.microbio E2: Antivirals

Front 1

Name the 5 classes of antiviral drugs for HIV.

Back 1

NRTI's
NNRTI's
Protease Inhibitors
Integrase Inhibitor
Fusion Inhibitor

Front 2

What HIV drug class is described:
Analogues of nucleosides/nucleotides, phosphorylated by HOST kinases to triphosphate. Competitive inhibitor of HIV reverse transcriptase Once incorporated , acts as chain terminator.

A. NRTI's
B. NNRTI's
C. Protease Inhibitors
D. Integrase Inhibitor
E. Fusion Inhibitor

Back 2

A. NRTI's

ex. Zidovudine (AZT), Stavudine (D4T), Didanosine (DDI), Tenofovir, Emtricitabine (FTC), Lamuvidine (3TC), Abacavir

Front 3

What HIV drug class is described:
NONcompetitive inhibitor of reverse transcriptase, locks it in an inactive conformation.

A. NRTI's
B. NNRTI's
C. Protease Inhibitors
D. Integrase Inhibitor
E. Fusion Inhibitor

Back 3

B. NNRTI's

Front 4

What HIV drug class is described:
Inhibits viral protease

A. NRTI's
B. NNRTI's
C. Protease Inhibitors
D. Integrase Inhibitor
E. Fusion Inhibitor

Back 4

C. Protease Inhibitors

Front 5

What HIV drug class is described:
Inhibits insertion into host genome.

A. NRTI's
B. NNRTI's
C. Protease Inhibitors
D. Integrase Inhibitor
E. Fusion Inhibitor

Back 5

D. Integrase Inhibitor

Front 6

What HIV drug class is described:
binds to host CCR5 or HIV gp41

A. NRTI's
B. NNRTI's
C. Protease Inhibitors
D. Integrase Inhibitor
E. Fusion Inhibitor

Back 6

E. Fusion Inhibitor

Front 7

Describe the general characteristics for each class of HIV drugs.

A. NRTI's
B. NNRTI's
C. Protease Inhibitors
D. Integrase Inhibitor
E. Fusion Inhibitor

Back 7

A. NRTI's: analogues of nucleosides/tides , phosphorylated by host kinases to triphosphate, competitive inhibitor of HIV RT, once incorporated acts as chain termination
B. NNRTI's: noncompetitive inhibitor of RT, locks it in inactive conformation
C. Protease Inhibitors: inhibits viral protease to prevent maturation
D. Integrase Inhibitor: inhibits insertion into host genome
E. Fusion Inhibitor: binds to CCR5 host receptor or HIV gp41 to block fusion

Front 8

What HIV drug class family does the following belong to:
Zidovudine (AZT)

A. NRTI's
B. NNRTI's
C. Protease Inhibitors
D. Integrase Inhibitor
E. Fusion Inhibitor

Back 8

A. NRTI's

Front 9

What HIV drug class family does the following belong to:
Stavudine (D4T)

A. NRTI's
B. NNRTI's
C. Protease Inhibitors
D. Integrase Inhibitor
E. Fusion Inhibitor

Back 9

A. NRTI's

Front 10

What HIV drug class family does the following belong to:
Didanosine (DDI)

A. NRTI's
B. NNRTI's
C. Protease Inhibitors
D. Integrase Inhibitor
E. Fusion Inhibitor

Back 10

A. NRTI's

Front 11

What HIV drug class family does the following belong to:
Tenofovir

A. NRTI
B. NNRTI
C. Protease Inhibitors
D. Integrase Inhibitor
E. Fusion Inhibitor

Back 11

Tenofovir = NRTI

Commonly adminstered as disoproxil prodrug, improves pharmacokinetics. Rare renal toxicity adverse effect. Treats both HIV and HepB.

Front 12

What HIV drug class family does the following belong to:
Emtricitabine (FTC)

A. NRTI
B. NNRTI
C. Protease Inhibitors
D. Integrase Inhibitor
E. Fusion Inhibitor

Back 12

Emtricitabine (FTC) = NRTI

Long half life enables QD dosing, good bioavailability. Treats HIV and Hep B.

Front 13

What HIV drug class family does the following belong to:
Lamuvidine (3TC)

A. NRTI
B. NNRTI
C. Protease Inhibitors
D. Integrase Inhibitor
E. Fusion Inhibitor

Back 13

Lamuvidine (3TC) = NRTI

Good oral bioavailability , generally well tolerated. Treats HIV and Hep B.

