Antiviral Drugs Quiz
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Questions and Answers

What is the primary means of preventing influenza?

  • Antiviral drugs
  • Vaccines (correct)
  • Neuraminidase inhibitors
  • Antibacterial drugs

    • What is the enzyme that neuraminidase inhibitors target in influenza A and B viruses?

  • DNA polymerase
  • Reverse transcriptase
  • Neuraminidase (correct)
  • Protease

    • What is the benefit of starting neuraminidase inhibitor therapy as early as possible for patients with confirmed or suspected influenza?

  • Reducing the risk of complications (correct)
  • Preventing the spread of influenza
  • Shortening the duration of illness by several weeks
  • Increasing the severity of symptoms

    • What is the role of neuraminidase in the life cycle of influenza viruses?

    <p>It enables the release of virions from infected cells</p> Signup and view all the answers

    What is the effect of neuraminidase on the respiratory tract mucous?

    <p>It inactivates the mucous to allow the spread of virions</p> Signup and view all the answers

    When are neuraminidase inhibitors most beneficial in reducing symptom severity and duration of illness?

    <p>If given within 48 hours of the onset of symptoms</p> Signup and view all the answers

    What type of patient should receive neuraminidase inhibitor therapy?

    <p>Patients who are hospitalized or at higher risk of complications</p> Signup and view all the answers

    What is the effect of neuraminidase inhibitors on the complications of influenza?

    <p>They reduce the risk of complications</p> Signup and view all the answers

    What is the unique mechanism of action of Baloxavir Marboxil (Xofluza)?

    <p>Targets ribonuclease activity that affects transcription of viral RNA</p> Signup and view all the answers

    What is the primary reason the CDC recommended against prophylaxis for influenza?

    <p>Due to risk of resistance</p> Signup and view all the answers

    What is the main advantage of valacyclovir over acyclovir?

    <p>Higher oral bioavailability</p> Signup and view all the answers

    Which of the following is NOT a nucleoside analogue used to treat herpesvirus infections?

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

    What is the main benefit of using antiviral medications to treat genital herpes?

    <p>Prevents replication of HSV and reduces pain and symptoms</p> Signup and view all the answers

    Which medication has the greatest bioavailability for treating herpesvirus infections?

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

    What is the primary indication for using Baloxavir Marboxil (Xofluza)?

    <p>Treatment of influenza A and B</p> Signup and view all the answers

    What is the benefit of the Zostavaz vaccine for older adults?

    <p>Reduces the incidence and severity of herpes zoster infections</p> Signup and view all the answers

    What is the primary mechanism of action of NRTIs in the treatment of HIV?

    <p>Inhibiting the reverse transcription of viral RNA to DNA</p> Signup and view all the answers

    What is the benefit of using HAART in the treatment of HIV infection?

    <p>Markedly reducing viral load and improving survival</p> Signup and view all the answers

    What enzyme is responsible for cleaving polyproteins into smaller functional proteins during viral maturation?

    <p>HIV protease</p> Signup and view all the answers

    What is the result of the incorporation of viral DNA into the host genome?

    <p>Transcription and translation of viral DNA</p> Signup and view all the answers

    What is the primary mechanism of action of PIs in the treatment of HIV?

    <p>Inhibiting the cleavage of polyproteins during viral maturation</p> Signup and view all the answers

    What is the goal of recent developments in HAART regimens?

    <p>Developing regimens that require only a few doses each day</p> Signup and view all the answers

    What is the function of reverse transcriptase in the replication of HIV?

    <p>Converting viral RNA to DNA</p> Signup and view all the answers

    What is the result of the entry of HIV into CD4 cells?

    <p>Reverse transcription of viral RNA to DNA</p> Signup and view all the answers

    What is the primary mechanism of action of enfuvirtide?

    <p>It blocks the fusion of HIV with CD4 cells.</p> Signup and view all the answers

    Which of the following statements about non-nucleoside reverse transcriptase inhibitors (NNRTIs) is TRUE?

