Antiviral Agents and CMV Infections
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Antiviral Agents and CMV Infections

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Questions and Answers

What is the mechanism of action of Cidofovir?

  • Inhibits reverse transcriptase
  • Inhibits viral entry into cells
  • Inhibits viral DNA synthesis (correct)
  • Acts as a nucleoside analog

    • Which side effect is common to both Ganciclovir and Valganciclovir?

  • Hepatotoxicity
  • Cardiotoxicity
  • Myelosuppression (correct)
  • Nephrotoxicity

    • Which drug interaction is associated with Ganciclovir?

  • Increased nephrotoxicity with loop diuretics
  • Decreased effect of zidovudine
  • Enhanced myelosuppression with zidovudine (correct)
  • Increased effect of acyclovir

    • What is the primary contraindication for the use of Cidofovir?

    <p>Elevated serum creatinine levels greater than 1.5</p> Signup and view all the answers

    Valganciclovir is a prodrug of which antiviral medication?

    <p>Ganciclovir</p> Signup and view all the answers

    Which common side effect occurs with Valganciclovir?

    <p>Diarrhea</p> Signup and view all the answers

    What should be done regarding dosage for patients taking Ganciclovir?

    <p>Renal function must be monitored for dosage adjustment</p> Signup and view all the answers

    What is a significant characteristic of the Black Box Warning (BBW) for these antivirals?

    <p>Myelosuppression and teratogenic effects</p> Signup and view all the answers

    Which of the following is a common side effect of Acyclovir?

    <p>Rash</p> Signup and view all the answers

    What is the primary mechanism of action of Acyclovir?

    <p>Inhibition of DNA synthesis</p> Signup and view all the answers

    Which statement regarding the renal dosing of Acyclovir is true?

    <p>Dose adjustment is necessary in patients with renal impairment</p> Signup and view all the answers

    What should be monitored closely when administering Acyclovir intravenously?

    <p>Hydration status</p> Signup and view all the answers

    Which of the following is a serious adverse effect of Acyclovir?

    <p>Renal failure</p> Signup and view all the answers

    What is a contraindication for Acyclovir?

    <p>Hypersensitivity to the drug</p> Signup and view all the answers

    What is the significance of labeling Valacyclovir as a prodrug?

    <p>It converts to Acyclovir in the body</p> Signup and view all the answers

    Which of the following is NOT a common side effect of Valacyclovir?

    <p>Diarrhea</p> Signup and view all the answers

    What adjustment is necessary for the dosing of Acyclovir?

    <p>Adjustment based on ideal body weight</p> Signup and view all the answers

    Which common side effect is associated with both Valacyclovir and Acyclovir?

    <p>Abdominal pain</p> Signup and view all the answers

    What is the primary mechanism of action for nucleoside and nucleotide analogues?

    <p>Phosphorylation of prodrug by viral kinases</p> Signup and view all the answers

    Which of the following is a common side effect associated with Oseltamivir (Tamiflu)?

    <p>Vomiting</p> Signup and view all the answers

    What is a contraindication for Amantadine (Symmetrel)?

    <p>Severe renal impairment</p> Signup and view all the answers

    Which of the following statements accurately describes the mechanism of action for inhibitors of viral uncoating?

    <p>They block M2 proton channels to inhibit virus disassociation</p> Signup and view all the answers

    What drug interaction should be considered when administering Baloxavir (Xofluza)?

    <p>Decreased absorption with divalent cations</p> Signup and view all the answers

    What is the mechanism of action of nucleoside and nucleotide analogues?

    <p>They inhibit viral DNA polymerase by phosphorylation.</p> Signup and view all the answers

    Which common side effect is associated with the use of Penciclovir?

    <p>Local irritation</p> Signup and view all the answers

    Which statement about Idoxuridine is true?

    <p>It is used to treat herpes simplex keratoconjunctivitis.</p> Signup and view all the answers

    What mechanism does Trifluridine utilize to disrupt viral replication?

