Therapeutics - Viral 1

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kyleannkelsey
ID:
286771
Filename:
Therapeutics - Viral 1
Updated:
2014-10-23 12:00:16
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Therapeutics Viral
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Therapeutics - Viral
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Therapeutics - Viral
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  1. What constitutes High-risk for immunocoprimise/viral infection?
    • Hematological malignancies (Lymphomas, Leukememias)
    • AIDS patients with low CD4+ counts
    • Bone marrow transplantation
    • Splenectomy (More likely to get an infection)
    • Genetic disorders such as severe combined immunodeficiency
  2. What constitutes Intermediate-risk for immunocoprimise/viral infection?
    • Solid tumors (particularly after cytotoxic chemotherapy)
    • HIV
    • Solid organ transplant
  3. What constitutes Low-risk for immunocoprimise/viral infection?
    • Long-term corticosteroid use (e.g. rheumatoid arthritis)
    • Diabetics
  4. What patients are at high risk of complications from influenza?
    • Unvaccinated infants aged 12-24 months OR > 65 years
    • Chronic pulmonary or cardiac disease (COPD/Asthma, etc.)
    • Immunosuppressive disorders or immunosuppressive therapy (*highest risk of complications*)
    • Hemoglobinopathies (sicke cell anemia, thalassemias)
    • Rheumatoid arthritis, Kawasaki disease
    • Chronic kidney disease
    • Chronic metabolic disease (diabetes mellitus)
    • Neuromuscular disorders (seizures, cognitive dysfunction with impaired handling of respiratory secretions, dementia)
    • Residents of nursing homes or other long-term care institutions
    • Cancer (particularly those on immunosuppressive therapy)
  5. What are the complications of Influenza?
    • Pneumonia
    • Myositis/Rhabdomyolysis
    • CNS disease
    • Cardiac involvement
    • Toxic shock syndrome
  6. Amantadine has what target?
    M2 protein
  7. Why can’t Amantadine be used for Influenza B?
    Influenza B does not have the M2 target required by Amantadine
  8. What are the classes of antiviral therapies indicated for Influenza?
    Adamantanes and Neuraminidase inhibitors
  9. What are the antiviral drugs indicated for Influenza?
    • Amantadine (Symmetrel)
    • Rimantadine (Flumanide)
    • Oseltamivir (Tamiflu)
    • Zanamivir (Relenza)
  10. Amantidine (Symmetrel) and Rimantadine (Flumanide) are not recommened in the treatment of Influenza _______________ because of widespread resistance.
    A
  11. Neuaminidase inhibitors are used for what viruses?
    Influenza A and B
  12. The Benefits of therapy are greatest when neuraminidase inhibitors (Oseltamivir/Tamiflu, Zanamivir/Relenza) are given within the first ____________hours (FROM 1ST SYMPTOM ONSET).
    • 24-30
    • Earlier the better
  13. What benefits are imparted when neuraminidase (Oseltamivir/Tamiflu, Zanamivir/Relenza) are given within the first 24-30 hours after 1st symptom onset?
    • Reduced duration and severity of illness
    • Reduced viral shedding and viral titer
  14. What Drug-drug interactions do neuraminidase inhibitors (Oseltamivir/Tamiflu, Zanamivir/Relenza) have and how can they be avoided?
    • Live influenza vaccine (theoretical)
    • Interval of 48 hours between administrations
    • Antiviral should not be restarted for at least 2 weeks
  15. Should neuraminidase inhibitors (Oseltamivir/Tamiflu, Zanamivir/Relenza) be used in pregnancy?
    • Yes, though Pregnancy category C – benefits outweigh risks
    • Treatment should be initiated regardless of symptom onset (i.e. ≥ 48 hours)
  16. What is the adult dose for Oseltamivir (Tamiflu)?
    • Treatment: 75 mg PO BID x 5 days
    • Chemoprophylaxis OR CrCl 10-30 mL/min: 75 mg PO QD
    • Prophylaxis in patients with CrCl 10-30 mL/min: 75 mg EOD or 30 mg QD
    • Morbidly obese or critically ill: 150 mg PO BID, consider extending beyond 10 days
  17. What is the Child treatment dose for Oseltamivir (Tamiflu)?
    • Children (≥ 12 months):
    • ≤ 15 kg: 30 mg PO BID x5 days
    • 15-23 kg: 45 mg PO BID x5 days
    • 24-40 kg: 60 mg PO BID x5 days
    • > 40 kg: 75 mg PO BID x5 days
    • Children (< 12 months):
    • 0-11 months: 3 mg/kg dose twice daily
  18. What is the Child chemoprophylaxis dose for Oseltamivir (Tamiflu)?
    • Children (≥ 12 months):
    • ≤ 15 kg: 30 mg PO QD
    • 15-23 kg: 45 mg PO QD
    • 24-40 kg: 60 mg PO BID x5 days
    • > 40 kg: 75 mg PO QD
    • Children (< 12 months):
    • 3-11 months: 3 mg/kg dose QD
    • <3 months: Not recommended
  19. What is the dose for adults taking Zanamivir (Relenza)?
    • Treatment: 10 mg INH BID x 5 days
    • Chemoprophylaxis: 10 mg INH QD
    • (No adjustments for CrCl, obesity, illness, etc.)