    <p>They do not bind to the active site of the HIV protease enzyme.</p> Signup and view all the answers

    What is the benefit of using maraviroc in HIV treatment?

    <p>It is active against HIV strains resistant to RTIs and PIs.</p> Signup and view all the answers

    What is the mechanism of action of raltegravir?

    <p>It prevents the incorporation of viral DNA into host DNA.</p> Signup and view all the answers

    Which of the following is a unique characteristic of efavirenz?

    <p>It is teratogenic and should be avoided in pregnancy.</p> Signup and view all the answers

    What is the main mechanism of action of protease inhibitors (PIs)?

    <p>They bind to the active site of the HIV protease enzyme and inhibit its activity.</p> Signup and view all the answers

    What is the advantage of using a regimen containing raltegravir for initial HIV treatment?

    <p>It is recommended by recent guidelines for initial treatment.</p> Signup and view all the answers

    Which of the following is a characteristic of atazanavir and darunavir?

    <p>They are the preferred PIs for treating HIV today.</p> Signup and view all the answers

    What is the primary indication for using enfuvirtide?

    <p>Treatment of drug-resistant HIV strains.</p> Signup and view all the answers

    What is the route of administration for enfuvirtide?

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

    What is the role of ritonavir in boosted therapy?

    <p>It inhibits the metabolism of other PIs, increasing their plasma levels and duration.</p> Signup and view all the answers

    What is a common side effect of enfuvirtide?

    <p>Injection site reactions</p> Signup and view all the answers

    What is the common adverse effect of nevirapine?

    <p>Rash is the most common side effect.</p> Signup and view all the answers

    Why is efavirenz avoided in pregnancy?

    <p>Because it is teratogenic.</p> Signup and view all the answers

    What is the name of the combo drug product containing ritonavir and another PI?

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

    What is the unique characteristic of HIV protease?

    <p>It is responsible for maturation of the virus.</p> Signup and view all the answers

    Study Notes

    Antiviral Drugs

    • Antibacterial and antifungal drugs have little to no effect on viral infections
    • Compounds have been developed to treat some viral infections (e.g., HIV, influenza, and hepatitis)
    • Antiviral drugs work in a variety of ways (e.g., prevent replication of viral nucleic acid; inhibit entry, uncoating, or release of virus)

    Influenza

    • One of the most common causes of infectious disease-related deaths
    • Vaccines are the primary means of prevention
    • Neuraminidase inhibitors are useful for prophylaxis, during outbreaks, can shorten duration of illness in infected persons and prevent complications

    Neuraminidase Inhibitors

    • Reduce complications including otitis media (OM) and pneumonia (PNA)
    • Drug therapy should be started as early as possible for any patient with confirmed or suspected influenza who is hospitalized, has severe illness, or is at higher risk of complications
    • Most beneficial in reducing symptom severity and duration of illness if given < 3 days after onset, preferably within 48 hours
    • May still provide benefit in reducing respiratory failure and death in pregnant women if started 3-4 days after onset

    Prophylaxis

    • 70-90% effective in preventing influenza, useful adjuncts to vaccines
    • CDC recommended against prophylaxis because of risk of resistance
    • Only prophylaxis, populations at risk of complications and control institutional outbreaks

    Baloxavir Marboxil (Xofluza)

    • Single dose PO treatment for influenza A and B
    • First-in-class medication
    • Unique mechanism of action (MOA) targets ribonuclease activity that affects transcription of viral RNA
    • Approved in the US in 2018
    • Potentially less side effects vs oseltamivir

    Herpesviruses

    • Cytomegalovirus (CMV) infections in immunocompetent are usually asymptomatic
    • CMV retinitis, esophagitis, and colitis usually seen in immunocompromised patients

