not throwing away my shot :)

which type of block are NA inhibitors? what drugs in this clas

the ones thatrpevent budding— finsihed virons cannot levae cell

oselt (Tamiflu)

zana (relenza)

peramivir

which cabotegravir is for q2 mo PrEP ? (insti)

apretude

• the IM is vocabria?

what ra eNA inhibitors first linef or

flu a and B

oselt (Tamiflu)

zana (relenza)

peramivir

when must start NA inhibitors for flu ? exception? how much decrase

w/in 48 horus symtposm

oselt (Tamiflu)

zana (relenza)

peramivir

exception is hospitalized

• decreaes symptom by one day

what is teh only IV NA inhibitor

peramivir

which NA inhib is a produrg

Oseltamivir phosphate— carbyoxylate is active drug

• by hepatic

with NA inhib which do you consel to take with food

oselt

how elmin all the NA inhib

renally

serious ad eff of NA inhib (oseltamivir, zanamivir, peramivir)

• neuropsychiatric events: seizures, abnormal behavior, delirium

• sjs/ten

which NA inhib can cause bronchospasm

Zanamivir

common ad eff of NA inhib (oseltamivir, zanamivir, peramivir)

cough, nasal, n.v

which NA inhib in astma or copd? formulation

its inhaled! so zanamivir

preg for NA inhib (oseltamivir, zanamivir, peramivir)

not great— peramivir may cause fetal harm

• oselt pref

how Baloxavir marboxil (Xofluza®) work

which blocks the cap-dependent endonuclease of the polymerase acidic (PA) protein → influenza cannot snatch caps from host mRNA to start its own mRNA. Influenza A and B.

what sttep of viral process does tBaloxavir marboxil

(Xofluza®) effect

initial step of viral replication— cannot get caps off of mRNA to repurpose them

how soon must start Baloxavir marboxil

(Xofluza®)

also 48 h

Baloxavir marboxil

(Xofluza®) is it a produge? how is lhalf life?

LONG half life

• yes produrg

what can’t take with Baloxavir marboxil

(Xofluza®)

cations

Baloxavir marboxil

(Xofluza®) serious ad eff

SJS/skin, rhabdo

list the nucleoSide anglods for shingles /herpes

★ Acyclovir

(Zovirax®) PO · IV · topical

★ Valacyclovir

(Valtrex®) PO

★ Famciclovir

(Famvir®†) PO

MOA of nuceloSide analgouds (★ Acyclovir

(Zovirax®) PO · IV · topical

★ Valacyclovir

(Valtrex®) PO

★ Famciclovir

(Famvir®†) PO)

viral thyminide kinase activates them; when integrated into host genome stops DNA replication

what activates nucleoside analogs for herpes/shingles adn where it comes from

VIRUS BASED thymidine kinase

★ Acyclovir

(Zovirax®) PO · IV · topical

★ Valacyclovir

(Valtrex®) PO

★ Famciclovir

(Famvir®†) PO

if Acyclovir/ Valacyclovir/Famciclovir (nuceloSide analgoes) are met with resistance, what give for shing;es/her

foscarnet and cidofovir bc don’t need TK activation

Acyclovir/ Valacyclovir/Famciclovir what firs tline for

HSV and VZV

• herpes n shingles

Acyclovir/ Valacyclovir/Famciclovir which is given IV nad why

acyclovir and given for HSV that cause caused brain swelling (enceph)