    <p>Incorporation into viral DNA in place of thymidine</p> Signup and view all the answers

    Which of the following is a serious side effect commonly reported for the agents discussed?

    <p>None reported</p> Signup and view all the answers

    Which drug is used for the treatment of herpetic lesions on the lips and face?

    <p>Penciclovir</p> Signup and view all the answers

    What is a contraindication for using topical antiviral agents?

    <p>Avoiding contact with eyes and mucous membranes</p> Signup and view all the answers

    What side effect is associated with Vidarabine?

    <p>Photophobia</p> Signup and view all the answers

    How does the administration of nucleoside analogues affect viral cells?

    <p>It decreases DNA synthesis in virus-infected cells.</p> Signup and view all the answers

    What is a common indication for the use of Trifluridine?

    <p>Keratoconjunctivitis caused by HSV</p> Signup and view all the answers

    What serious condition is associated with the use of a certain nucleoside analogue?

    <p>Thrombotic thrombocytopenic purpura</p> Signup and view all the answers

    Which common side effect is reported for Famciclovir?

    <p>Nausea, vomiting, and diarrhea</p> Signup and view all the answers

    What is the best way to adjust the dosage of penciclovir?

    <p>Adjust based on renal function</p> Signup and view all the answers

    Which condition represents a contraindication for nucleoside analogue use?

    <p>None reported</p> Signup and view all the answers

    What mechanism of action is associated with nucleoside analogues?

    <p>Inhibition of viral DNA synthesis</p> Signup and view all the answers

    Which serious side effect is particularly associated with nephrotoxicity?

    <p>Hemolytic uremic syndrome</p> Signup and view all the answers

    What is a known common side effect of certain nucleoside analogues?

    <p>Fatigue</p> Signup and view all the answers

    Which adverse reaction requires patients to maintain adequate hydration while using nucleoside analogues?

    <p>Crystalluria</p> Signup and view all the answers

    Which condition can be classified as a serious side effect of nucleoside analogues?

    <p>Encephalopathy</p> Signup and view all the answers

    What is the pharmacological classification of Famciclovir?

    <p>Prodrug of penciclovir</p> Signup and view all the answers

    What is the primary function of Oseltamivir (Tamiflu®) in treating influenza?

    <p>It inhibits neuraminidase, preventing the release of new virions.</p> Signup and view all the answers

    Which of the following is a serious side effect associated with Oseltamivir?

    <p>Severe rash (SJS/TENS)</p> Signup and view all the answers

    What is the recommended timing for initiating Oseltamivir treatment for it to be effective?

    <p>Within 48 hours of symptom onset</p> Signup and view all the answers

    Which type of drug interaction is noted for Oseltamivir?

    <p>Adverse effects when taken with live influenza vaccine</p> Signup and view all the answers

    What specific warning is associated with Oseltamivir that patients should be aware of?

    <p>Severe neuropsychiatric events</p> Signup and view all the answers

    Study Notes

    Antiviral Agents

    • Mechanism of Action: Antivirals target viral enzymes and processes to interfere with viral replication. Some common mechanisms include:
      • Nucleosides and Nucleotide Analogues: These drugs get incorporated into viral DNA and/or RNA, leading to faulty and nonfunctional viral components.
      • Enzyme Inhibition: Inhibiting viral enzymes required for viral replication.

    Antiviral Agents for Cytomegalovirus (CMV) Infections

    • Ganciclovir (Cytovene®):

      • Available in oral, intravenous, and ophthalmic formulations.
      • Indications: CMV infection, certain HSV and VZV infections, and as a special chemotherapy agent.
      • Administered via IV as a special formulation.
      • Black Box Warning (BBW): Myelosuppression, carcinogenic, and teratogenic.
      • Common Side Effects: Fever, nausea, vomiting, diarrhea, and anorexia.
      • Serious Side Effects: Myelosuppression, seizures, increased serum creatinine (Scr).
      • Drug Interactions: Significant interaction with zidovudine, potentially causing myelosuppression.
      • Pregnancy Category: C, but considered teratogenic.
      • Administration: Renal dose adjustments are required. Special chemotherapy handling is needed.