    Drugs for Herpesviruses

    • Nucleoside analogues:
      • Acyclovir (Zovirax): IV acyclovir most effective for serious herpesvirus infections, including encephalitis and infections in immunocompromised patients; topical acyclovir can be used to treat genital herpes and mild mucocutaneous infections
      • Ganciclovir (Cytovene)
      • Trifluridine (Viroptic)
      • Valacyclovir (Valtrex): prodrug that gets rapidly converted to acyclovir by intestinal and hepatic enzymes, more completely absorbed (55%)
      • Famciclovir (Famvir): has the greatest bioavailability (80%)
    • Other drugs:
      • Foscarnet (Foscavir)

    Treating Genital Herpes

    • When given orally for genital herpes, prevents replication of HSV and reduces pain and other symptoms of acute infection
    • Shortens time to healing of lesions, reduces the amount of viral shedding
    • Does not eliminate the virus, recurrent episodes are common (can be treated with lesser doses)

    Treating Shingles

    • When given orally for shingles, shortens duration of acute illness and pain and lowers incidence of postherpetic pain
    • Famciclovir and valacyclovir are more effective than acyclovir
    • Newer drugs have less frequent administration, higher serum levels
    • A vaccine is now available (Zostavaz) that reduces the incidence and severity of herpes zoster infections in older adults

    Human Immunodeficiency Virus (HIV)

    • Many remarkable advancements have been made in treating HIV infection and AIDS
    • Combined use of 2 or more drugs from different classes have been shown to markedly reduce viral load and improve survival
    • Multidrug treatment called highly active antiretroviral therapy (HAART)

    HAART

    • Initially were complicated regimens requiring multiple doses of several drugs every day
    • Recent emphasis on developing drug regimens that require only a few doses each day or even a single pill (like Atripla)
    • Guidelines continue to evolve as new regimens are developed and testing

    Pathophysiology of HIV

    • Enters CD4 cells, viral RNA produced double-stranded DNA via reverse transcriptase
    • Viral DNA enters host cell nucleus and gets incorporated into host genome via HIV integrase
    • Eventually, the viral DNA gets transcribed/translated to produce polyproteins that get packed into immature virions
    • HIV protease cleaves polyproteins into smaller functional proteins during viral maturation where virions get released into plasma

    Drug Classes

      1. Nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs)
      1. Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
      1. Protease inhibitors (PIs)
      1. Fusion and entry inhibitors
      1. Integrase inhibitors

    Non-nucleoside Reverse Transcriptase Inhibitors (NNRTIs)

    • Do not require metabolic activation and are not incorporated into viral DNA
    • Efavirenz is the most potent NNRTI available, preferred for initial treatment of people with HIV because it can be taken qd
    • Nevirapine is used in combo with two NRTIs
    • Delaviridine, not recommended for most patients, has lower antiviral activity compared to others in this class

    Protease Inhibitors (PIs)

    • HIV protease is responsible for maturation of the virus
    • Protease inhibitors bind to the active site of the enzyme and inhibit its activity, resulting in production of immature, non-infectious virus particles
    • First PI introduced in 1995, ushered in a new era of HIV treatment
    • Newer PIs like atazanavir are better tolerated and have improved pharmacokinetic properties
    • Atazanavir and darunavir are the preferred PIs for treating HIV today

    Fusion and Entry Inhibitors

    • Enfuvirtide (Fuzeon [T-20]): large peptide that binds to HIV glycoprotein 41 and blocks fusion process; not active when given orally, must be injected sq bid
    • Maraviroc (Selzentry)
    • Newer drugs that inhibit fusion and entry of HIV
    • Active against HIV strains resistant to RTIs and PIs
    • Approved to treat HIV infection caused by drug-resistant strains

    Integrase Inhibitors

    • Integrase incorporates viral DNA formed by reverse transcriptase into DNA of CD4 cells
    • Raltegravir (Isentress) is the first integrase strand inhibitor approved to treat HIV
    • Works by preventing DNA strand transfer
    • Potent in vitro activity against wild-type and MDR HIV strains
    • Recent recommendations for initial treatment include a regimen containing raltegravir

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    Description

    This quiz covers the basics of antiviral drugs, including their mechanism of action and effectiveness against various viral infections such as HIV, influenza, and hepatitis.

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