SABS Pharm Exam 4

first generation antihistamines

diphenhydramine (Benadryl) and hydroxizine (Atarax)

second generation antihistamines

loratidine (Claritin), cetirizine (Zyrtec), and Fexofenadine (Allegra, possibly 3rd gen)

first gen antihistamine side effects

xerostomia, sedation, drowsiness

decongestants (like Sudafed) are

alpha-adrenergic agonists

decongestants may

contribute to hypertension/high HR, peripheral vasoconstriciton, and xerostomia

topical decongestants

is a selective alpha adrenergic, modulates arachidonic acid (ex. oxymetazoline (Afrin)

antitussive example

dextromethorphan (Delsym)

antitussives (like delsym) are

NMDA receptor agonists, raises cough threshold, as strong as opioids, can lead to drowsiness/hallucinations

expectorants

clear mucous from airways, irritates gastric vagal receptors, increases respiratory fluid secretions, reduces viscosity (clearance helps remove debris)

expectorant example

guaifenesin (Mucinex)

influenza example

oseltamivir (Tamiflu)

oseltamivir

inhibits neuraminidase, prevents budding, prevents replication (may cause nausea or vomiting, needs refrigerated) doesn’t replace vaccine

RSV examples

ribavirin, nirsevimab, and palivizumab

ribavirin

prevents mRNA synthesis, aerosolized for children/autoimmune patients

nirsevimab and palivizumab given to

lower chances of developing RSV

COVID examples

paxlovid (nirmatrelvir)+ritonavir, Veklury (remdesivir), Olumiant (baricitinib)+Actemra(tocilizumab)

paxlovid (nirmatrelvir)+ritonavir

for COVID outpatient

Veklury (remdesivir) for

IV infusion for hospitalized COVID patients (children or elderly)

Olumiant (baricitinib) +Actemra(tocilizumab) for

IV infusion for hospitalized COVID adults

varicella zoster (chickenpox)

takes 1-2 weeks to clear, calamine lotion to help itch (has live attentuated vaccine)

varicella zoster (shingles) antiviral medications

acyclovir (zovirax), valacyclovir (valtrex), and famciclovir (famvir)

shingrix

shingles recombinant vaccine for over 50 year olds

measles/mumps vaccine is

live attentuated

mumps

caused by paramyxovirus, effects parotid glands, causes cheek swelling,

rubella (german measles)

rubivirus, not as contagious, can cause deafness, heart defects, and retardation (rash behind ear)

polio

from contaminated food/water, spinal nerve damage

HIV

spread via bodily fluids (not saliva), targets CD4 lymphocytes,

HIV therapy initiated

asap, when CD4 <350

nucleoside reverse transcriptase inhibitors (NRTI’s)

inhibits by mimicking nucleosides which integrate into complementary DNA, terminating elongation (reduces neonatal HIV)

NRTI example

zidovudine (retrovir) first HIV medication

NRTI combo example

lamivudine and zidovudine (combivir)

NRTI oral side effects

xerostomia, erythema multiforme, ulcers, and facial lipoatrophy

Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTI’s)

inhibits reverse transcriptase by binding to enzyme by active site (cyt p450)

NNRTI examples

efavirenz (Sustiva) and Etravirine (Intelence)

NNRTI caution

reduces benzodiazepine effficacy/metabolism (resistance may occur)

NNRTI oral side effects

xerostomia, erythema multiforme (more than NRTI), and ulcers

protease inhibitors

slow HIV progression by blocking protease (used by HIV to mature), prevents the virus copying itself

protease inhibitor examples

ritonavir (norvir) and saquinavir (invirase)

protease inhibitor oral effects

altered taste, parotid lipomatosis, xerostomia, and perioral lipomatosis (reduces oral candidiasis)

protease inhibitor interactions

don’t take with benzodiazepines, fluconazole, or ketoconazole (prevents protease inhibitors)

fusion inhibitors

blocks virus from merging with CD4, binds to gp41 of virus that allows attachment, resistance can occur

fusion inhibitor example

enfuvirtide (fuzeon)

fusion inhibitor oral effects

xerostomia, gingivitis, and altered taste

integrase strand transfer inhibitors (INST’s)

block integrase that inserts viral DNA into CD4

INST example

bictegravir (Biktarvy)

CCR5 inhibitor

receptor that allows viral HIV to attach to CD4, entry inhibitor (can dilate neck veins)

CCR5 example

Maraviroc (Selzentry), don’t use antifungals with this

pharmacokinetic enhancers (PK)

non antiretroviral, CYP3a inhibitor, slows metabolism/increases efficacy of other HIV drugs

PK examples

Cobicistat (Tybost) and Ritonivir can as well (Norvir)

highly active antiretroviral therapy (HAART)

combos of meds (cocktails) in low doses (protease inhibitor+2 NRTIs OR NNRTI+2 NRTIs)

pre-exposure prophylaxis (PrEP)

reduces contraction risk from sex by 99% and from injection by 74%

post-exposure prophlyaxis

risk lowered by 80% within 72 hours done asap, take meds for 28 days

Hep C use

protease inhibitors as first drug (interacts with azoles, benzos, prednisone, and clarithromycin)

Hep C Oral effects

intraoral (bruising, gingivitis, xerostoma, jaundice), decreased clotting=more bleeding (consult, no acetaminophen/NSAIDS)

Hep B vaccine

recombinant DNA vaccine

Hep B treatments

interferons (Roferon-A) not a cure

HPV vaccine

recombinant vaccine

HSV-1 symptoms

primary herpetic gingivastomatitis

HSV-1 primary infection treatments

acetaminophen or ibuprofen 10 mg/kg po 6 hrs (HYDRATION is key-popsicles)

HSV-1 chronic treatment

docosanol (Abreva) and penciclovir (Denavir)

docosanol (Abreva)

5x a day, inhibits fusion between HSV envelope and cell membrane

acyclovir (Zovirax)

200 mg capsules every 4 hours for 5 days, indicated for immuno patients

acyclovir/pencyclovir function

phosphorylated by thymidine kinase into acyclovir-TP, which inhibits viral DNA replication by analog of dGTP

valcyclovir and pencyclovir turn into

acyclovir by liver

HSV-1 recurrent Valtrex (valacyclovir) dose

1 g caplet (2 g now, 1 g rest of days)

HSV-1 prophylaxis Valtrex (valacyclovir) dose

500 mg daily

HSV-2 treatment

acyclovir 400 mg (3x daily, 7-10 days) or valacyclovir 500 mg (2x daily, 7-10 days)