Front 14

What HIV drug class family does the following belong to:
Abacavir

A. NRTI
B. NNRTI
C. Protease Inhibitors
D. Integrase Inhibitor
E. Fusion Inhibitor

Back 14

Abacavir = NRTI

Adverse side effect of skin rash, hypersensitivity reaction, nausea.vomiting. Possibly CV risk too. Is most effective of the current NRTIs.

Front 15

What HIV drug class family is described:
Many produce peripheral neuropathy due to mitochondrial toxicity.

A. NRTI
B. NNRTI
C. Protease Inhibitors
D. Integrase Inhibitor
E. Fusion Inhibitor

Back 15

A. NRTI

Front 16

What HIV drug class family does the following belong to:
Nevirapine

A. NRTI
B. NNRTI
C. Protease Inhibitors
D. Integrase Inhibitor
E. Fusion Inhibitor

Back 16

Nevirapine = NNRTI

Good bioavailability , long half life. Skin rash and hepatotoxicity can occur. Induces CYP4A4.

Front 17

What HIV drug class family does the following belong to:
Delaviridine

A. NRTI
B. NNRTI
C. Protease Inhibitors
D. Integrase Inhibitor
E. Fusion Inhibitor

Back 17

Delaviridine = NNRTI

Good bioavailability, short half-life limits its use though. No antacids or H2 blockers used in combo with this. Inhibits CYP3A4.

Front 18

What HIV drug class family does the following belong to:
Efavirenz

A. NRTI
B. NNRTI
C. Protease Inhibitors
D. Integrase Inhibitor
E. Fusion Inhibitor

Back 18

Efavirenz = NNRTI

Long halfe life enables QD. Side effects of rash, CNS effects (hallucinations, psychosis). Mixed action on CYP3A4.

Front 19

What HIV drug class family does the following belong to:
Etravirine

A. NRTI
B. NNRTI
C. Protease Inhibitors
D. Integrase Inhibitor
E. Fusion Inhibitor

Back 19

Etravirine = NNRTI

2nd generation NNRTI. Side effects of Rash, nausea, diarrhea but less so than 1st generations. Mixed actionon CYP3A4.

Front 20

What HIV drug class family does the following belong to:
Rilpiravine

A. NRTI
B. NNRTI
C. Protease Inhibitors
D. Integrase Inhibitor
E. Fusion Inhibitor

Back 20

Rilpiravine = NRTI

2nd generation. Long half life. Rash, hepatitis, CNS effects , but less severe than 1st generation.

Front 21

What are the two NNRTI drugs that are 2nd generation and what are their adverse effects and metabolic indications, if any.

Back 21

Etravirine, Rilpiravine are both second gen NNRTIs.

Etravirine: AE of rash, nausea, diarrhea, but less severe than 1st gen. Has mixed action on CYP3A4.

Reilpiravine: AE of rash, hepatitis, CNS effects, but less severe than 1st gen

Front 22

Name the NNRTI drugs. (5)

Back 22

Nevirapine, Delaviridine, Efavirenz, Etravirine, Rilpiravine.

Front 23

Of the NRTI drugs, which has adverse effects of :
main toxicity is hemotolagical and can see lipodystrophy and lactic acidosis?

A. Zidovudine
B. Stavudine
C. Didanosine
D. Tenofovir
E. Emtricitabine
F. Lamuvidine
G. Abacavir

Back 23

A. Zidovudine

Front 24

Of the NRTI drugs, which has adverse effects of : high incidence of neuropathies, lactic acidosis and lipodystrophy?

A. Zidovudine (AZT)
B. Stavudine (D4T)
C. Didanosine (DDI)
D. Tenofovir
E. Emtricitabine (FTC)
F. Lamuvidine (3TC)
G. Abacavir

Back 24

B. Stavudine (D4T)

Front 25

Of the NRTI drugs, which has adverse effects of :
high incidence of neuropathies and pancreatitis?

A. Zidovudine
B. Stavudine
C. Didanosine
D. Tenofovir
E. Emtricitabine
F. Lamuvidine
G. Abacavir

Back 25

C. Didanosine

Front 26

Of the NRTI drugs, which has adverse effects of :
Skin rash, hypersensitivity reaction, nausea.vomiting and possible risk of CV disease?

A. Zidovudine
B. Stavudine
C. Didanosine
D. Tenofovir
E. Emtricitabine
F. Lamuvidine
G. Abacavir

Back 26

G. Abacavir

Front 27

Which three NRTIs treat both HIV and Hep B?

Back 27

Tenofovir
Emtricitabine (FTC)
Lamuvidine (3TC)

Front 28

Which NRTI has been proven to be safe and effective during pregnancy?

