Pharm-Antiviral I

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Amantadine/Rimantadine

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MOA-blocks M2 H+ channel precenting entry into nucleus. Only works for influenza A.
Given prophylaxis with influenza immunization and 2 weeks after.
Will shorten symptoms.
Interactions with older first generation antihistamines due to CNS effects. Can cause insomnia, confusion, poor concentration, nervousness, hallucination and depression.
Resistant viruses exist, most influenza A are now resistant
Contraindicated in seizure or psychosis or if sustained concentration is needed.

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Zanamivir/Oseltamivir

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Blocks active site of influenza neuraminidase that is on the outside of influenza and helps it cleave sialix acid on mucus. Causes aggregation of viral particles and decreases spread of infection.
Used for uncomplicated influnza A and B within 48 hours or profalactically
Zanamivir can caused bronchospasms in those with asthma or COPD, resistance is rare. Oseltamivir can cause nausea and vomiting, ameliorated by food. Increased resistance reported.
Contraindicated in known hypersensitivity.

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Acyclovir/Valacyclovir

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MOA-is a potent inhibitor of viral DNA polymerase. incorporates into DNA and terminates syntehsis. Valacyclovir is turned into acyclovir
Used for HSV and VZV infection and prophylaxis
Drug is excreted through kidnes so dose modification for renal function.
Complications-phlebitis, reversible nephrotoxicity, neurotoxciity, nausea, vomiting, light headed, diaphoresis, rash, HUS and TTP in AIDs and BMT patients.
contr4aindicated only if precious hypersensitivity

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Famciclovir

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MOA-prodrug of penciclovir, works similar to acyclovir and is dependent on viral thymidine kinase.
Used in tratment and suppression of HSVF and herpes zoster.
Complications include headache, nausea, fatigue, and cross resistance with acyclovir
contraindicated in hypersensitivity-rare

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Ganciclovir/valganciclovir

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nuceloside analog of guanosine
MOA-inhibitor of viral DNA polymerase and incorporated into DNA terminating synthesis
used in treatment and suppression of CMV
inteacts with bone marrow suppressing drugs and increased risk of seizure when used with imipenem.
complications-bone marrow suppression, fever, rash, anemia, nausea, comitins, increased BUN/Cr, CNS, teratogenic
resistance has been documated
contraindicated in hypersensitivity

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Foscarnet

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MOA-inhibits viral DNA polymerase and reverse transcriptase
indicated for CMV, ganciclovir resistant CMV, acyclovir resistante HSV/VZV and HIV
interaction iwht nephrotoxic drugs
complications-nephrotoxicity, hypocalcemia, hypercalcemia, hypophosphatemia, hyperphosphatemia, nausea, vomiting, seizures, anemia, mucosal ulcerations
contraindicated in renal insufficiency
resistance documents in AIDS patients

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Cidofovir

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MOA-nucleotide analogue that inhibits DNA polymerase and incorporates into DNA.
Used in AIDS related CMV retinits, acyclovir and foscarmet resistant HSV and VZV, in vitro against smallpox
Interactions-probenecid affects metabolism and extretion, reduce zidovudine by 50%, nephrotoxic.
COmplications-nephrotoxic, neutropenia, uveitis, alopecia, ocular hypotony
contraindicated in hypersensitivity

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Adefovir Dipivoxil

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Nucleotide reverse transcriptase inhibitor, inhibits viral polymerase
used in active HBV infection
No interactions but should be used with caution with other nephrotoxic drugs
no significant complications at normal dosage
contraindicated with known hypersensitiivty, women should not breast feed

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Entecavir

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inhibits HBV DNA polymerase
used in chronic active HBV infection
no interactions or complications
contraindicated in known hypersentivity and HIV infection if not on antiretrovirals

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Telbivudine

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Inhibits HBC DNA polymerase and DNA chain termination
indicated for chronic active HBV infection
Complications-myopathy-peripheral neuropathy, lactiv acidosis
contraindicated with known hypersensitivity

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ribavirin

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MOA-inhibit inosine monophosphate dehydrogenase, depletes intracellular purines
used in severe respiratory syncytial virus infection, HCV with interferan
Complications-hemolytic anemia, nausea, lethargy, headache, increased bilirubin and uric acid
contraindicated in pregnancy

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interferon

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MOA-naturally occuring intercellular signaling molecules released in response to viral infection to prevent spread
indicated for Hep B, C, HIV, HSV, CMV, west nile
complications-flu like symptoms, granulocytopenia, thrombocytopenia, hepatic decompensation
resistance in advanced HIV with HCV
contraindicated in advanced liver disease with cirrhosis, coronary artery disease, bone marrow suppressive drugs