Term
| What are 6 common types of non-HIV viral infections? |
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Definition
1. Herpes simplex: Oral-facial, genital, encephalitis
2. Varicella-Zoster: chickenpox, shingles
3. Cytomegalovirus
4. Respiratory syncytial virus (RSV)
5. Hepatitis B, C, D
6. Influenza A, B |
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Term
| What are 6 types of antiviral classifications (non-HIV)? |
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Definition
1. Nucleoside analogs: acyclovir, valacyclovir, famciclovir, penciclovir, ganciclovir, valganciclovir
2. Foscarnet
3. Ribavirin
4. Interferon
5. Adamatanes: amantadine and rimantadine
6. Neuramididase inhibitors: oseltamivir and zanamivir |
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Term
| How do DNA viruses such as herpes virus "reproduce"? |
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Definition
| Require endogenous nucleosides to replicate in human cells. Viral and host kinase enzymes phosphorylate nucleosides to form triphosphate metabolites. Viral DNA polymerase then incorporates metabolite into viral DNA chain. |
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Term
| How do nucleoside analogs work? |
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Definition
| they compete with endogenous nucleosides for viral DNA polymerase, causing DNA chain termination |
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Term
| Which drug inhibits viral DNA synthesis by competing as a substrate of viral DNA polymerase, is used for herpes simplex and varicella-zoster infections, has poor oral availability (10-20%), and is renally excreted? |
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Definition
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Term
| Which drug's adverse effects are GI effects and h/a with oral, renal nephropathy due to crystallization in tubules after IV therapy? |
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Definition
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Term
| Which drug is converted to acyclovir, and has the same properties of acyclovir but better bioavailability (50%)? |
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Definition
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Term
| Which drug is structurally similar to ganciclovir, and is only available as topical formulation (cream for herpes labialis)? |
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Definition
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Term
| Which drug is an oral drug metabolized to penciclovir, has good absorption (80%), is renally excreted, and is used for herpes simplex and VZV? |
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Definition
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Term
| What is the initial treatment for Herpes Simplex virus - genital infection? |
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Definition
Acyclovir 400mg tid for 7-10 days
Valacyclovir 1000mg bid for 7-10 days
Famciclovir 250mg tid for 7-10 days |
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Term
| What is the treatment for recurrent episodes of Herpes Simplex virus - genital infection? |
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Definition
Acyclovir 400mg tid for 3-5 days
Valacyclovir 500mg bid for 3 days
Famciclovir 1000mg bid for 1 day |
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Term
| What is the treatment for chronic suppression of Herpes Simplex virus - genital infection? |
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Definition
Acyclovir 400mg bid
Valacyclovir 500-1000mg qd
Famciclovir 250mg bid |
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Term
| What is the treatment for Acute Herpes Zoster (Shingles)? |
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Definition
doses higher than for herpes simplex. start within 72 hours of first lesion.
Acyclovir 800mg qid for 7-10 days
10 mg/kg IV q8h for 7 days if pt is immunocompromised
Valacyclovir 1000mg tid for 7 days
Famciclovir 500mg tid for 7 days |
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Term
| Which drug's MOA and metabolism are similar to acyclovir, is active against CMV, and is available in IV and oral forms? |
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Definition
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Term
| Which drug's adverse effects are bone marrow suppression (50%), renal nephropathy, fever, and h/a? |
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Definition
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Term
| Which drug is a prodrug of ganciclovir, has largely replaced oral ganciclovir, and achieves plasma conc similar to IV ganciclovir? |
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Definition
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Term
| What is a secondary drug for CMV, is only in IV form, and is very nephrotoxic plus causes hypocalcemia? |
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Definition
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Term
| What drug is used for CMV if failing on ganciclovir or foscarnet and's AE are nephrotoxicity, neutropenia, and metabolic acidosis (25%)? |
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Definition
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Term
| What drug has 3 preparations available for chronic hep B and C infections, is given as IM or SC injections for 24 weeks, and's AE are flu-like symptoms, GI effects, CNS dysfunction, and bone marrow depression? |
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Definition
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Term
| What type of drugs inhibit uncoating of influenza A virus in cell by blocking activity of M2 protein and is indicated for prophylaxis and treatment of influenza A virus only? |
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Definition
Adamantanes
prophylaxis: 70-90% effective
treatment: could reduce duration of uncomplicated illness by 1 day if given w/in 48 hrs of onset.
have not been shown to prevent serious influenza related complications |
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Term
| Which drug is 90% renally eliminated, has common CNS adverse reactions (severe - delerium, hallucinations, sz), and has drug interactions with CNS stimulants, antihistamines, and anticholinergic drugs? |
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Definition
Amantadine
precautions: elderly, renal failure, pregnancy.