    • Valganciclovir (Valcyte®):

      • A prodrug of ganciclovir, converted to active form by GI esterases.
      • Given orally and absorbed better than ganciclovir.
      • Indications: CMV, HSV, and VZV infections.
      • BBW: Similar to ganciclovir.
      • Common Side Effects: Similar to ganciclovir.
      • Serious Side Effects: Myelosuppression (less common than with ganciclovir), but can still occur.
      • Drug Interactions: Limited drug interactions.
      • Pregnancy Category: C, but considered teratogenic.
      • Administration: Renal dose adjustments are required. Special chemotherapy handling is needed.
      • Take with food to improve absorption.

    • Cidofovir (Vistide®):

      • Given intravenously.
      • BBW: In addition to BBW for Ganciclovir, dose-related nephropathy should also be watched for.
      • Contraindications: Scr > 1.5 mg/dL and CrCl < 50 mL/min (adjust dose accordingly).
      • Common Side Effects: Similar to ganciclovir & valganciclovir.
      • Serious Side Effects: Nephropathy (dose-related).
      • Administration: Renal dose adjustments are required. Maintain adequate hydration.

    Other Antiviral Agents

    • Acyclovir (Zovirax®):

      • Available in oral, intravenous, and topical formulations.
      • Mechanism of Action: Inhibits viral DNA polymerase.
      • Indications: HSV and VZV infections, viral encephalitis.
      • Common Side Effects: Rash, nausea, vomiting, abdominal pain, headache, fatigue, transient changes in BUN and Scr.
      • Serious Side Effects: CNS (encephalopathy, confusion, delirium, seizures), crystalluria, renal failure, thrombotic thrombocytopenic purpura, hemolytic uremic syndrome, SJS/TENS.
      • Administration: Renal dose adjustments are required. Maintain adequate hydration. Drug is stable in normal saline (not D5W). Dose based on ideal body weight.

    • Valacyclovir (Valtrex®):

      • Oral prodrug of acyclovir, metabolized to active form via GI esterases.
      • BBW: None.
      • Common Side Effects: Rash, nausea, vomiting, abdominal pain, headache, fatigue.
      • Serious Side Effects: Thrombotic thrombocytopenic purpura, crystalluria, hemolytic uremic syndrome, seizures, CNS events (encephalopathy, confusion, delirium).
      • Administration: Renal dose adjustments are required. Maintain adequate hydration.

    • Famciclovir (Famvir®):

      • Oral prodrug of penciclovir.
      • BBW: None.
      • Common Side Effects: Headache, nausea, vomiting, and diarrhea.
      • Serious Side Effects: Erythema multiforme, SJS, nephrotoxicity (especially at high doses).
      • Administration: Renal dose adjustments are required.

    • Penciclovir (Denavir®):

      • Topical cream for treating herpetic lesions on the lips and face.
      • Common Side Effects: Local irritation, headache.
      • Serious Side Effects: None.
      • Important Considerations: Avoid contact with eyes and mucous membranes.

    • Trifluridine (Viroptic®):

      • Ophthalmic solution for keratoconjunctivitis.
      • Mechanism of Action: Incorporated into viral DNA in place of thymidine, resulting in faulty viral DNA.
      • Common Side Effects: Burning, edema
      • Serious Side Effects: None.
      • Administration: Refrigerate solution.

    • Idoxuridine (Herplex®):

      • Ophthalmic solution for keratoconjunctivitis.
      • Common Side Effects: Photophobia, local irritation.
      • Serious Side Effects: None.
      • Important Considerations: Not currently available in the United States.

    • Vidarabine (Vira-A®):

      • Topical ointment for keratoconjunctivitis.
      • Common Side Effects: Photophobia, local irritation.
      • Serious Side Effects: None.
      • Important Considerations: Not currently disponível nos Estados Unidos.

