B&l_Exam 2: Bridges_Antivirals

Front 1

Which of the antivirals used to treat HSV or CMV are not nucleoside analogs?

**OBJ**

Back 1

Foscarnet

Front 2

Describe the advantage that rimantadine has over amantadine regarding adverse effects

**OBJ**

Back 2

Rimantadine used more than amantadine because less CNS effects

Front 3

Drugs used for HSV, VZV?

Back 3

acyclovir, foscarnet

Front 4

Drugs used for CMV?

Back 4

ganciclovir, foscarnet

Front 5

Drugs used for Influenza?

Back 5

zanamivir, oseltamivir,

amantadine, rimantadine,

Front 6

Drugs used for RSV?

Back 6

ribavirin

Front 7

Drugs used for Hepatitis:

Hep C ?

Hep B?

Back 7

HCV: peginterferon alfa, ribavirin

HBV: interferon alfa, lamivudine

Front 8

acyclovir and ganciclovir are what class of drugs?

Back 8

Nucleoside Analogs

Front 9

What are the 3 Herpes Viruses?

Back 9

Herpes simplex (HSV)

Varicella zoster (VZV)

Cytomegalovirus (CMV)

Front 10

MOA: Nucleoside Analogs?

Back 10

TP competitively inhibits viral DNA polymerase

Front 11

Explain the selective toxicity behind Nucleoside Analogs when treating HSV and CMV

**EXAM**

Back 11

Initial conversion of nukes to TP is only carried out by VIRAL KINASES...

Since infected cells have a bunch of this the drug will accumulate in and kill these cells..

Uninfected cells remain SAFE

Front 12

This drug is a gaunosine analog

Clincal Activity Against:
HSV-1
HSV-2
VZV

Back 12

Acyclovir

Front 13

What is the DOC for:

HSV encephalitis

neonatal HSV infections

serious HSV or VZV infections

***

Back 13

ACYCLOVIR

Front 14

MOA: Acyclovir?

Back 14

Triphosphate inhibits viral DNA synthesis

Front 15

This drug is well tolerated when taken orally.

But, when given IV:

- Acute renal failure
(crystalline nephropathy)

- Neurologic toxicity
(eg, tremors, delirium, seizures)

Back 15

acyclovir

Front 16

This drug is a gaunosine analog

Used for:
-Prevention and treatment
of CMV infection

-Prevention of CMV reactivation
in transplant patients

Back 16

Ganciclovir

Front 17

Ganciclovir can cause bone marrow suppression and an additive effect can occur with zidovudine (AZT) or azathioprine

-What could you use instead of Ganciclovir along with AZT to treat CMV?

Back 17

Foscarnet + AZT is safer

Front 18

Ganciclovir treats ______

Back 18

CMV

Front 19

Adverse Effects:

Bone Marrow Suppression
-additive effect can occur with zidovudine (AZT) or azathioprine

CNS (dose limiting)
-headache, behavioral changes, convulsions and coma

Back 19

Ganciclovir

Front 20

DOC for:

Serious HSV and CMV infections such as ganciclovir-resistant CMV

-AIDS and transplant patients (principle use)

CMV retinitis in AIDS patients
-acyclovir-resistant HSV and VZV

Back 20

Foscarnet

Front 21

This drug is NOT a nucleoside analog and Inhibits viral DNA polymerase
(chain elongation)

Back 21

Foscarnet

Front 22

Adverse effects - Pretty toxic

- Nephrotoxicity (dose limiting)

- Symptomatic hypocalcemia (dose limiting)

Back 22

Foscarnet

(Highly Charged, so it binds up lots of ions like iron and causes HYPOCALCEMIA)

Front 23

-Effective against both influenza A & B

- Both are competitive inhibitors of
influenza A & B neuraminidase

Back 23

Zanamivir

Oseltamivir

Front 24

-Zanamivir - given by ___ ( poor oral BA)

-Oseltamivir - _____ prodrug

Back 24

-Zanamivir - given by inhalation ( poor oral BA)

-Oseltamivir - oral active prodrug

Front 25

Potentially effective against:
avian flu (influenza A H5N1)
swine flu (influenza A H1N1)

Back 25

Zanamivir

Oseltamivir

Front 26

Adverse effects of Oseltamivir ?

Back 26

NV (most common effect)

Neuropsychiatric effects
-Self injury & delirium
-Particularly in children

Front 27

Adverse effect of Zanamivir

Back 27

bronchospasm

**AVOID IN PT WITH ASTHMA AND CHRONIC RESP. DZ)

Front 28

These drugs only treat Influenza A

-Not effective for influenza B

Back 28

Amantadine / rimantadine

Front 29

MOA: Prevents uncoating of viral RNA

Back 29

Amantadine / rimantadine

Front 30

T/F

Both Amantadine and rimantadine enter the CNS and can treat Parkinson's

Back 30

FALSE

Only Amantadine Enters CNS

Front 31

Adverse effects:

- GI (nausea, anorexia)

-CNS (nervousness, difficulty concentrating,insomnia, light-headedness)

CNS effects more common in elderly***

Back 31

Amantadine/rimantadine

NOTE: Rimantadine is used most often b/c it has less CNS side effects

Front 32

The only FDA approved uses for this drug:

Severe RSV - high risk infants and kids

Hepatits C (in combo with interferon alpha)

Back 32

Ribivarin

Front 33

Standard of care (DOCs) for Hepatitis C?

Back 33

Peginterferon-alfa + Ribavirin

Front 34

MOA: Turns on gene expression of proteins with antiviral effects

Back 34

Interferon alpha

Front 35

Adverse Effects:

- Myelosuppression

- Flu-like symptoms

-Marked CNS effects
(Depression and suicidal behavior)

Back 35

Interferon alpha

(These are a big deal since pt's are on therapy for 48wks)

Front 36

This drug causes anemia and is absolutely contraindicated in women who are pregnant or thinking of becoming pregnant (Pregnancy category X)

Back 36

Ribavirin

Front 37

Standard of care (DOCs) for Hepatitis B?

Back 37

Interpheron alpha + Lamivudine