Also used for Parkinson's dz |
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Term
| What drug is 75% metabolized by liver, its AE are CNS effects (6%) and GI effects but less than with amantadine, and has no significant drug interactions? |
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Definition
Rimantadine (Flumadine)
Precautions: pregnancy, breast feeding
NOT indicated for treatment in kids <13 y/o |
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Term
| What type of drugs inhibit neuramidase on viral cell surface and decrease release of virus from infected cells, and is indicated for prophylaxis and treament of influenza A and B in adults and children? |
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Definition
Influenza Meds - Neuramidiase Inhibitors
Prophylaxis: 70-90% effective
Treatment: reduce duration of uncomplicated illness by almost 1 day if given w/in 36 hrs onset
do not prevent serious influenza related complications or mortality in high risk groups |
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Term
| Which drug is indicated for prophylaxis and treatment of flu, is a prodrug metabolized to active drug (oseltamivir carboxylate) and excreted renally? |
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Definition
Oseltamivir (Tamiflu)
Precautions: pregnancy
NOT indicated for kids <1 y/o |
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Term
| Which drug's AE are nausea, vomiting, h/a and has a new warning about delerium in children? |
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Definition
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Term
| Which drug is indicated for prophylaxis and treatment of flu, is inhaled, and excreted renally? |
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Definition
Zanamivir (Relenza)
precautions: pregnancy
NOT indicated for kids <5 y/o |
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Term
| Which drug has a black box warning of bronchospasm possible if history of asthma or COPD? |
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Definition
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Term
| There is a high level of resistance of influenza A to what two drugs? |
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Definition
| amantadine and rimantadine |
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Term
| Influenza A is what 2 strains? |
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Definition
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Term
| What is an RNA virus or retrovirus, in which the retrovirus infects human CD4 (helper) cells where new virions are made and the CD4 cell is destroyed? |
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Definition
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Term
| What's diagnosis is made by CD4 count and presence of opportunistic infections? |
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Definition
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Term
| What is a multiple drug combination (at least 3) necessary to reduce viral load as well as to reduce development of resistance? |
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Definition
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Term
| What are 5 drug classifications of antiretroviral drugs for HIV infection? |
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Definition
1. Nucleoside reverse transcriptase inhibitors (NRTI)
2. Non-Nucleoside reverse transcriptase inhibitors (NNRTI)
3. Protease inhibitors (PI)
4. Entry and fusion inhibitors
5. integrase inhibitor |
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Term
| What are 4 issues with antiretroviral drug therapy? |
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Definition
1. significant adverse effects
2. multiple drug-drug interactions
3. high cost
4. adherence |
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Term
| What type of drug competitively inhibits reverse transcriptase to prevent formation of viral DNA from viral RNA? |
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Definition
| Nucleoside Reverse Transcriptase Inhibitors |
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Term
| What are the class adverse effects and drug interactions of NRTIs? |
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Definition
Potential for lactic acidosis, hepatic steatosis, and lipdystrophy (all higher with stavudine)
No significant drug interactions |
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Term
| What is a nucleoTide reverse transcriptase inibitor? |
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Definition
Tenofovir (Viread)
structurally different from NRTIs but same MOA |
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Term
| What type of drugs do not require metabolic conversion to inhibit reverse transcriptase and are not incorporated into viral DNA and have an additive effect to NRTIs? |
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Definition
| Non-Nucleoside reverse transcriptase inhibitors (NNRTI) |
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Term
| What are the class AE and drug interactions of NNRTIs? |
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Definition
AE: rash, sometimes severe and progressing to Stevens Johnson syndrome
Drug interactions: significant |
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Term
| Which drug is a modest inducer of CYP3A4 and may precipitate withdrawal in methadone maintenance patients? |
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Definition
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Term
| Which drug is a modest inducer/inhibitor of CYP3A4? |
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Definition
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Term
| Which drug is a modest inducer of CYP3A4 and an inhibitor of CYP2C9 and 2C19? |
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Definition
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Term
| Which drug is a potent inhibitor of CYP3A4 so is rarely used? |
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Definition
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Term
| What type of drugs prevent viral protease from forming functional viral proteins necessary for maturation of viral particle and viral replication? |
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Definition
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Term
| What class causes GI distress, hyperglycemia, insulin resistance, hyperlipidemia, CAD, fat accumulation, and hepatotoxicity (essentially develop DM)? |
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Definition
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Term
| What are all PIs metabolized by and inhibit? |
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Definition
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Term
| Which drug is often used to "boost" drug levels of other PIs, thus reducing # tablets/day? |
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Definition
Ritonavir - has most inhibitory action on CYP3A4 of all PIs
Also induces CYP1A2 and inhibits CYP2C9 |
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Term
| What induces metabolism of PIs? |
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Definition
| rifampin, phenytoin, and autoinduction (ritonavir, nelfinavir) |
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Term
| What drug binds to transmembrane glycoproteins and prevents fusion of viral particles to CD4 cell membranes and is given by SC injection? |
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Definition
| Enfuvirtide (Fuzeon) - a fusion inhibitor |
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Term
| What drug is an antagonist of CCR5 receptors on CD4 cell surfaces necessary for HIV entry and is active against HIV strains resistant to other classes? |
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Definition
| Maraviroc (Seizentry) - an entry inhibitor |
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Term
| What drug's AE are cough, rash, and infections and is a substrate of CYP3A4 so will interact with PIs? |
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Definition
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Term
| What drug blocks the integrase enzyme necessary for integration of viral DNA into cellular DNA? |
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Definition
| Raltegravir (Isentress) - an integrase inhibitor |
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Term
| What are 4 goals of antiretroviral therapy? |
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Definition
1. preserve and strengthen immune system
2. prevent development of resistance and preserve future treatment options
3. select HAART regimen that pt will take
4. minimize short and long-term adverse drug events |
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Term
| What are 4 rules of antiretroviral therapy? |
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Definition
1. determine class-sparing HAART regimen
2. select agents in class
3. avoid regiments of overlapping toxicities
4. consider quality of life factors |
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Term
| What are 3 class sparing approaches to antriretroviral therapy? |
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Definition
1. NNRTI-based: 1 NNRTI + 2 NRTIs
2. PI-based: 1 or 2 PIs + 2 NRTIs
3. Quadruple NRTI (generally not recommended) |
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