Anti-Herpes Agents: RNA Polymerase Inhibitors and Other Drugs – Antiviral Drugs

00:00 Let's move on to RNA polymerase agents and other agents.

00:05 Once again we're talking about nucleic acid synthesis.

00:09 But now we're talking about RNA as oppose to DNA.

00:13 Foscarnet that is probably the best known in this drug.

00:18 It does not require phosphorylation for activity.

00:21 It is not an antimetabolite.

00:24 Now it inhibits both DNA and RNA polymerase.

00:28 And it also inhibits HIV reverse transcriptase.

00:32 So it's kind of a convenient drug to use for multiple situations.

00:37 It inhibits DNA polymerase in acyclovir resistant strains that are also thymidine kinase deficient.

00:43 So it's quite a useful drug in that regard.

00:46 Adverse events are quite severe.

00:48 So nephrotoxicity, up to one-third of patients can develop nephrotoxicity with this agent.

00:55 So we tend to be very careful in monitoring renal function in people who are on this drug.

01:00 Gastro, sorry, genitourinary ulceration can also occur in patients who are on foscarnet as well.

01:08 So we keep an eye out for that too.

01:10 In terms of neurological side effects patients often complain of headache.

01:15 I see that all the time in patients that I co-manage with our HIV specialist who are hepatitis specialists.

01:22 We also see hallucination and seizures with this agent on rare occasion.

01:30 So in terms of these agents that we're talking about, I just wanted to put this in one slide so that you can see in terms of those agents that are analogs of the different components of DNA or RNA, you can see where they all fit in to the armamentarium. Remember that analogs of the different portions of DNA do have to be phosphorylated whereas the other agents don't have to be phosphorylated.