Acyclovir/ Valacyclovir/Famciclovir. when need to start for shingles

72 hours of rash start

Acyclovir/ Valacyclovir/Famciclovir does it ure

no just suppress

Acyclovir/ Valacyclovir/Famciclovir which requires like 5 times PO bc bad absorption

acyclovir

Acyclovir/ Valacyclovir/Famciclovir which is prodrug of acyc

valacyclovir

Acyclovir/ Valacyclovir/Famciclovir what is fam a prodrug of

penciclovir

Acyclovir/ Valacyclovir/Famciclovir how are they elminated

renally

Acyclovir/ Valacyclovir/Famciclovir serious ad eff

• nephrotox— crystaluria

• CNS tox

• TTP/HUS

how is IV acycl dosed

IDEAL bw

Acyclovir/ Valacyclovir/Famciclovir common ad eff

rise in BUN/Scr, IV rxn (phlebitis)

what durgs do you have to counsel on to drink water

Acyclovir/ Valacyclovir/Famciclovir

how do the following drugs work

★ Ganciclovir

(Cytovene®†, Zirgan® ophthalmic gel) IV · ophthalmic gel

★ Valganciclovir

(Valcyte®) PO

Cidofovir

(Vistide®†) IV

Foscarnet

(Foscavir®) IV

block DNA polyermase

DID YOU REVIEW HOW EACH DNA POLUERMASE INHIB IS ACTIVATED

NOT. YET

ganciclovir, valganciclovir, Cidofovir, Foscarnet what is first line

ganciclovir, valganciclovir,

ganciclovir, valganciclovir, Cidofovir, Foscarnet

valgan what is prodrug of and what is point

better PO absrob

of ganiciclovir

ganciclovir, valganciclovir, Cidofovir, Foscarnet how elminated

renally

ganciclovir, valganciclovir, Cidofovir, Foscarnet box warning

myelosuppression (neutropenia, anemia, thrombocytopenia); carcinogenic; teratogenic; aspermatogenesis. Lab: CBC with differential and platelets.

bw for cidofovir

dose-related nephrotoxicity — probenecid + IV saline with every dose

which DNA poluermase inhibtor for herpes should you not give with poor reneal

cidofovir

bw foscarnet

nephrotoxicity — adequate hydration; seizures from electrolyte changes

which drug can cause qt prolongation

Foscarnet

how in preg ganciclovir, valganciclovir, Cidofovir, Foscarnet

may cause fetal harm

who would reiceve Nirsevimab, Clesrovimab (the mAbs for RSV)

premies, neonates— cannot get vax at that age bc don’t have the immune system for it

Nirmatrelvir+ritonavir(Paxlovid®)/ Remdesivir what for

covid -19

Nirmatrelvir+ritonavir(Paxlovid®)/ Remdesivir whcih is the inpatient one

remdesivir (veklury)

Nirmatrelvir+ritonavir(Paxlovid®)/ Remdesivir what does the ritonavir do

just a booster— a cyp3a inhibitor that slows metabolism

Nirmatrelvir+ritonavir(Paxlovid®)/ Remdesivir how elmin

renally

Nirmatrelvir+ritonavir(Paxlovid®)/ Remdesivir when have to start paxlovid by

within 5 days of symptoms

Nirmatrelvir+ritonavir(Paxlovid®) bw

signif drug inx

Nirmatrelvir+ritonavir(Paxlovid®) CI

drugs who levles ritaonivr riases to dangouers levels lol

• amiodarone, dronedarone, flecainide, ranolazine, lovastatin, simvastatin, triazolam, oral midazolam, colchicine in kidney/liver impairment, ergot

Nirmatrelvir+ritonavir(Paxlovid®) ad eff

Altered Taste, dia, hep, sjs

Remdesivir ad eff

raised ALT/ast

Nirmatrelvir+ritonavir(Paxlovid®)/ Remdesivir how does NIRM work

blocks the main protease of covid-19 that cutss proteins into working enzymes

Nirmatrelvir+ritonavir(Paxlovid®)/ Remdesivir moa for REMDES

a nucleotide prodrug athat buidling into RNA and stops the chain three nucleotides later

Hep B what are teh main drugs

Entecavir

Tenofovir alafenamide

Tenofovir disoproxil fumarate

MOA of nucleotide/side analogues (Entecavir/Tenofovir alafenamide/Tenofovir disoproxil fumarate)

active form of HBV polymerase (reverse transcriptase) to end DNA chain

• has to be phosphorylated to be active

what has reuced incidence of hep B

vax in US!

which is the virus that has to occur as a coinfec with Hep B or C

Hep D

which hep has a cure?

