antiviral, HPV, Influenza, COV19, HIV, TB/Leprosy/MAC, Antiprotozoal, ,

Acyclovir (Zovirax)

Inhibits viral DNA synthesis to stop viral replication.

Indications: HSV1 (topical), HSV2 & VZV (PO), IV for immunocompromised. AE: Phlebitis (IV), nephrotoxicity, neurotoxicity.

NC: Monitor renal function & hydration, monitor neuro status, wear gloves with topical, avoid sexual contact with lesions present.;

Ganciclovir (Cytovene)

Inhibits viral DNA synthesis via chain termination.

Indications: CMV prevention/treatment in immunocompromised.

AE: Granulocytopenia, thrombocytopenia, teratogenic.

NC: Monitor CBC, administer with food, coadminister with CSF, contraception education.;

Simeprevir (Olysio)

Protease inhibitor required for HCV replication.

Indications: Hepatitis C.

AE: HA, nausea, fatigue, hepatic injury, photosensitivity, rash.

NC: Monitor liver enzymes, caution with sulfa allergy, avoid monotherapy.;

Daclatasvir (Daklinza)

NSSA inhibitor preventing HCV protein formation.

Indications: HCV.

AE: HA, fatigue, anemia.

NC: Monitor liver enzymes, drug reconciliation due to many interactions.;

Ribavirin (Rebetol)

Unknown MOA; boosts alpha-interferon response.

Indications: HCV (combined therapy).

AE: Flu-like symptoms, agitation, depression, bone marrow suppression, hepatotoxicity, hemolytic anemia, fetal injury.

NC: Monitor CBC, LFTs, mental status; contraception required long-term.;

Interferon Alfa

Blocks viral entry, mRNA synthesis, and assembly.

Indications: HBV, HCV.

AE: Flu-like symptoms, neuropsychiatric effects, bone marrow suppression. NC: Tylenol for flu symptoms, monitor CBC and LFTs.;

Lamivudine (Epivir)

Nucleoside analog inhibiting HBV DNA synthesis.

Indications: HBV.

AE: Lactic acidosis, pancreatitis, hepatomegaly.

NC: Use lowest dose in HIV+, monitor amylase, lipase, ABG.;

Oseltamivir (Tamiflu)

Inhibits neuraminidase preventing viral replication/spread.

Indications: Influenza (within 48 hrs).

AE: N/V, rare neuropsychiatric effects.

NC: Confirm flu test, assess vax hx, educate allergic symptoms.;

Palivizumab (Synagis)

IM monoclonal antibody binding RSV surface protein.

Indications: RSV prevention.

AE: Hypersensitivity, rare anaphylaxis.

NC: Proper IM technique, stop if severe reactions.;

Baloxavir (Xofluza)

Endonuclease inhibitor preventing viral gene transcription.

Indications: Influenza (within 48 hrs).

AE: Uncommon; avoid with Ca/Fe/Mg salts.

NC: Avoid with LAIV vaccine; take early.;

Nirmatrelvir & Ritonavir (Paxlovid)

PO protease inhibitor; ritonavir increases plasma levels.

Indications: Symptomatic non-severe COVID-19 w/ high risk.

AE: HTN, diarrhea, altered taste, myalgia, rebound COVID.

NC: Multiple drug interactions, HIV resistance risk, 2x/day x 5 days.;

Molnupiravir (Lagevrio)

PO RNA polymerase inhibitor causing viral genome errors.

Indications: Non-severe covid-19 (alternative).

AE: Rash, urticaria, hypersensitivity.

NC: Do not crush; twice daily x 5 days; not widely available.;

Remdesivir (Veklury)

IV nucleotide analog inhibiting viral RNA polymerase.

Indications: Hospitalized COVID requiring O2.

AE: Bradycardia, ↑ALT/AST, hypersensitivity, prolonged PT.

NC: Monitor CMP, renal, stop if reaction occurs.;

Abacavir (Ziagen)

NRTI suppressing HIV DNA synthesis.

Indications: HIV.

AE: Lactic acidosis, hepatic steatosis, MI risk, hypersensitivity.

NC: HLA-B testing, monitor cardiac & LA symptoms, safe sex education.;

Efavirenz (Sustiva)

NNRTI inhibiting HIV reverse transcriptase.

Indications: HIV.

AE: CNS effects, rash, teratogenic.

NC: Take HS on empty stomach, avoid interactions, educate on CNS changes.;

Darunavir (Prezista)

Protease inhibitor blocking HIV virion maturation.

Indications: HIV.

AE: N/D/HA, rash, hyperglycemia, hyperlipidemia, lipodystrophy.

NC: Many interactions (HCV drugs), refrigerate long-term, lipid control.;

Raltegravir (Isentress)

INSTI preventing viral DNA insertion into host genome.

Indications: HIV.

AE: Elevated LFTs, rare hypersensitivity.

NC: Monitor liver, report skin reactions; resistance common.;

Enfuvirtide (Fuzeon)

Fusion inhibitor blocking HIV entry via CD4 membrane.

Indications: Resistant HIV.

AE: Injection site rxn, pneumonia, hypersensitivity.

NC: Technique education, monitor respiratory & skin.;

Maraviroc (Selzentry)

CCR5 antagonist blocking HIV entry.

Indications: Resistant HIV.

AE: Hepatic injury, ↑MI risk.

NC: Monitor CV/liver; CCR5 tropism assay required.;

Cabotegravir/Rilpivirine (Cabenuva)

INSTI + NNRTI preventing viral replication.

Indications: HIV-1 complete regimen.

AE: Hypersensitivity, injection rxn, hepatotoxicity, depression.

NC: Gluteal injection; two injections; warm to room temp 15 min.;

Emtricitabine/Tenofovir Alafenamide (Descovy)

NRTI combination blocking HIV DNA synthesis.

Indications: HIV treatment & PrEP.

AE: N/D.

NC: Report symptoms, med adherence, cannot use alone, HIV testing q6mo.;

Isoniazid (INH)

Inhibits mycolic acid synthesis (cell wall).

Indications: TB treatment & prophylaxis.

AE: Hepatotoxicity, neuropathy (B6 deficiency), optic neuritis.

NC: Avoid antacids, monitor LFTs, supplement B6, report vision changes.;

Rifampin (Rifadin)

Rifamycin inhibiting RNA synthesis.

Indications: TB (combo therapy), leprosy, MAC.

AE: Hepatotoxicity, red-orange fluids, hematologic disorders, drug interactions.

NC: Monitor liver & CBC, backup contraception, educate discoloration.;

Pyrazinamide

Converted to pyrazinoic acid lowering pH; inhibits M. tuberculosis enzymes. Indications: TB combo therapy.

AE: Hepatotoxicity, hyperuricemia, gout.

NC: Monitor liver, uric acid; report gout symptoms.;

Ethambutol (Myambutol)

Inhibits arabinosyl transferase impairing TB cell wall.

Indications: TB combo; MAC.

AE: GI upset, optic neuritis, hepatotoxicity.

NC: Monitor vision, LFTs; take with food.;

Chloroquine (Aralen)

Prevents heme detoxification causing parasite death.

Indications: Acute P. vivax/P. falciparum malaria; prophylaxis.

AE: GI upset, visual changes, pruritus.

NC: Take with meals; monitor liver; not effective against liver phase.;

Artesunate

Creates reactive oxygen species damaging parasite membranes.

Indications: Severe P. falciparum malaria (IV).

AE: Delayed hemolytic anemia, ↑LFTs, rare cardiac issues.

NC: Weight-based dosing, slow IV, monitor CBC for hemolysis, notify CDC.;