Back 28

Zidovudine (AZT)

Front 29

[ NRTIs / NNRTIs ] are metaboilzed mostly by CYP3A4 enzymes thus have numerous drug interactions.

Back 29

NNRTIs

Nevirapine and Delaviridine both induce CYP3A4; Efavirenz and Etravirine both have mixed action on CYP3A4.

Front 30

Which two NNRTIs induce CYP3A4 and which two NNRTIs have mixed action on CYP3A4?

A. Delaviridine
B. Efavirenz
C. Enfuvitride
D. Etravirine
E. Nelfinavir
F. Nevirapine
G. Rilpiravine

Back 30

F. Nevirapine and A. Delaviridine both induce CYP3A4; B. Efavirenz and D. Etravirine both have mixed action on CYP3A4.

Front 31

Which NNRTI's short half life limits its use?

A. Nevirapine
B. Delaviridine
C. Efavirenz
D. Etravirine
E. Rilipiravine

Back 31

B. Delaviridine

Front 32

Which second generation NNRTI has side effects of rash, nausea, diarrhea?

A. Nevirapine
B. Delaviridine
C. Efavirenz
D. Etravirine
E. Rilipiravine

Back 32

D. Etravirine

Front 33

Which second generation NNRTI has side effects of rash, hepatitis, CNS effects?

A. Nevirapine
B. Delaviridine
C. Efavirenz
D. Etravirine
E. Rilipiravine

Back 33

E. Rilipiravine

Front 34

Protease inhibitors as a class have adverse effects of....

A. peripheral neuropathy due to mitochondrial toxicity
B. Gi disturbances and lipodystrophy syndrome
C. skin rash and CNS effects like hallucinations and psychosis
D. minor nausea/ vomiing, HA

Back 34

B. Gi disturbances and lipodystrophy syndrome

Front 35

Which class of HIV antivirals characteristically has the following adverse effects?

1. skin rash and CNS effects like hallucinations and psychosis
2. peripheral neuropathy due to mitochondrial toxicity
3. Gi disturbances and lipodystrophy syndrome
4. minor nausea/ vomiing, HA

Back 35

1. skin rash and CNS effects like hallucinations and psychosis = NNRTIs
2. peripheral neuropathy due to mitochondrial toxicity = NRTIs
3. Gi disturbances and lipodystrophy syndrome = Protease Inhibitors
4. minor nausea/ vomiting, HA = Integrase Inhibitor

Front 36

For which class of HIV antivirals does resistance require multiple mutations?

Back 36

Protease Inhibitor

Front 37

For which class of HIV antivirals does are there risks with concurrent statin use?

Back 37

Protease inhibitor class

Front 38

Which antiviral drug alters metabolism of protease inhibitors and gives them a "boost"?

Back 38

Protease inhibitor Ritonavir

side effects; GI distrubances, HA.
PK: ihibits CYP34A thus boosts other PIs

Front 39

Which Fusion inhibitor binds to CCr5 (host receptor) to block fusion and insertion?

A.Maraviroc
B. Enfuvitride (T20)
C. Raltegravir

Back 39

Maraviroc

AE: cough, URI, muscle and joint pain, GI disturbances. Rare but possible: depression and HTN. Has potential drug intrxns via CYP3A4. Must test for susceptibility - the CCR5-tropic strain.

Front 40

Which fusion inhibitor binds to HIV gp41 to prevent conformational change required for insertion?

A.Maraviroc
B. Enfuvitride (T20)
C. Raltegravir

Back 40

B. Enfuvitride (T20)

Given as BID SC injections. Painful injection site is adverse RXN.

Front 41

What is the only integrase inhibitor antiviral med?

Back 41

Raltegravir

Avoid antacids with its use.

Front 42

Which protease inhibitor inhibits CYP3A4 and thus is commonly combined with other PIs to produce a "boost" effect?

A. Efavirenz
B. Saquinavir
C. Ritonavir
D. Nelfinavir
E. Indinavir

Back 42

C. Ritonavir

Front 43

Which protease inhibitor has AE of GI distrubances, hyperbilirubinemia and kidney stones?

A. Saquinavir
B. Ritonavir
C. Lopinavir
D. Nelfinavir
E. Indinavir
F. Amprenavir
G. Tipranavir
H. Atazanir

Back 43

E. Indinavir

Front 44

Which protease inhibitor has AE increased stroke risk?

