Antiviral drugs

acyclovir MOA

inhibits viral DNA polymerase to block viral replication

IV acyclovir adverse effects

phlebitis, nephrotoxicity, rare neurotoxicty

oral/topical acyclovir adverse effects

mild GI upset or local burning

drug to treat herpes simplex and varicella-zoster virus

acyclovir

drug to treat cytomegalovirus

ganciclovir

ganciclovir moa

inhibits viral DNA polymerase to block viral replication

adverse effects of ganciclovir

bone marrow suppression, teratogenic, anemia, liver dysfunction, CNS effects

drugs to treat viral hepatitis C

simeprevir, daclatasvir, interferon alfa, ribavirin

drugs to treat viral hepatitis B

interferon alfa and lamivudine

simeprevir moa

inhibits viral protease to stop HCV replication

adverse effects of simeprevir

headache nausea fatigue hepatic injury photosensitivity rash

daclatasvir moa

inhibits NS5A protein for HCV RNA replication & assembly

adverse effects daclatasvir

headache & fatigure; anemia when given with ribavirin

interferon alfa moa

blocks viral entry, viral mRNA/protein synthesis, and viral assembly/release

adverse effects of interferon alfa

flu-like symptoms, neuropsychiatric effects, bone marrow suppression

ribavirin moa

not clear, enhances response when combined with other agents

adverse effects of ribavirin

hemolytic anemia and fetal injury

lamivudine moa

inhibits viral DNA synthesis

adverse effects lamivudine

lactic acidosis, pancreatitis, hepatomegaly, hepatic complications

drugs to treat flu

tamiflu, xofluza, synagis

tamiflu moa

neuraminidase inhibitor prevents newly formed influenza from spreading to other cells

adverse effects of tamiflu

nausea/vomiting, rare hypersensitivity and neuropsychiatric symtpoms

xofluza moa

oral endonuclease inhibitor, active metabolite blocks viral gene transcription

xofluza adverse effects

uncommon

synagis moa

binds rsv surface protein prevents viral replication

synagis adverse effects

hypersensitivity reactions

drugs to treat SARS-CoV2 and COVID 19

paxlovid, veklury

paxlovid moa

Nirmatrelvir inhibits SARS-CoV-2 protease; ritonavir boosts
nirmatrelvir plasma concentrations.

adverse effects of paxlovid

Hypertension, diarrhea, altered taste, myalgia, and possible
rebound COVID-19

veklury moa

Acts as an ATP analog and causes delayed chain
termination during viral replication

adverse effects of veklury

Bradycardia, elevated ALT/AST, hypersensitivity
reactions, and prolonged prothrombin time.

drugs that inhibit HIV enzymes

abacavir, efavirenz, darunavir, raltegravir, cabotegravir

drugs that block HIV entry

enfuvirtide, maraviroc, fostemsavir, ibalizumab-uiyk

abacavir moa

• PO nucleoside reverse transcriptase inhibitor (NRTI)

• Acts as substrate for reverse transcriptase

• Suppresses viral DNA synthesis and helps lower viral load

when combined with other ART

abacavir

• Lactic acidosis and hepatic steatosis related to

mitochondrial toxicity

• Hypersensitivity may be severe or fatal

• Possible myocardial infarction concern in patients with

cardiac risk

efavirenz moa

• PO non-nucleoside reverse transcriptase

inhibitor (NNRTI)

• Binds to reverse transcriptase and disrupts the

enzyme active center

• Suppresses HIV DNA synthesis

• Used as part of combination ART, not

monotherapy

adverse effects efavirenz

• CNS symptoms are common: dizziness,

insomnia, vivid dreams, impaired concentration

• Rash may occur; severe rash requires

immediate evaluation

• Teratogenicity warning

darunavir moa

• PO protease inhibitor (PI)

• Inhibits HIV protease, which is needed for virion

maturation

• Leaves new virus particles immature and

noninfectious

darunavir adverse effects

• Common: nausea, diarrhea, and headache

• Rash may occur; caution with sulfonamide allergy

history

• Lipodystrophy, hyperlipidemia, and possible

glucose effects

raltegravir moa

• PO integrase strand transfer inhibitor (INSTI)

• Blocks integrase so HIV DNA cannot be inserted into

host DNA

raltegravir adverse effects

• Elevated liver enzymes may occur

• Rare skin hypersensitivity reactions

enfuvirtide moa

Binds to HIV envelope glycoprotein and prevents

fusion of the HIV lipid bilayer with the CD4 cell

membrane

enfuvirtide adverse effects

SQ injection-site reactions are common

• Pneumonia symptoms may occur

• Hypersensitivity reactions are possible

maraviroc moa

• Blocks HIV entry by binding CCR5, a co-receptor
needed for entry into CD4 cells

maraviroc adverse effects

• Hepatic injury warning

• Possible increased risk for cardiovascular events,

including MI

Prototype Entry Inhibitors: Attachment and Post-Attachment

Fostemsavir (Rukobia)-Attachment Inhibitor
Ibalizumab-uiyk (Trogarzo)-Post attachment Inhibitor

fostemsavir moa

Binds gp120 and prevents HIV attachment to CD4

receptors

adverse effects of fostemsavir

Monitor nausea, serum creatinine, hepatotoxicity, QT

risk, and drug interactions

Ibalizumab-uiyk moa

Binds domain 2 of CD4 receptor

• Blocks a post-attachment entry step without directly

causing immunosuppression

cabenuva

For adults and adolescents ≥12 years and ≥35 kg

with HIV-1 who are virologically suppressed, stable on

ART, and have no treatment failure or

known/suspected resistance to either drug

Descovy

HIV-1 treatment: use only with other antiretroviral agents

• HIV-1 PrEP: for at-risk adults and adolescents ≥35 kg;

indication does not include receptive vaginal sex risk

• Blocks reverse transcriptase and causes viral DNA chain

termination

drugs for TB

isoniazid, rifampin, pyrazinamide, ethambutol

isoniazid moa

Inhibits synthesis of mycolic acid, a component needed for

mycobacterial cell walls

isoniazid adverse effects

• Hepatotoxicity

• Peripheral neuropathy from B6 deficiency

rifampin moa

Inhibits bacterial DNA-dependent RNA polymerase,
suppressing RNA and protein synthesis

adverse effects rifampin

• Hepatotoxicity and red-orange body-fluid discoloration.

pyrazinamide moa

Metabolized to pyrazinoic acid and may inhibit fatty
acid synthetase I

pyrazinamide adverse effects

• Most hepatotoxic first-line TB drug

• Hyperuricemia

• Possible gouty arthritis

ethambutol moa

Bacteriostatic; inhibits arabinosyl transferase and impairs

mycobacterial cell wall synthesis

ethambutol adverse effects

• GI upset

• Optic neuritis

• Blurred vision

• Constricted visual field

• Altered color discrimination

• Possible hyperuricemia