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Anti-Virals
Anti-Virals
42
Pharmacology
Graduate
10/05/2011

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Cards

Term
Varivex
Definition
Live attenuated Varicella vaccine
Healthy kids 1-12: 1 injection
Healthy kids 13+ and adults: 2 injections 4-8 weeks apart
Term
Zostavex
Definition
Live attenuated vaccine against Zoster and post herpetic neuralgia(PHN)
More affective in younger populations
Recommended regardless og history of Zoster
Term
Acyclovir
Definition
Analogue of guanine/Viral DNA Chain terminator
Viral Thymidine Kinase acts on it first so its only active in infected cells
Has preference for Viral DNAPoly
Sx: N/V, Headache, Nephropathy, encephalopathy
Oral bioavailability (15-20%)
Distributes widely so short half life(2.5-3hrs)
Dose every 3-5 hours
Resistance in immunocompromised
Term
Valacyclovir
Definition
Prodrug with increased bioavailability
Cleaved in intestinal wall to Acyclovir
Dose every 12 hrs
Term
Famciclovir
Definition
Oral prodrug of Penciclovir
Competitive inhibitor of viral DNAPoly
Similar to acyclovir
Dose evry 8-12hrs (Longer halflife than acyclovir)
Term
Ganciclovir
Definition
Structure similar to acyclovir but 100x more active against CMV
1st P added by viral and cellular kinases
Competitively inhibits dGTP selectively in Viral DNA polymerase
Bioavail(5-10%)
Excreted in urine
Plasma Halflife(3-4hrs); Intracellular halflife(16-24hrs)
Toxicities: BM suppresion, renal tox, teratogenic and mutagenic
Term
Valganciclovir
Definition
Prodrug of gancicylovir
Bioavail 60% with food
used for long term maintanence against CMV
Term
Foscarnet
Definition
Pyrophosphate analogue that inhibits DNA polymerase
Works in CMV, HSV, HIV, Influenza, Hep B
Especially in acyclovir and ganciclovir resistance
Only IV(poor bioavail);70-90% unchanged in urine(t1/2 4-5hrs)
Chelates metal ions so electrolyte imbalance occurs (Seizures, oral numbness, CNS)
Term
Cidofovir
Definition
Cytosine analogue that doesnt require TK
Used to treat resistanct CMV retinitis and maybe smallpox
Long intracellular halflife (MD every2 weeks)
Renal toxicity-tubules take it up and it causes necrosis
Probenicid prevent stubules from taking up the cidofovir
Term
Influenza vaccine
Definition
3 strains (2 type A and 1 type B)
Given to all people age 6+
between 6mo and 8yrs give 2 doses
TIV-everyone
LAIV-healthy non pregnant 2-49yo(nasal spray)
Term
Amantadine
Definition
Influenza A only
at [low] M2 ion channel blocked with inhibits viral uncoating
at [high] in lysosomes it increases pH so membranes wont fuse releasing virus
excreted >90% unchanged in urine
CNS toxicity
Term
Rimantadine
Definition
Influenza A only
at [low] M2 ion channel blocked with inhibits viral uncoating
at [high] in lysosomes it increases pH so membranes wont fuse releasing virus
Metabolized in Liver
CNS toxicity (less then amantidine
Term
Zanamavir
Definition
Neuraminidase inhibitor for Influenza A and B, prevents the further spread of the virus
Treatment >7yrs; Prophylaxis >5ys
Inhaled powder
Side affects: sinusitis, nasal symptoms, bronchitis, cough, ENT infections, exascerbation of asthma
Term
Oseltamivir
Definition
Neuraminidase inhibitor for Influenza A and B, prevents the further spread of the virus
Treatment and prophylaxis >1yr
Oral dose
Delirium, self-harm, hallucinations
Term
Gardasil
Definition
Quadrivalent HPV vaccine against 6, 11, 16, 18 using L1 VLP L1 protein
M&F 9-26
Term
Cervavax
Definition
Bivalent HPV vaccine against 16, 18
