for HBV; use this if Bariculde (Entecavir) fails

Front 27

What drugs have this black box warning:
lactic acidosis
severe hepatomegaly with steatosis
severe acute exacerbations of HepB
when discontinued

Back 27

Entecavir (Baraclude)
Telbivudine (Tyzeka)

Front 28

Ribavirin (virazole) MOA

Back 28

1. RMP inhibits IMP dehydrogenase
2. RTP inhibits vRNA polymerase
3. RTP inbhitis guanyl n-methyltransferase

Front 29

Ribavirin (virazole) indications:

Back 29

. Rabies
c. Adeno V
d. HSV I and II
e. Pox viruses
f. Influ A and B
g. Hepatitis
h. E bola
i. RSV

Front 30

What drug is used to treat RSV in toddlers and infants?

Back 30

Ribavirin (virazole)

Front 31

Condylomata Acuminata treatment options:

Back 31

Podofilox (podophyllotoxin)
Imiquimod (aldara)
Veregen

Front 32

How would you counsel for a topical treatment for HPV with podofilox ?

Back 32

25% tincture; needs to be applied directly the wart and NOT surrounding soft tissue because it will cause necrosis and infection; Apply 1 or 2 x d until wart is gone

Front 33

MOA of podophyllum peltatam (podofilox)

Back 33

Interferes with replication; more of a mitotic spindle apparatus

Front 34

Imiquimod (aldara) indication

Back 34

Alternate to podofilox for external wet anogenital warts and superfiicla basal cell carcinoma

Front 35

How would you counsel for a patient on Imiqimod?

Back 35

Do not bandage/occlude;Wash area 6-10 hr later with soap (does not damage other areas of the skina s much as podofiliox) 4-16 weeks 1 every other week

Front 36

What agent is not yet available, but is the only agent that shows promise in reversing symptoms of MS

Back 36

Laquinimod

Front 37

Veregen indication

Back 37

15% topical ointment 60% cure HPV 9 or 11 anogenital warts (does not work for warts on hands)

Front 38

What is Veregen?

Back 38

Sinecatechins: active compounds from extract of green tea; Polyphenon E (EGCG)

Front 39

Docosanol and how effective is it?

Back 39

Abreva; Long chain fatty alcohol (C22H46O). Not very effective

Front 40

Amantadine indication

Back 40

Influenza A; treating cocaine withdrawal (CNS stimulation)

Front 41

Oseltamivir (tamiflu) and MOA?

Back 41

Oral antiviral against influenza A and B
(MOA: neuraminidase inhibitor)

Front 42

Zanamivir (relenza) and MOA?

Back 42

Inhaled antiviral against influenza A and B (MOA: neuraminidase inhibitor)

Front 43

Drug used for use against H1N1

Back 43

Peramivir (IV for hospitalized adult and peds when______)

Front 44

What drugs are available for ocular virus treatment?

Back 44

Idoxuridine IIDU)
Vidarabine
TriFluorothymidine

Front 45

How are antivirals for the eye dosed?

Back 45

1gtt q 2 h to max of 9 gtts/d
Must be monitored and dose adjusted accordingly based on healing of ulcer, size of ulcer reduction, etc

Front 46

SE of drugs are available for ocular virus treatment?

Back 46

Increases IOP

Front 47

What are the ocular agents active agaist?

Back 47

HSV I and II Keratoconjunctiviits

Front 48

What is preferred for genital herpes?

Back 48

Valacyclovir (better absorbed)

Front 49

Acyclovir indications

Back 49

Herpes Zoster Infections: ZOVIRAX is indicated for the acute treatment of herpes zoster (shingles).

Genital Herpes: ZOVIRAX is indicated for the treatment of initial episodes and the management of recurrent episodes of genital herpes.

Chickenpox: ZOVIRAX is indicated for the tr eatment of chickenpox

Front 50

What is the Black bock Warning associated with gancyclovir?

Back 50

The clinical toxicity of ganciclovir includes:
granulocytopenia
anemia
thrombocytopenia.
(In animal studies ganciclovir was carcinogenic, teratogenic and caused aspermatogenesis.)

Front 51

Which drugs require phosphorylation and which do not?

Back 51

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Front 52

Who should not use Zanamivir?

Back 52

Treatment/prophylaxis in people with asthma or COPD (airway disesease) because bronchospasm is a SE. Not for use in nursing homes.