Pharm - Antivirals

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Antiviral chemotherapy

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Viral adsorption and penetration into the cell is blocked by ---------.

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Gama-globulins (non-specific).

Front 3

Uncoating of the virus after its penetration into the cell is blocked by --------.

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Amantadine (influenza A).

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Early viral protein synthesis is blocked by --------.

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Fomivirsen (CMV).

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Viral nuclei acid synthesis is blocked by --------. 3

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Purine, pyrimidine analogs; reverse transcriptase inhibitors.

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Late viral protein synthesis and processing is blocked by --------.

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Methimazole (variola); protease inhibitors.

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Packaging and assembly of new viron is blocked by --------.

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Rifampin (vaccinia).

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Amantadine, Rimantidine

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411

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Mechanism of action of Amantadine. 2

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Blocks viral penetration/uncoating; may buffer pH of endosome. Also causes the release of dopamine from intact nerve terminals. Amantadine blocks influenza A and rubellA and causes problems with the cerebellA.

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Clinical uses of Amantadine. 2

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Prophylaxis for influenza A; Parkinson's disease.

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Symptoms of Amantadine toxicity. 4

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Ataxia, dizziness, slurred speech. (Rimantidine is a derivative with fewer CNS side effects.)

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Zanamivir, Oseltamivir

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Mechanism of action of Zanamivir.

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Inhibits influenza neuraminidase.

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Clinical use of Zanamivir. 2

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Both influenza A and B; O = prophylaxis

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Tox 3

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GI, cough, bronchospasm in asthmatics

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Acyclovir

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405

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Mechanism of action of Acyclovir.

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Perferentially inhibits viral DNA polymerase when phosphorylated by viral thymidine kinase; chain termination

Front 21

Clinical use of Acyclovir. 4

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HSV, VZV, EBV. Mucocutaneous and genital herpes lesions. Prophylaxis in immunocompromised patients.

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Resistance by

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lack thymidine kinase

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Symptoms of Acyclovir oral toxicity. 2

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GI, HA

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Symptoms of Acyclovir IV toxicity. 2

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delirium, nephrotox

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Ganciclovir

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407

Front 27

Mechanism of action of Ganciclovir.

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Phosphorlation by viral kinase; perferentially inhibits CMV DNA polymerase; chain termination

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Clinical use of Ganciclovir. 2

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CMV, especially in immunocompromised patients; HSV

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Resistance by

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Lack thymidine kinase

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Symptoms of Ganciclovir toxicity. 4

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Leukopenia, thrombocytopenia, renal tox, hepatotox. More toxic to host enzymes than acyclovir.

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Cidofovir

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408

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Mech

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Actvated by host cell kinase to inh DNA pol

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Use 4

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HSV, CMV, HPV, adenovirus (esp resistant strains)

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Tox 1

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nephrotox that can be reversed with probenecid

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Foscarnet

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408

Front 38

Mechanism of action of Foscarnet.

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Inh RNA pol, DNA pol, RT; does not req phosphorylation activation

Front 39

Clinical use of Foscarnet. 2

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CMV retinitis in immunocompromised patients when ganciclovir fails, HSV esp in AIDS pt

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Resistance by

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mutation in DNA pol gene

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Symptoms of Foscarnet toxicity. 3

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Nephrotoxicity, hypoglycemia, CNS fx

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HIV therapy

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408

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Protease Inhibitors 6

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Saquinavir, lopinavir/ritonavir, indinavir, nelfinavir, amprenavir, atazanavir

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Mechanism of action of protease inhibitors.

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Inh assembly of new virus by blocking protease enzyme.

Front 46

Symptoms of protease inhibitor toxicity. 4

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GI intolerance (nausea, diarrhea), hyperglycemia, lipid abnormalities, thrombocytopenia (indinavir).

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Reverse transcriptase inhibitors:

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409

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NRTIs 8

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Zidovudine (AZT), didanosine (ddI), zalcitabine (ddC), stavudine (d4T), lamivudine (3TC), abacavir, emtricitabine, tenofovir

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NNRTI 3

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Nevirapine, delavirdine, and efavirenz

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Mech of NRTI 2

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Binds RT; chain termination

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Mech of NNRTI

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Binds RT

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Symptoms of reverse transcriptase inhibitor toxicity.

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Bone marrow supression (neutropenia, anemia), periphral neuropathy, lactic acidosis (nucleosides), rash (non-nucleosides), megaloblastic anemia (AZT).

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Highly active antiretroviral therapy (HAART) generally entails combination therapy with ---------- and -----------.

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Protease inhibitors, reverse transcriptase inhibitors.

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When should HIV therapy be initiated?

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When patients have low CD4 counts (500 cells/mm3) or high viral load.

Front 56

Which is used during pregnancy to reduce risk of fetal transmission.

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AZT

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Common tox?

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Lactic acidosis; severe hepatomegaly with steatosisi

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Interferons

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412

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Mechanism of action of Interferons.

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cytokine that activates JAKS/STATS to activate ribonuclease, NK cells

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Clinical use of Interferons. 3

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HBV, HCV, Kaposi's sarcoma.

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Symptoms of Interferon toxicity. 4

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Neutropenia, depression, flu-like Sx, GI

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Ribavirin

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413

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Mechanism of action of Ribavirin.

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Inhibits synthesis of guanine nucleotides by competitively inhibiting IMP dehydrogenase.

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Clinical use of Ribavirin.

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RSV

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Symptoms of Ribavirin toxicity.

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Hemolytic anemia. Severe teratogen.