AntiViral-Fung24_Tbl (2-16-24).pdf

Anti-Infective (Anti-Viral)Drugs/Pharm II Diane T. Adamczyk, OD/Copyright © 2024 AntiViral Drug Pharmacology Use Dosage ADR Miscellaneous Vidarabine (Vira-A) Discontinued Idoxuridine Adenosine analog > Inhibit viral DNA polymerase HSV cornea Sting Corneal changes Not available Thymidine analog > Cre...

Anti-Infective (Anti-Viral)Drugs/Pharm II Diane T. Adamczyk, OD/Copyright © 2024 AntiViral Drug Pharmacology Use Dosage ADR Miscellaneous Vidarabine (Vira-A) Discontinued Idoxuridine Adenosine analog > Inhibit viral DNA polymerase HSV cornea Sting Corneal changes Not available Thymidine analog > Creates fraudulent DNA HSV cornea Toxic (corneal) Not available Thymidine analog 1-Inhibit thymidine synthetase>Inhibit DNA synthesis in virus infected & normal host cells 2-Incorporate DNA>faulty DNA > no virus replication Guanosine derivative Inhibit DNA replication; competitive inhibition of viral DNA polymerase; incorporate into viral DNA Guanosine analog > 1-Affects viral enzymes (DNA polymerase) 2-Incorporates into and terminates growing viral DNA chain Antimicrobial-broad spectrum HSV cornea Solution 9X (Q2H)(while awake)>reepithelization, Q4Hx7dy Toxic to cornea Corneal defects Hyperemia, chemosis May use during pregnancy HSV cornea Gel 5x/day (Q3H), then TIDx7days Blurred vision Eye irritation May use during pregnancy HS keratitis Ointment 5x/day until healed; then TID x 7 days Low toxicity Not available US EKC Periocular surg prep Solution 4-5 drops/lavage/anesthetic Corneal stippling Sting Use with anesthetic Use within 4 days of symptom onset Single in office use Guanosine analog 1-Competitively inhibits and inactivates viral DNA polymerase 2-Incorporates into and terminates growing viral DNA chain HS/HZ/Varicella Off-label: HZ: 800mg 5x/dy x 7dys (72hrs onset max efficacy 48hr; >72hrs if still new lesions) HS keratitis: 400mg 5x/day HS keratitis prophylactic: 400mg BID Bell Palsy (new onset): 400mg 5x/dy x 10dys (with steroid)(within 72h) HZ: 1000mg TID X 7dys (72hrs onset) HS keratitis: 500mg TID HS keratitis prophylactic: 500mg QD Bell Palsy (new onset): 1g TID x 7dys (with steroid)(within 72h) Safe/Low toxicity Nausea, vomit, diarrhea, HA May be use during pregnancy HZ: 500 mg TIDX 7dys (72hrs onset, max efficacy w/in 48h) HA Nausea, diarrhea, vomit Caution in renal impairment Ophthalmic Antiviral (Topical) (IDU,Stoxil) Discontinued Trifluridine (Viroptic) Generic Ganciclovir (Zirgan 0.15%) Acyclovir ophthalmic (Not availableUS) Povidone-Iodine 5% ophthalmic solution Ung (Betadine) Systemic Antiviral Acyclovir (Zovirax) Valacyclovir (Valtrex) 20% bioavailability L-valyl ester acyclovir (prodrug of acyclovir) 50% bioavailability Famciclovir Selective inhibit viral DNA polymerase Rapid absorb GI> convert to penciclovir (Prodrug penciclovir) 77% bioavailability Ganciclovir (Cytovene) Foscarnet (Foscavir) Deoxyguanosine analog (differ ACV by add hydroxymethyl group) Pyrophosphate analog Inhibits viral DNA polymerase and reverse transcriptase (RNA polymerase) Thymidine analog Zidovudine (Retrovir) Please confirm online for latest updates HSV prophylaxis HSV keratitis Acute retinal necrosis HZO Bell palsy (new onset) HS/HZ Off label use: HSV prophylaxis Acute retinal necrosis HZO Bell palsy (new onset) HS/HZ Off label use: HSV prophylaxis Acute retinal necrosis HZO Bell palsy (new onset) CMV retinitis in immunocompromised CMV retinitis-AIDS Associated HIV HS keratitis: 250mg TID x 7-10dys Bell’s Palsy: 500mg TID x 7dys (with steroid) (within 72h) IV infusion IV infusion PO (post exposure-prophylaxis) Caution in renal impairment and dehydration Nausea, vomiting HA May use during pregnancy Caution in renal impairment and dehydration Weigh risk/benefit during pregnancy; inadequate human data; no known risk of fetal harm Bone marrow depression Fever GI disturb Renal Impairment Bone marrow hypoplasia 1 Anti-Infective (Anti-Viral)Drugs/Pharm II Diane T. Adamczyk, OD/Copyright © 2024 Antifungal Drug Mechanism Pharmacology Use Effect Dosage ADR Miscellaneous Natamycin 5% suspension (Natacyn) Bind irreversibly to ergosterol in cell membrane, ^membrane permeability Polyene Corneal fungal infections Q1-2H/dy x 3-4 days, then 6-8x/day Hyperemia Only topical drug for fungal infection US Suspension Polyene Systemic fungal infection Aspergillus Fusarium Blastomyces Histoplasma Candida Coccidioides INJ Toxic HA Chills, fever Vomit, GI cramps Hypokalemia Renal toxicity (Intravitreal Subconj) Candida Oral Aspergillus Candida Fusarium Candida Aspergillus Oral/IV/Susp Use Effect Dosage ADR Miscellaneous Topical antiseptic Bacteria Fungi Viruses Single use Ophthalmic Antifungal (Topical) Includes: Aspergillus Fusarium Candida Similar Amphotericin Systemic Antifungal Amphotericin B Bind irreversibly to ergosterol in cell membrane, ^membrane permeability Fluconazole Alters fungal cell membrane Triazole Voriconazole Derivative of fluconazole Triazole Nystatin Alters fungal cell membrane Polyene Other Mechanism Pharmacology Povidone-Iodine (7.5% and 10%) (Betadine) Broad-spectrum microbicide Tea Tree Oil (Cliradex) Antimicrobial mechanism poorly understood Possible compromise of cytoplasmic membrane Ectoparasiticide Lotilaner 0.25% ophthalmic solution (xdemvy) Please confirm online for latest updates Off label: Fungal corneal ulcers Fungal endophthalmitis Fungal infection Off label: Fungal corneal ulcers Fungal endophthalmitis Fungal Infection Off label: Fungal corneal ulcer Fungal infection Off label: Fungal ulcers Terpinen-4-ol Demodex related blepharitis Gammaaminobutyric acid (GABA) gated chloride channel inhibitor Demodex blepharitis Topical Fortified Use Oral Topical (non-ocular) Betadine solution (10%) Betadine Surgical Scrub (7.5%) Prep for surgery Surgical scrub QD or BID x 6-8 weeks Selective for Demodex mites BID x 6 weeks 2