    • (Same as child)
  20. What is the dose for children taking Zanamivir (Relenza)?
    • Children > or = to 7 years:
    • Treatment: 10 mg INH BID x 5 days
    • Chemoprophylaxis: 10 mg INH QD
    • (same as adult)
  21. What dose would you use to treat Avian Flu (H5N1) with Oseltamivir (Tamiflu)?
    150 mg/kg x 10 days
  22. What viruses are Adamantanes (Rimantidine/Flumanide, Amantadine/Symmetrel) useful against?
    • Influenza A in some cases, though widespread resistance
    • No activity against Flu B
    • Basically not useful
  23. What are the SE for Neuraminidase inhibitors (Oseltamivir/Tamilflu, Zanamivir/Relenza)?
    • N/V
    • Neuropsychiatric (Delirium, delusions, hallucinations, confusion)
    • Bronchospasm (Zanamivir) = caution COPD/Asthma, CI w/ ventilators
  24. What are the adjusted doses for Rimantadine:
    • Age > 65 years: 100 mg PO once daily
    • Severe liver disease: 100 mg PO once daily
    • CrCl ≤ 10-30 mL/min: 100 mg PO once daily
  25. What are the adjusted does for Amantadine:
    • Age > 65 years: 100 mg PO once daily
    • CrCl 30-50 mL/min: 200 mg PO x1, then 100 mg once daily
    • CrCl 15-29 mL/min: 100 mg PO x1, then 100 mg Q48 hours
    • CrCl < 15 mL/min: 200 mg PO every 7 days
  26. What conditions require dose adjustment of Rimantadine (Fluminide)?
    • Age over 65
    • Sever liver disease
    • CrCl < or = to 10-30 mL/min
  27. What conditions require dose adjustment of Amantadine (Symmetrel)
    • Age over 65
    • CrCl < 50
  28. Are neuraminidase inhibitors or Adamantanes used more often for Influenza?
    • Neuraminidase inhibitors
    • Amantadines are not used often
  29. What are the SE of Adamantanes (Rimantidine/Flumanide, Amantadine/Symmetrel)?
    • Nausea
    • Anorexia
    • CNS disturbances: insomnia, difficulty concentrating, lightheadedness, seizures, delirium, Hallucinations)
  30. What is the normal adult dose of Rimantidine (Flumainde)?
    • 200 mg PO QD for both Treatment and Chemoprophylaxis
    • Treatment = X 5-7 days or until 24-48 hours after resolution of signs/symptoms
  31. What is the normal pediatric dose of Rimantidine (Flumainde)?
    • Treatment = X 5-7 days or until 24-48 hours after resolution of signs/symptoms
    • 1-9 yrs:
    • Treatment: 6.6 mg/kg/day PO BID (Max 150 mg/day)
    • Chemoprophylaxis: 5 mg/kg PO QD (Max 150 mg/day)
    • > or = to 10 yrs (Single or divided doses):
    • Treatment and Chemoprophylaxis: 200 mg PO QD
  32. What is the normal pediatric dose of Amantadine (Symmetrel)?
    • Treatment = X 5-7 days or until 24-48 hours after resolution of signs/symptoms
    • 1-9 yrs:
    • Treatment and Chemoprophlyaxis: 5-8 mg/kg/day PO
    • 9-12 yrs:
    • Treatment and Chemoprophylaxis: 200 mg PO QD
  33. What is the adult dose of Amantadine (Symmetrel)?
    • 200 mg PO QD for Treatment or Chemoprophylaxis
    • In single or divided doses
    • X 5-7 days or until 24-48 hours after resolution of signs/symptoms
  34. Once a laboratory confirmed case or highly suspected case of influenza has been noted, who should be treated?
    • Onset <48 hours
    • High risk
    • Hospitalized patients
  35. What high risk individuals should not receive the influenza vaccine and instead should receive chemoprophylaxis?
    • Unvaccinated
    • Diminished vaccine efficacy due to severely immunocompromised or antigenically distant circulating virus
  36. How long should chemoprophylaxis last for Influenza?
    • Adults: 2 weeks
    • Children <9 years requiring 2 doses of vaccine: at least 6 weeks
  37. What are the recommended Chemoprophylaxis drugs for Influenza A H1N1?
    • Zanamivir – preferred over amadamantanes
    • Rimantadine – preferred over amantadine
    • Amantadine
  38. What are the recommended Chemoprophylaxis drugs Influenza H3N2?
    • Oseltamivir
    • Zanamivir

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