    Anti-Influenza Agents

    • Inhibitors of Viral Uncoating prevent influenza A viruses from uncoating inside host cells by blocking M2, a proton channel that acidifies the interior of the virus. This is necessary for the dissociation of the viral matrix protein from the viral ribonucleic protein (RNA).
    • Rimantadine and Amantadine are drugs that work by inhibiting viral uncoating. They are both administered orally and metabolized differently; Rimantadine is metabolized in the liver, while Amantadine is excreted by the kidneys.
    • Both drugs are used to treat or prevent influenza A but not influenza B infections.
    • Amantadine can increase the risk of neurologic effects and greater dose adjustments are necessary with lower creatinine clearance (CrCl), a measure of kidney function.
    • Rimantadine is a common drug but can be difficult to use due to the need to adjust dosages in patients with impaired liver function.

    Inhibitors of Viral Release

    • Inhibitors of Viral Release prevent influenza viruses from spreading by inhibiting neuraminidase, an enzyme that enables newly synthesized virions to detach from host cells.
    • Oseltamivir is the most common inhibitor of viral release, and is a prodrug (a substance that becomes active in the body) that gets activated via ester hydrolysis.
    • Zanamivir is a well-established inhibitor of viral release, with low bioavailability (~4-17%). It is administered via a diskhaler device.
    • Peramivir is also a well-established inhibitor of viral release that requires a single 600-mg dose.
    • Oseltamivir, Zanamivir, and Peramivir are all recommended for use in influenza A and B infections.

    Endonuclease Inhibitor

    • Baloxavir marboxil is a prodrug that is converted to baloxavir, which inhibits influenza virus replication. Baloxavir inhibits the endonuclease activity of the polymerase acidic (PA) protein, which is essential for the replication of influenza virus.
    • Baloxavir marboxil has an 80-hour half-life and is administered orally.

    Agents for Human Papillomavirus (HPV)

    • Immune Modulating agents for HPV infections work by interacting with Toll-like receptor 7 to boost innate immunity and interferon secretion.
    • Imiquimod is the most common immune modulating agent for HPV infections. It is applied topically and is effective against a variety of HPV-related conditions, including condyloma acuminatum, actinic keratosis, and basal cell carcinoma.

    Agents for Herpes Simplex Virus (HSV) and Varicella-Zoster Virus (VZV)

    • Fusion Inhibitors prevent the fusion of the HSV membrane with the plasma membrane of the host cell, preventing the virus from entering the cell and replicating.
    • Docosanol is a topical agent that is used to treat herpetic lesions on lips and face.

    Nucleoside and Nucleotide Analogues

    • Nucleoside and Nucleotide Analogues are used to treat HSV and VZV infections. These drugs work by inhibiting DNA polymerase, which slows viral replication.
    • Nucleoside and Nucleotide Analogues are phosphorylated by viral kinases, which leads to inhibition of DNA polymerase.

    Influenza Viral Release Inhibitors

    • Mechanism of Action: Prevents release of newly formed virus particles by inhibiting the enzyme neuraminidase, leaving the virus attached to the host cell.

    • Oseltamivir (Tamiflu®)

      • Pharmacokinetics: PO (oral) prodrug that is activated in the liver via ester hydrolysis to the active form.
      • Clinical Uses: Recommended by the CDC for both treatment and prophylaxis of Influenza A and B infections.
      • Timing: Begin taking within 48 hours of symptom onset for optimal efficacy.
      • Administration: Take with food.
      • Adverse Effects:
        • Common: Nausea, vomiting, abdominal pain.
        • Serious: Rash (Stevens-Johnson syndrome (SJS)/Toxic epidermal necrolysis (TEN), neuropsychiatric events (e.g., delirium, hallucinations, seizures).
      • Drug Interactions: Avoid concurrent administration with live influenza vaccine.

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    Description

    This quiz covers antiviral agents, focusing on their mechanisms of action, specifically for cytomegalovirus (CMV) infections. Learn about ganciclovir, its formulations, indications, and potential side effects. Test your knowledge on how these agents function in combating viral replication.

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