Anti Viral

Anti viral
drugs
BY. KEVIL LORIYA

Anti Herpes Drugs (1)
ACYCLOVIR AND VALACYCLOVIR
Acyclovir, valacyclovir, and famciclovir are guanosine analogs
Valacyclovir is the prodrug of acyclovir
Valacyclovir can be taken orally because it has better bioavailability
Mechanism of action
Thymidine kinase is an enzyme produced only by virus infected cells

Thymidine kinase monophosphorylates the drug
Triphosphorylation is completed by normal cellular enzymes which fully activates the drug
Once fully activated, the drug will inhibit viral DNA polymerase by terminating the growing DNA chain
Uses
Famciclovir or valacyclovir are used to treat shingles (Herpes zoster)

Used to treat herpes simplex virus (including HSV-1 and HSV-2)
Treats varicella zoster virus (VZV), or chicken pox
Adverse effects
Can cause nausea and vomiting

Hydration can prevent kidney injury while using these drugs
Resistance through
Resistance to these drugs can develop through alteration of viral thymidine kinase
GANCICLOVIR AND VALAGANCICLOVIR

Ganciclovir and valganciclovir must be activated by viral kinases
Ganciclovir and valganciclovir require 3 phosphate groups (1 added via viral kinase and 2 added via cellular kinases) in order to become fully activated
primarily inhibit the viral DNA polymerase
Valganciclovir has better bioavailability than ganciclovir
Resistance through
Uses
can be used to treat CMV and Herpes
Adverse effects
cause bone marrow suppression as a toxic side effect

may cause renal toxicity
Anti Herpes Drugs (2)
FOSCARNET AND CIDOFOVIR
Foscarnet is a pyrophosphate analog

Cidofovir has a long half-life
Both work by inhibiting viral DNA polymerase
Foscarnet inhibits both viral DNA polymerase and reverse transcriptase
Foscarnet and cidofovir do not require intracellular activation by viral or cellular kinases
Uses
can be used to treat ganciclovir-resistant CMV infections

can be used to treat acyclovir-resistant HSV infections
Adverse effects
Cidofovir and Foscarnet is nephrotoxic

Cidofovir should be administered with probenecid and IV saline to reduce nephrotoxicity
Foscarnet can cause hypocalcemia, hypomagnesemia, hypokalemia, hypophosphatemia
Foscarnet may cause seizures
Resistance through
Anti HIV Drugs (1)
NRTI
Nucleosides must be phosphorylated because they Lacks a 3'OH group
ZIDOVUDINE
can also be used for the prophylaxis of needle stick injury patients
is safe in pregnancy and helps reduce fetal transmission
can cause myopathy
can cause anemia (bone marrow suppression)
DIDANOSINE
dose limiting pancreatitis TENOFOVIR
hyperuricemia, optic neuritis nucleotide and does not need to be
phosphorylated
STAVUDINE can cause Fanconi syndrome
Dose limiting peripheral neuropathy cause bone marrow suppression,
lipodystrophy, and peripheral neuropathy
LAMIVUDINE
Best tolerated
EMTRICITABINE
Adverse effects
can cause lipodystrophy

can cause peripheral neuropathy
can cause bone marrow suppression
Lactic acidosis can be caused by all nucleoside NRTIs
NNRTI
DELAVIRDINE NEVIRAPINE
Adverse effects
inhibits cytochrome P-450 induces cytochrome P-450
can cause rashes
EFAVIRENZ can cause hepatotoxicity
cause vivid dreams can cause Stevens-Johnson Syndrome
induces cytochrome P-450 Can cause jaundice
Anti HIV Drugs (2)
ENFUVIRTIDE
Gp41 permits HIV to enter the host cell
Skin reaction at enfuvirtide injection site
Enfuvirtide can cause diarrhea, nausea and vomiting
MARAVIROC
Gp120 acts by binding to the CCR-5 surface protein on macrophages
Maraviroc blocks the activity of gp120
can cause upper respiratory infections
Works by inhibiting the post-translational modification of viral

This group of drugs inhibits CYP3A4
All protease-inhibitor containing regimens use ritonavir boosting if possible.
(Except Nelfinavir)
Adverse effects
hypercholesterolemia
Diabetes mellitus Lipodystropy syndrome
Hyperlipidemia
Insulin resistance and altered fat distribution
oral drugs
Cobicistat is used to boost the effect of elvitegravir.
Anti Influenza drugs
OSELTAMIVIR AND ZANAMIVIR
Oseltamivir is an oral prodrug

zanamivir is administered by inhalation route
Oseltamivir is drug of choice for bird flu and swine flu
Neuropsychiatric disorders including suicidal have been associated with oseltamivir and zanamivir.
AMANTADINE AND RIMANTADINE
prevent uncoating of influenza A virus (not influenza B).

These drugs decrease the duration of symptoms of influenza if used prophylactically.
Rimantadine is longer acting than amantadine.
Amantadine is also effective for the treatment of Parkinsonism.
Adverse effects
gastrointestinal complaints
minor CNS effects.
Anti Hepatitis B drugs
New drugs
Older drugs
If-alpha
Lamivudine
Ribavirin
Entecavir
Adefovir

Anti Viral

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Anti Viral

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Anti viral

BY. KEVIL LORIYA

Thymidine kinase is an enzyme produced only by virus infected cells

Famciclovir or valacyclovir are used to treat shingles (Herpes zoster)

Can cause nausea and vomiting

GANCICLOVIR AND VALAGANCICLOVIR

cause bone marrow suppression as a toxic side effect

Foscarnet is a pyrophosphate analog

can be used to treat ganciclovir-resistant CMV infections

Cidofovir and Foscarnet is nephrotoxic

can cause lipodystrophy

Works by inhibiting the post-translational modification of viral

Oseltamivir is an oral prodrug

AMANTADINE AND RIMANTADINE

prevent uncoating of influenza A virus (not influenza B).

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