Hep C (c for cure)

Entecavir/Tenofovir alafenamide/Tenofovir disoproxil fumarate

Entecavir/Tenofovir alafenamide/Tenofovir disoproxil fumarate what is TENOFOVIR ALSO USED OFR

HIV!

Entecavir for hep B counseling and why

take on empty stomach bc food limits absorption

Entecavir/Tenofovir alafenamide/Tenofovir disoproxil fumarate when is teno pref

lamivudine-resistant HBC

Entecavir/Tenofovir alafenamide/Tenofovir disoproxil fumarate

Entecavir how elminated

renally

Entecavir bw ? htere are three

1. severe acute exacerbatino of hep B on stopping

2. hiv resist

3. lactic acidosis and severe hepatolomegaly with steatosis

do i need to enter in PEG INTERFERON

YES

how do the hep C drug targets work

work either to 1) stop inititaition of replication (asvirs, buvirs) or 2) stop leaving (previrs)

previr stops cutting of PROTEIN

asvir stops DNA integration

buvir copies the RN a to Build proteins

can hep C sorta be cured

YES

list the hep C drugs

Glecaprevir/pibrentasvir (Mavyret®)— inititaion only

Sofosbuvir/velpatasvir (epclusa)— maturation and init

which protein -previr targers

for hep c

the maturation one

NS3/4A protease

which protein -asvirs target

hep c

NS5a

helps build replication complex

which for acute hep C

mayvret

• Glecaprevir/pibrentasvir

which hep has acute treatment and what is the drug

hep C

mavyret

what prtein do buvirs target

NS5Bs

hep C

part of replciation

which hep C drug take with food

mavyret

boxwed warnring for hep c drugs (Epclusa, Mavyret)

• (all HCV direct-acting antivirals): hepatitis B reactivation

  • test for HBV (hep b)every time

with sofobuvir (hep C) what drug with it can cause bradycardia

amiodarone

which hep C drug needs sotmach acid to be absorbed/what should you not take with it

Velpatasvir needs stomach acid to be absorbed: avoid PPIs

what hep C drug cna be taken by itself adn which enzyme it work on (a replication one)

NS5B—b is buvir

• Sofosbuvir

are the hep c drugs (ie Sofosbuvir) only for certain genotypes

noooo no no

whihc hep c drug is a prodrug

Sofosbuvir (ns5b target)(

Sofosbuvir how elmianted

renally

Sofosbuvir bw

hep b recativation

true for all hcv drugs— they MAY OCCLUDE hep b (mayvret, epclusa)

Sofosbuvir which ddi enzyme most a problem

p-gp inducers

• rifampin

• st johns wort

• carbamazepine

what are some CI for the hep C drugs

decompensation (of heart stuff?)

like liver cirrohis i think

• mavyret, epclusa

when would you use Ribavirin for hep C

NOT first line— if they fail other treatmetns

Ribavirin (hep C) bw

hemolytics anemia

not effecitve alone

teratogenic

inhaled so can cause bronchospasm

Ribavirin ind

hep C

• inhaled version can be used in severe RSV

Ribavirin moa

guanosine analogue that creates copying errors in viral DNA

Ribavirin CI

• preg

• CrCl under 50

  • heme problems ex sickle cell or thalassemias (RBC disorders)

Ribavirin ad ef

hemolutic anemia (need to get CBC whilst on)

• insomnia, cough, rash, itch

Ribavirin what need to be on bc of tetragotenic

at least two forms of contraception

• use for 6 months after as well c

what do the NRTIs and NNRTIs do

converting RNA to DNA

which NRTIs also block some hep B stuff

Lamivudine, emtricitabine and tenofovir