4.2.2_Pharm

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Anonymous
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12809
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4.2.2_Pharm
Updated:
2010-04-01 10:59:23
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viral drugs
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4.2.2_Pharm
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  1. Prevent or reduce transmission (hygiene, public health, nosocomial prevention)
    Immunization
    Controlling viral disease
  2. Effective against many viruses, directed against surface antigens
    Monoclonal: Palivizumab for RSV
    Polyclonal: CMV ___ ___, hep B ___ ___, Rabies ___ ___, and varicella-zoster ___ ___ are used to prevent viral infection in exposed Pt's.
    Usefulness: acute, serious dz administered w/ nucleoside antiviral to obtain synergistic effect; post exposure prophylaxis
    IV-IG to obtain high titer of antiviral antibodies
    Immune Globulin
  3. Lead to rapid secondary immune response
    Effective for HPV (Gardacil for HPV 6,11,16,18), Hep A (Havrix) and B, Polio, Rabies, yellow fever, VZV (Varivax); MMR, Flu (effective for 6 mo. or longer)
    Side effects: fever, achy muscles, malaise
    Administered IV or orally
    Vaccines
  4. 3 classes of antiviral chemotherapy
    • Immune modulators (Vaccines, immune globulin, IFNs)
    • Inhibitors of viral replication
    • Inhibitors of viral entry

    Goal is to inhibit virus w/out causing cell toxicity
  5. Viruses: influenza A & B
    Mech: inhibits neuraminidase (enables virus to be released from cell)
    Notable ADME: (1) inhalation poorly adsorbed), (2) oral prodrug, hepatic metabolism
    Adverse effects: Psychiatric bx, bronchospasm (1), d/n and sinusitis
    • (1) Zanamivir
    • (2) Oseltamivir

    Neuraminidase inhibitors
  6. Viral uncoating inhibitors
    Influenza A
    Mech: inhibits M2 ion channel; inhibits uncoating of virus endosome
    (1) Hepatic clearance; (2) renal clearance
    Resistance since 2005 (no longer used)
    Adverse effects: GI, CNS
    (2) Exhibits some anti-parkinsons activity
    (1) Rimantadine; (2) Amantadine)
  7. Activity: HSV, VZV (limited use for CMV and EBV)
    Mech: converted by viral thymidine kinase; Tri-PO4 cmpd inhibits viral DNA synthesis
    higher affinity for viral DNA polymerase, competes w/ guanine, incorporated into growing DNA chain of virus => terminating synthesis
    Resistance: Deficient TK, altered TK, altered DNA polymerase
    Side effects: n/v, rash, phlebitis, CNS & nephrotoxicity in renal impaired Pt's
    Acyclovir and Valacyclovir
  8. Activity: CMV (much greater the acyclovir), HSV, VZV, human herpes virus 6
    Mech: less dependent on viral TK
    More toxic than acyclovir; myelosuppression
    Ganciclovir
  9. Similar to acyclovir but longer duration of action
    cross resistance w/ acyclovir
    Side effects: headache, GI
    Famciclovir
  10. Activity: CMV, HSV, VZV, EBV, HHV-6 (secondary to gancyclovir and acyclovir in compromised Pt's)
    Mech: Cytosine analog, inhibits viral DNA synthesis (not dependent on TK)
    DLT: nephrotoxicity
    Resistance due to mutations in viral DNA polymerase
    Administered IV (not orally)
    Cidofovir
  11. Activity: HSV, VZV, CMV, HHV-6, HIV
    Mech: inhibits DNA polymerase (mimics pyrophosphate)
    Side effects: many, Headache, tremor, irritability, seizures, hallucinations (due to changes in Ca levels)
    DLT: nephrotoxicity and hypocalcemia
    ADME: IV, accumulates in bone (but no myelosuppression)
    Foscarnet
  12. Activity:
    Idoxuridine and Trifluridine
  13. First anti-sense therapy for viral infection
    Fomivirsen
  14. Long chain fatty acid alcohol
    Docosanol
  15. RNA and DNA viruses
    Interferon
  16. Activity:
    Ribavirin
  17. Adefovir
    Lamivudine
  18. FDA approved for HPV infections
    Mech: dependent on TLR7, induces secretion of pro-inflammatory cytokines (IFN & TNF & interleukins)
    Topical Admin
    Imaquimod

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