Pharm 2 Quiz 2

Front 1

Acyclovir

Back 1

• Elimination is renal PO/IV dosages should be reduced in patients with kidney disease, severe toxicity with delayed excretion, neurotoxic SE, neurologic SE w/ poor renal function
• Topical Adverse Effects, limited uses, not absorbed;Occasional stinging and burning at application site
• Oral Adverse Effects with good renal functions;Nausea, vomiting, headache, and vertigo
  
• Adverse Effects with IV Acyclovir *watch the site and IV fluids
• high incidence of Phlebitis, caustic to veins
• Reversible nephrotoxicity
• Infuse slowly, hour or longer, dliuted, assess for redness pain, infalmmation, tenderness at IV site,
• prehydrate and IV fluids afterward Adequate hydration
  

Front 2

Valtrex, valacyclovir

Back 2

• *prodrug of acyclovir, newer more expensive
  
• suppress outbreaks
  
• PO better availability don’t have to take as often, 1x dosing
  

Front 3

*Ganciclovir (Cytovene, Vitrasert)

Back 3

• AntiviralActive against herpes viruses including CMV
  
• Inhibits DNA replication
  
• Pharmacokinetics: Renal elimination

Therapeutic Uses

• Active against CMV retinitis in immunocompromised patients, HIV/AIDS, transplant pts
• Prevention of CMV retinitis in transplant patients considered at risk
• Treatment of CMV pneumonitis
• Treatment of CMV colitis
• Require maintenance therapy indefinitely
• Viral resistance can develop during treatment
• Adverse Effects: Granulocytopenia
• Stop if absolute neutrophil count falls below 500/mm3
• Thrombocytopenia - risk for bleeding, tachycardia, pallor
• Stop if platelet count falls below 25,000/mm3Can be exacerbated by concurrent therapy with Zidovudine
• Teratogenic and embryotoxic
• Avoid pregnancy during therapy and 90 days after treatment
• Possibility of infertility in both men and women
  

Front 4

Interferon Alfa

Back 4

• synthetic of body’s own cytokine to block replication of virus cycle
  
• Long-Acting (Pegylated) dosing is less frequent
  
• Alfa Adverse: EffectsFlu like syndrome, malaise body aches, tored low grade fever
• Neuropsychiatric effects, depression psychosis, suicidal thoughts
• GI disturbances
• Alopecia
• Injection site reactions, subQ
  

Front 5

Ribavirin (Rebetol, Copegus)

Back 5

• Broad spectrum of antiviral activity
  
• Unknown mechanism of action
  
• Used in combination with peginterferon alfa to combat resistance
  
• Aerosol form treats RSV in children
  
• 24-48 weeks of treatment
  
• Adverse Effects: Flu like syndrome
  
• Neuropsychiatric effects
  
• Hemolytic anemia
  
• Birth defects
  
• Pregnancy category X
  
• Females must prevent pregnancy
  
• Males using ribaviron must not impregnate female partners
  
• Continues during and 6 months after therapy has ended!
  

Front 6

Influenza

Back 6

• Soreness at injection site
• Adverse EffectsSoreness at injection site
• Flu like symptoms, immune response to dead virus
• Protection begins 1-2 weeks after vaccination
• Lasts 6 months or longer
  

Precautions and contraindications

• Guillain Barre Syndrome (GBS) ascending paralysis, rare
• Acute febrile illness
• Egg allergy
• Previous reaction
• Hx of GBS
• Who should be vaccinated – has changed since book published!Everyone > 6 months old unless contraindicated
• Best time: CDC recommends as soon as it’s available
• IM injection
• Intranasal: Live vaccine, Ages 2-49, Generally used for those with healthy immune systems
  

Second generation drugs to lessen effects of influenza: Oseltamivir (Tamiflu) (PO) and Zanamivir (Relenza) (Oral inhalation)

• Type A and B
  
• Less risk of resistance
  
• Less adverse effects
  
• Must start within 2 days of onset of symptoms! or no effective use
  

Front 7

Zidovudine (Retrovir)

Back 7

• Administered orally and IV
  
• Serious adverse effects: anemia, neutropenia; may induce lactic acidosis and severe hepatomegaly
  
• Other Adverse effects: n/v/d, abdominal pain, dyspepsia, anorexia and CNS reactions
  
• Laboratory Values to assess prior to therapy

Drug Interactions

• Myelosuppressive, nephrotoxic or toxic to circulating blood cells
  
• Bactrim, dapsone, ampho B, flucytosine, vincristine, vinblastin
  

Front 8

Nucleoside Reverse Transcriptase Inhibitors (NRTI)

Back 8

The first class of drugs approved by the FDA to treat HIV infection and AIDSlZidovudine (Retrovir) (AZT) is the prototype for NRTIs.

• Didanosone (Videx)
  
• Tenofovir (Viread)
  
• Stavudine (Zerit)
  
• Lamivudine (Epivir)
  
• Emtricitabine/tenofovir (Truvada)
  
• Comibination NRTI
  

Front 9

Efavirenz (Sustiva)

Back 9

• Adverse effects: Rash
  
• CNS side effects of altered mood, sleep, anxiet
  
• Teratogenic
  
• Drug Interactions
  
• Induces P450
• St John’s wort may reduce levels of efavirenz and other NNRTI’s due to accelerated metabolism secondary to induction of P450
  

Front 10

Protease Inhibitors (PI)

Back 10

The PIs represent the most effective anti-retroviral drugs known.

PIs have been associated with hyperglycemia, deposition of fatty-like tissue at the base of the posterior neck and the abdominal area, hyperlipidemia, & bone loss

Most common adverse effects: diarrhea, abdominal discomfort, nausea, and vomiting

• Lopinavir/Ritonavir (Kaletra)
  
• Ritonavir (Norvir)
  
• Indinavir (Crixivan)
  
• Saquinavir (Invirase)
  

Front 11

Fusion Inhibitor enfuvirtide (Fuzeon)

Back 11

• Pharmacodynamics: blocks HIV envelope from fusing with cell membrane of CD4 – blocking viral entry & replication
  
• SQ injection
  
• Therapeutic Use
  
• Adverse effect: injection site reactions