Therapy & Prophylaxis Of Viral Infections

Front 1

1. Virucides

2. Antivirals

3. Immunomodulators

Back 1

1. inactivate intact viruses

2. inhibit viral replication @ cellular level

3. augment/modify host response to infection

Front 2

Antivirals for Herpesviruses:
1-7

Back 2

Acyclovir; Valacyclovir; Famciclovir; Ganciclovir; Cidofovir; Foscarnet; Fomivirsen sodium

Front 3

Acyclovir
1. MOA
2. Properties
3. Use
4. Toxicity

Back 3

1. guanosine analogue; valine group allows better intestinal absorption; chain terminator and inhibitor of viral DNA pol
2. IV, oral, topical; 2.5hr h.l.; adjust dosage for renal impairment
3. HSV, VZV
4. minimal; does not affect host enzymes; GI symptoms

Front 4

Valacyclovir
1. MOA
2. Properties
3. Use
4. Toxicity

Back 4

1. prodrug of acyclovir; same as acyclovir
2. almost 100% conversion to acyclovir
3. VZV, HSV
4. minimal

Front 5

Famciclovir
1. MOA
2. Properties
3. Use
4. Toxicity

Back 5

1. guanosine analogue; converted to penciclovir in GI/liver; does NOT cause chain termination
2. penciclovir - poor absorption; fam - 75% bioavailability
3. VZV, HSV
4. minimal

Front 6

Ganciclovir
1. MOA
2. Properties
3. Use
4. Toxicity

Back 6

1. guanosine analogue; similar to acyclovir
2. IV, oral, ocular insert; 3hr HL; CSF; oral prodrug
3. life-threatening CMV
4. SIGNIFICANT - hematologic myelosuppression (additive with zidovudine), thrombocytopenia, anemia

Front 7

Cidofovir
1. MOA
2. Properties
3. Use
4. Toxicity

Back 7

1. nucleotide analogue; inhibits viral DNA pol
2. 3hr HL; long intracellular HL - long dosing intervals
3. significant CMV disease - IV only
4. renal toxicity - need IV saline/probenecid

Front 8

Foscarnet
1. MOA
2. Properties
3. Use
4. Toxicity

Back 8

1. pyrophosphate analogue; against viral DNA/RNA pol, rev txcriptase; blocks pyrophosphate binding site of viral DNA pol - chain terminator
2. IV; renal excretion
3. acyclovir-resistant HSV or VZV; ganciclovir-resistant CMV
4. renal; anemia

Front 9

Fomivirsen sodium
1. MOA
2. Properties
3. Use
4. Toxicity

Back 9

1. inhibits viral replication
2. injection into eye
3. CMV in AIDS
4. inflammation; increased intraocular pressure

Front 10

Antiviral Drugs for Respiratory Viruses
1-3

Back 10

Ribavirin; Amantadine; Zanamavir

Front 11

Influenza viruses have two protuberances: ____ (15) and ____ (9)

_____ binds to sialic acid residues on cells to allow virus to bind

_____ cleaves remaining sialic acids after adsorption, to avoid re-penetrating the same cell

Back 11

H and N

hemagglutinin

neuraminidase

Front 12

1. 1918 pandemic
2. 1957 pandemic
3. 1968 pandemic
4. current

Back 12

1. H1N1
2. H2N2 (most likely for next)
3. H3N2
4. H5N1 avian virus - not yet jumped to humans

Front 13

Ribavirin
1. MOA
2. Properties
3. Use
4. Toxicity

Back 13

1. guanosine analogue; competitive inhibitor of DNA/RNA synthesis
2. given by aerosol
3. pneumonitis due to RSV
4. minimal if aerosolized

Front 14

Amantadine
1. MOA
2. Properties
3. Use
4. Toxicity

Back 14

1. cyclic amine - targets ion channel; prevents uncoating of virus; interferes with release of viral RNA genome
2. oral; good absorption; 12hr HL
3. Influenza A; Parkinson's; resistance develops quickly
4. GI intolerance; CNS effects - insomnia/anxiety/psychosis; potentiated by antihistamines

Front 15

Zanamavir
1. MOA
2. Properties
3. Use

Back 15

1. neuraminidase inhibitors (neu. cleaves terminal sialic acid from glycoconjugates)
2. intranasally; orally
3. Influenza A/B

Front 16

Antiviral Drugs for HIV
1. NRTI's - 3
2. NNRTI's - 3
3. Protease Inhibitors - 6

Back 16

1. Zidovudine; Lamivudine; Tenofovir
2. Nevirapine; Delavirdine; Efavirenz
3. Saquinavir; Ritonavir; Indinavir; Nelfinavir; Amprenavir; Lopinivir

Front 17

Zidovudine - NRTI
1. MOA
2. Used
3. Toxicity

Back 17

1. Competitive inhibition of reverse transcriptase and chain termination
2. combination therapy only
3. hematologic; lactic acidosis; hepatomegaly

Front 18

Lamivudine - NRTI
1. Toxicity

Back 18

1. less than many other anti-retrovirals; pancreatitis

Front 19

Tenofovir - NRTI
1. MOA
2. Used
3. Toxicity

Back 19

1. less dependent on phosphorylation
2. 1st-line agent
3. GI complaints, rare renal failure; avoid combo with didanosine

Front 20

NNRTI's
1. MOA
2. Use
3. Toxicity

Back 20

1. direct binding to rev txcriptase at different site than NRTI
2. combo therapy only
3. rash, hepatoxicity; contraindicated with pregnancy

Front 21

Protease Inhibitors
1. MOA
2. Properties
3. Use
4. Toxicity

Back 21

1. inhibit HIV aspartic protease -> production of non-infectious virus
2. oral; poor CNS penetration; cytochrom p450
3. combo therapy only
4. GI; diabetes; inhibitor of cytochrome p450

Front 22

Highly Aggressive Anti-Retroviral Therapy
1.
2.
3.

Back 22

1. 1 NNRTI & 2 NRTI
2. 1 PI & 2 NRTI
3. NRTI

Front 23

NNRTI-Base HAART:

PI-Base HAART:

Back 23

Efavirenz; 2-5 pills/day

Lopinavir; 8-10 pills/day

Front 24

Early antiviral therapy is better because:

Back 24

1. HIV mutations increase with time
2. HIV immunity wanes with progression
3. may prevent spread to other organs
4. immunodeficiency may be only partial

Front 25

1. Immunomodulators

2. Interferons

Back 25

1. compounds that alter IR via direct/indirect interaction with T/B cells and APC (IL's, interferons)
2. produced by cells in response to viral infection - antiviral, antiproliferative, immunomodulatory

Front 26

Interferon Alpha drug
1. MOA
2. Properties
3. Use
4. Toxicity

Back 26

1. blocks viral transcription/translation
2. inactivated in GI tract
3. hep B/C; papillomavirus; HIV
4. flu-like symptoms; CNS disorders