A. Saquinavir
B. Ritonavir
C. Lopinavir
D. Nelfinavir
E. Indinavir
F. Amprenavir
G. Tipranavir
H. Atazanir

Back 44

G. Tipranavir

Front 45

Which protease inhibitor has AE of prolonged QT interval, hyperbilirubinemia, but not lipodystrophy?

A. Saquinavir
B. Ritonavir
C. Lopinavir
D. Nelfinavir
E. Indinavir
F. Amprenavir
G. Tipranavir
H. Atazanir

Back 45

H. Atazanir

Front 46

What are the two protease inhibitors that have an AE of hyperbilirubinemia?

A. Saquinavir
B. Ritonavir
C. Lopinavir
D. Nelfinavir
E. Indinavir
F. Amprenavir
G. Tipranavir
H. Atazanir

Back 46

E. Indinavir - it also has kidney stones and GI disturbance side effects

H. Atazanir - also has prolonged QT interval, but lacks lipodystrophy

Front 47

What is the name of the only integrase inhibitor drug?

A. Raltegravir
B. Ribavirin
C. Rilpiravine
D. Ritonavir

Back 47

A. Raltegravir

Ribavirin is an M2 Chanel inhibitor (resp viruses).
Rilpiravine is a 2nd generation NNRTI.
Ritonavir is a protease inhibitor.

Front 48

Regarding Herpes Virus therapy, what is the prototypical drug for HSV 1 and HSV 2, and VZV?

A. Acyclovir
B. Cidofovir
C.Famciclovir
D. Gancyclovir
E. Penciclovir
F. Trifluridine
G. Valacyclovir

Back 48

A. Acyclovir

Front 49

What is the mechanisom of action for many Herpes VIrus antivirals?

Back 49

They are mostly DNA polymerase inhibitors by being nucleoside/ nucleotide analogues. They bind to and inhibit DNA polymerase. Many of them act as chain terminators. THey are selective for virus v.s human DNA polymerase. They can reduce the severity of recurrences but cannot cure latent infection.

Front 50

How are Herpes Virus antivirals eliminated from the body?

Back 50

Renally. Thus, decrease dose with renal insufficiencies.

Front 51

With Herpes virus therapy antivirals, resistance is due to mutation in...(2)

A. viral kinase
B. host kinase
C. viral DNA polymerase
D. host DNA polymerase

Back 51

both of the viral stuff.

Front 52

Which Herpes antivirals are used primarily for CMV? (2)

Back 52

Gancyclovir ,
Cidofovir (primarily CMV retinitis)

Front 53

Which Herpes antiviral is the only one that is phosphorylated by HOST kinases?

A. Cidofovir
B. Famciclovir
C. Trifluridine

Back 53

C. Trifluridine

Front 54

What is the prodrug for acyclovir? for Gancyclovir?

Back 54

Acyclovir prodrug is called valacyclovir.

Gancyclovir prodrug is called Valgancyclovir.

Front 55

Which herpes virus antivirals hare contraindicated in pregnancy?

Back 55

Gancyclovir and Cidofovir

Front 56

What is used for CMV retinitis?

A. Famciclovir
B. Valgancyclovir
C. Cidofovir
D. Trifluridine
E. Acyclovir

Back 56

Cidofovir

Front 57

For severe infections that are resistant to all other herpes antivirals, use this drug.

Back 57

Foscarnet

but has high nephrotoxicity! Infuse very slowly and w/ good patient hydration or else arrythmias and seizures can occur!

Front 58

For respiratory viruses, name the neuraminidase inhibitors and the M2 channel inhibitors.

Back 58

Oseltamivir (Tamiflu) and Zanamivir for Influenza A and B. Note: need to use early, within 48 hours of exposure or onset of symptoms.

M2 channel inhibitors: Amantadine and Rimantadine (use for Influenza A only)

Front 59

Which respiratory antivirals class is used for Influenza A only? Both influenza A and B?

Back 59

Influenza A only are M2 channel inhibitors Amantadine and Rimantadine. Blocks viral uncoating and release.

Influenza A and B are via Neuraminidase inhibitors like Oseltamivir, Zanamivir.

Front 60

___________ has had noteable adverse effect of neuropsychiatric effects, especially in children and young adults.

A. Oseltamivir
B. Zanamivir
C. Amantadine
D. Rimantadine

Back 60

A. Oseltamivir

Front 61

Wide spectrum of activity, active against Influenza A and B, RSV, and used with Hep C. But contraindicated in pregnancy.

What antiviral is this?

Back 61

Ribavirin

Front 62

What antiviral is used for RSV specifically?

Back 62

Palivizumab