What are the 3 neuraminidase inhibitors used as anti-influenza drugs and which can be given orally, via IV, and inhalation?
- Oseltamivir = oral
- Zanamivir = inhaled
- Peramivir = IV
What are the 2 adamantanes used as anti-influenza drugs?
Which anti-influenza class has activity against both influenza A and B?
What is the MOA of the neuraminidase inhibitors as anti-influenza drugs?
Interfere w/ release of progeny influenza A and B from infected host cells, thus stopping spread of infection
Which rare/unique AE associated with neuraminidase inhibitors has been more frequently seen in adolescents and adults living in Japan?
Neuropsychiatric events (self-injury or delirium)
3 common AE's of Olseltamivir; what may be done to decrease them?
- HA, nausea, and vomiting
- Take w/ food to decrease N/V
Doses of Oseltamivir need to be adjusted in pt's with what underlying problem?
Which anti-influenza class of drugs can be given as once-daily prophylaxis?
Neuraminidase inhibitors (oseltamivir and/or zanamivir)
What are the 2 common AE's of oseltamivir associated with prophylactic use?
Fatigue and diarrhea
After inhalation of Zanamivir, where does 80-90% of it deposit?
Major AE's associated with Zanamivir; should not be administered with what underlying issue?
- Bronchospam (ocassionally severe)*** --> don't give to pt w/ underlying airway disease!
- Reversible ↓ in pulmonary function
When should tx with neuraminidase inhibitors be given to be most effective against influenza?
Within 48 hours
What is the main potential AE of peramivir, and which rare AE has been seen?
- Main = diarrhea
- Hypersensitivity rxns --> Steven-Johnsons syndrome, Erythema multiforme have rarely been seen
- ↑ risk for delirium, hallucinations, and abnormal behavior
What is the MOA of the Adamantanes, Amantadine and Rimantadine used as anti-influenza drugs?
Block M2 proton ion channel --> inhibit uncoating of the viral RNA WITHIN infected cells, thus preventing its replication
Both Adamantanes require dose reductions in the elderly and pt's with renal insufficiency, but which must be reduced in hepatic insufficiency as well?
Which Adamantane is excreted unchanged in the urine and which undergoes extensive metabolism?
- Amantadine is excreted unchanged
- Rimantadine undergoes extensive metbolism
Why are the Adamantanes no longer recommended for prevention or treatment of influenza?
High rates of resistance in both H1N1 and H3N2 viruses
Which anti-influenza class are both teratogenic and embryotoxic?
2 most common AE's of the Adamantanes?
- GI (nausea and anorexia)
- CNS --> nervousness, difficulty in concentrating, insomnia, light-headedness
What is a more serious AE associated with the Adamantanes; more frequent with which drug in the class?
- Marked behavioral changes + Delirium + Hallucinations
- Agitation + Seizures
- More frequent w/ amantadine