Antiviral Drugs

  • Treatment Strategies

    • prevent virus binding

    • prevent virus uncoating

    • prevent virus replication

  • Respiratory Virus Infections

    • Neuraminidase Inhibitors: oseltamivir and zanamivir

      • MoA

        • effective against influenza A and B

        • prevents the release of new viruses from infected cells

      • Kinetics

        • oral for oseltamivir

        • intranasal for zanamivir

      • Adverse effects

      • Resistance

    • Adamantane Derivatives: amantadine and rimantidine

      • MoA

        • block viral uncoating

      • Kinetics

        • Amant - good CNS

        • Rimant - poor

      • Adverse effects

        • CNS effects

      • Resistance

    • Ribavirin

      • inhibits replication of RNA and DNA viruses

      • Kinetics

        • oral and inhalation

        • Adverse effects

          • Transient anemia

  • Hepatic Viral Infections

    • inflammation of the liver

    • Viruses (A-E)

      • common

        • Hepatitis B (DNA virus)

          • treatment

            • Interferons

              • MoA

                • induction of host’s enzymes to breakdown viral RNA

              • Kinetics: not for oral use

              • Adverse Effects

            • Lamivudine: inhibits HBV and HIV

            • Adefovir: nucleotide analog incorporated into viral DNA in HBV

            • Entecavir: guanosine nucleotide analog for HBV

            • Telbivudine: thymidine analog

            • Boceprevir and Telaprevir: serine protease inhibitors

        • Hepatitis C (RNA virus)

          • treatment

            • Direct Acting Antivirals

              • NS3/NS4A Protease Inhibitors

                • MoA

                  • disrupts RNA replication within the host cell

                • scaffolding for viral RNA polymerase

                • side-effects include rash, pruritis nausea, fatigue, and anemia

              • NS5B Polymerase Inhibitors

                • MoA

                  • interferes with HCV replication mainly through nucleotide/nucleoside analogs

                • low side-effects

              • NS5A Replication Complex Inhibitors

                • MoA

                  • interferes with platform for assembly

                • strong inducer of CYP enzymes

            • Ribavarin

              • inhibits replication of RNA and DNA viruses

              • Kinetics

                • oral and inhalation

              • Adverse Effects

                • transient anemia

  • Herpesvirus Infections

    • herpes copies DNA into host DNA

      • difficult to clear

      • push to remission

    • Acyclovir

      • MoA

        • Guanine analog

      • Kinetics

      • Adverse effects depends upon route of administration

    • Cidofovir

      • CMV rhinitis

      • cytosine analog

    • Foscarnet

      • phosphonoformate

      • reversibly inhibits DNA and RNA polymerase

    • Ganciclovir

    • Penciclovir and Famcicyclovir

      • guanosine

    • Trifluridine

      • similar to thymidine

  • HIV

    • Classes

      • Nucleotide Reverse Transcriptase Inhibitors (NRTIs)

        • inhibit viral RNA from transcribing a DNA copy

      • Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)

        • inhibit viral RNA from transcribing a DNA copy

      • Protease Inhibitors

        • inhibit viral protease from cleaving polyproteins and creating virion

      • Entry Inhibitors

        • inhibits HIV from entering the host cell

      • Integrase Inhibitors

        • inhibit viral DNA from integrating with host DNA

      • PrEP

        • tenofovir and emtricitabine

        • prevent HIV infection if at high risk of exposure