Term
Hep A vaccine
Definition
Havrix
Term
Interferons
Definition
Used in Hep C(40-82%) and Hep B(20%)
causes flulike symptoms and depression and suicide
Term
Lamivudine
Definition
Nucleoside analogue that inhibits Reverse Transcriptase
No side effects but high relapse and resistance
Resistance due to point mutation in YMDD of RNA dependent DNA polymerase
Highly affective against HBV
Term
Adefovir
Definition
nucleotide analogue that competitives with dATP to inhibit viral DNA polymerase and HBV Reverse transcriptase
Minor side effects: weakness, heaaches, increased creatinine
Used in YMDD resistant strains
2nd line drug behind tenofovir and entecavir
Term
Entecavir
Definition
nucleoside analogue that is 30-100x more potent than lamivudine with halflife of 15 hrs
Used in some lamivudine resistant HBVs
First line drug with tenofovir
Term
Telbivudine
Definition
thymidine nucleoside analogue that uses cellular enzymes for phosphorylation
15hr halflife
elevated creatine phosphokinase leading to muscle weakness, fatigue, lactic acidosis
Term
Tenofovir
Definition
nucleotide originally for HIV
no resistance to HepB but there is resistance to HIV so HIV screening is necessary
Used with emtracitibine to treat Hep B and HIV at the same time
First line drug with entecavir
Renal tox; Fanconi like syndrome
Term
Ribaviron
Definition
Treats Hep C in combination with IFN
used 24 weeks for type 2,3 and 48 weeks for 1,4
Term
Pegylated Interferon
Definition
Used in HepB and C
has a longer halflife and requires 1 dose per week
Term
Boceprevir
Definition
NS3/4A serine protease inhibitor used to treat Hep B with Ribavirin
Given to patients with cirrhosis who didnt respond to IFN
Major side affect if Anemia
Term
Telaprevir
Definition
NS3/4A serine protease inhibitor used to treat Hep B with Ribivirin
Given to patients
Major side effect is major skin rash
Term
RespiGam
Definition
RSV immune globulin
given IV monthly
Term
Palivizumab
Definition
Monoclonal AB against RSV protein
Intramuscular injecton monthly during RSV season
Term
Hep B Vaccine
Definition
Recombinant Heptavax
Given at 0, 1, and 6 months
Term
Truvada
Definition
Tenofovir and emtrabicitabine
treats HepB and HIV coinfected people
Term
Abacavir
Definition
NRTI
rare potential hypersensitivity rxn so screen for HLA B5701, look for rash
Also increased CV complications
Term
Stavudine
Definition
NRTI
May cause mitochondrial toxicity, and potential fatal syndrome with lactic acidosis and hepatic steatosis
Term
Nevirapine
Definition
NNRTI-no phos needed;bind noncompetitively to RT(long1/2life)
Immune reaction with severe hepatotoxicity (contraindicated if CD4>250W or >400M
Term
Efavirenz
Definition
NNRTI
teratogenic and psych disturbances
Term
Zidovudine
Definition
NRTI
Used for general prophylaxis and during pregnancy to prevent transmission
Side effect of Megaloblastic anemia
Term
Kaletra
Definition
Lopinavir+Ritonavir
Side effect nausea vomiting diarrhea
Term
Ritonavir
Definition
Protease Inhibitor
Potent pharmaco-enhancer(CYP3A inhibitor)
Term
Occupational HIV exposure
Definition
Combivir or Truvada and/or Kaletra or Reyataz
Term
Raltegravir
Definition
Integrase inhibitor
Causes rapid drop in viral load and effective with resistant viruses
Term
Enfuvirtide
Definition
Entry inhibitor tha binds gp41 and prevents HIV entrance\Twice daily subQ injections
Term
Maraviroc
Definition
CCR5 Inhibitor
Blocks HIV entrance for CCR5 cells only
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