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Chapter 29: Anti-Viral Medications


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What is the general mechanism of antiviral action?
Inhibit steps in viral replication --> virustatic, not virucidal.
Most of the drugs are nucleotide analogues, which are like monkey wrenches thrown into the gears of replication.
Which drugs act against the herpesviruses?
Acyclovir and ganciclovir
Which herpesviridae virus is not targeted by acyclovir? Why?
CMV, because it lacks the thymidine kinase necessary to phosphorylate the drug to its active form
Gancyclovir is toxic to which human cells?
Rapidly replicating human cells: neutrophils and platelets
What are the clinical uses of acyclovir?
1. In the immunocompetent patient, it is reserved for more serious infections including HSV encephalitis and HSV and zoster infections of the eye
2. In the immunocompromised host, it is used for most herpes infections (mucocutaneous, varicella, and zoster)
What are the adverse effects of acyclovir?
Minimal. Reversible renal toxicity, CNS side effects.
How do famciclovir and valacyclovir improve upon acyclovir? Indications?
Increased drug levels after oral absorption. Herpes zoster and recurrent genital herpes in immunocompetent adults
Ganciclovir is used for...?
CMV infections in immunocompromised hosts:
1. CMV retinits, esophagitis in AIDS patients
2. CMV pneumonitis in bone marrow transplant patients.
Foscarnet is used for...?
AIDS patients with CMV retinitis or acyclovir-resistant strains of herpesviridae.
What drug is used for fighting influenza A? Mechanism?
Amantadine. Inhibits viral genome uncoating in the host cell.
Amantidine is used in which situations?
1. Decreasing the duration of flu symptoms if given early.
2. Preventing an outbreak of Influenza A in nursing homes
What are the benefits of rimantadine?
As effective as amantadine in preventing Influenza A, with fewer CNS side effects and renal complications.
Which drugs have clinical activity against both influenza A and B types? Name them.
Neuraminidase inhibitors. Oseltamivir and zanamavir.
What are the indications for Ribavirin?
1. Severe RSV infections in infants
2. Lassa fever
3. Hantavirus pulmonary syndrome
Interferon alpha has been used to treat...?
Hep C and B infection.

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