Antivirals, antifungals, and antiTB

What are the 4 RNA viruses (anti-virals)

Influenza, RSV, HIV, Hep C

What are the 4 DNA viruses (anti-virals)

HSV 1 and 2, VZV, CMV, Hep B

What influenza category blocks the virus from uncoating?

Adamantanes

Amantadine and Rimantadine

Influenza, adamantanes

Adamantanes MOA

block the virus from uncoating

Adamantanes drugs

Amantadine and Rimantadine

“mantadine”

adamantanes - influenza

Neuraminidase inhibitors MOA

prevent budding and release of new virus

Which influenza drug category prevents budding and release of new virus?

Neuraminidase inhibitors

Oseltamivir and Zanamivir drug class

Neuraminidase inhibitors

Drugs that are neuraminidase inhibitors

Oseltamivir and Zanamivir

List the 4 drugs that must be given within 36 hours of symptom onset

Amantadine, Rimantadine, Oseltamivir, Zanamivir

What is the leading cause of hospitalizations and morbidity and mortaliity in infants and young children?

RSV

What is RSV treated with?

Ribavirin and Palivizumab

What is ribavirin used to treat?

RSV

Is ribavirin preganancy safe?

NO, category X (inhaled)

What is palivizumab used to treat?

chronic lung disease in preemies and young children - NO SIDE EFFECTS

What does ART stand for?

antiretroviral therapy

list the 3 ART therapies

2 NRTI + 1 NNRTI
2 NRTI + 2 PI
2 NRTI + INSTI or FI

What does NRTI stand for?

nucleotide antiretroviral therapy

MOA of NRTI

inhibit reverse transcriptase and cause DNA termination

Side effects of NRTI

lactic acidosis with hepatic steatosis

Drugs that are NRTIs

Zidvudine, Emtricitabine, Tenofovir, Lamivudine

zidovudine (class, !)

NRTI, AE bone marrow depression, GI, lactic acidosis

Emtricitabine (class, !)

NRTI, AE hyperpigmentation of palms and soles

Tenofovir (class, !)

NRTI, AE osteoporosis

What does NNRTI stand for

Nonnucleoside reverse transcriptase inhibitors

MOA NNRTI

active only against HIV, resistant can be built quick

PI class

NNRTI

PI drugs

Ritonavir, Darunavir

List the two PI and what they do as a class

Ritonavir, Darunavir - blocks mutation, always used in combination therapy

Is ritonavir or darunavir a newer PI?

Darunavir

Side effect of darunavir (first list its class and subcategory)

NNRTI, PI - sulfonamide allergic reaction

FI class

NNRTI

FI MOA

stop vital entry and replication

List a FI

Enfuvirtide

INSTI class

NNRTI

INSTI MOA

stop HIV replication

Abacavir, Dolutegravir, Bictegravir are in what class and subcateggory?

NNRTI, INSTI

RNA virus, leading cause of liver transplant and death

Hep C

Ribavurin + IFN alfa, Telaprevir, Sofoburir

Hep C

Besides Hep C, what is ribavirin + IFN alfa also used to treat?

RSV

List the 4 DNA virus categories

Hep B, HSV, CMV, Varicella

Is there a cure for Hep B?

No cure, treatment is suppression of virus

Tenofovir, Entacavir, Interferon alfa -2b

Hep B

Acyclovir

Pregnancy safe

Valacyclovir

Reduces risk of transmission between patients

Ganciclovir AE

Bone marrow supression

Which DNA antiviral is pregnancy safe (this is the only one)

Acyclovir

What is prescribed if acyclovir doesn’t work?

Foscarnet

Foscarnet AE

kidney infection

AZOLES = ?

antifungals

Antifungals (azoles) MOA

increase cell permeability

Topical antifungals (azoles)

miconazole, clotrimazole

Itraconazole, fluconazole, ketoconazole, miconazole, clotrimazole

antifungals (azoles)

Broad or narrow? Itraconazole

broad

AE of itraconazole

cardiosupression, hepatotoxicity

Which anti fungal (azole) is a HIV prophlaxisis

Fluconazole

What does fluconazole commonly treat?

meningitis

AE of fluconazole

Seizures, dermatitis, NO PREGANT

Which antifungal (azole) is chronic systemic

ketoconazole

AE of ketoconazole

gynecomastia, irregular menstrual

Polyenes MOA

bind to ergosterol, cause leak

Ampholericin, Nystatin

Polyenes (antifungals)

Specifications for amphotericin

highly toxic, infuse slowly and watch renal function

What is nystatin commonly used for

candidal infections (oral thrush)

Induction phase of TB treatment (amount of drugs, how long)

4 drugs, 2 months

Continuation phase of TB treatment (amount of drugs, how long)

2 drugs, 4 months

What are the four drugs in the induction phase of TB treatment?

isoniazid, rifampin, pyrazinamide, ethambutol

What are the two agents in the continuation phase of TB treatment?

Isoniazid, rifampin

In what population is there a higher incidence of TB

HIV

AE of rifampin (class, answer)

antiTB, orange body fluids, increase CYP450, decrease oral contraceptives

If CYP450 is increased, this can decrease metabolites of other drugs such as ?

oral contraceptives

What is the newest and best anti-TB drug

Bedaquinline

What is the problem with bedaquinline

QT prolongation, death