Therapeutics - Viral 2
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What are the recommended Chemoprophylaxis drugs when the influenza subtype is unknown? Zanamivir
Oseltamivir in combination with rimantadine
What are the recommended Chemoprophylaxis drugs Influenza B?
When influenza viruses are circulating in the community, antiviral chemoprophylaxis can be considered for _______ persons during the ______ weeks after vaccination before an immune response to inactivated vaccine develops.
Antiviral chemoprophylaxis for influenza should be considered in high risk persons for whom the vaccine is___________, _______________ or ____________________.
Contraindicated, unavailable, or expected to have low effectiveness
Antiviral chemoprophylaxis should be considered in high risk, unvaccinated individuals when influenza activity has been ______________________________________.
Documented in the community
Antiviral chemoprophylaxis may be considered for_________________, __________________ and __________________, who are in close contact with high risk individuals during periods of influenza activity.
Unvaccinated adults, including healthcare workers and children ≥ 1 year
Antiviral chemoprophylaxis should be initiated in ALL non-infected family members, when ______________________ and __________________________.
1 family member develops suspected or confirmed influenza and any other family member is at high risk for complications
Antiviral chemoprophylaxis is recommended for ALL residents (vaccinated and unvaccinated) in institutions that are_____________________________________________________________.
Experiencing influenza outbreaks (≥ 2 residents with influenza-like symptoms within 72 hours)
What Herpesviridae are associated with encephalitis or Meningitis?
What Herpesviridae are associated with Mononucleosis?
What are the Alphaherpesviruses?
What are the Betaherpesviruses?
What are the Gammaherpesviruses?
HHV stands for:
Human herpes virus
CMV stands for:
EBV stands for:
HSV stands for:
Herpes simplex virus
VZV stands for:
What are the common locations for HSV-1 to manifest?
What are the common locations for HSV-2 to manifest?
HSV can be treated with what drugs?
- Acyclovir (Zovarix)
- Valacyclovir (Valtrex)
- Famcyclovir (Famvir)
- Penciclovir (Denavir)
- Foscarnet (Foscavir)
Which drug has lower bioavailability at higher doses?
What is the oral bioavailability of Valacyclovir?
What is Acyclovir/Valacyclovir’s activity spectrum?
- Most against HSV-1 and half as active against HSV-2
- Some activity against CMV, VZV, and EBV
What group would you dose adjust Acyclovir/Valacyclovir in?
What group is usually resistant to Acyclovir/Valacyclovir?
What are the SE for Acyclovir/Valacyclovir?
- Renal insufficiency (IV form = crystalline nephropathy)
- Phlebitis/Injection site reactions
- Thrombotic thrombocytopenia purpura ( At very high doses)
How can you reduce the risk of injection site reactions with Acyclovir/Valacyclovir?
Reduce the dose to < or = to 7 mg/mL (10 mg/mL in fluid restricted patients)
What is the spectrum of activity for Famciclovir and Penciclovir?
HSV-1, HSV-2 and VZV
What are the SE for Famciclovir and Penciclovir?
When should you dose adjust Famciclovir/Penciclovir?
For renal insufficiency
What is the activity spectrum fro Docosnol?
- Not virucidal (stops virus from entering the cell)
What is the expected benefit of Ducosonol?
Reduces the duration of symptoms attributed to cold sores and fever blisters
How should Ducosonal be administered?
- 10% cream 5 times a day to lesions
- Beginning at start of symptoms
- Up to 10 days
What are the dependent factors for treatment choice of Orolabial HSV in an immunocompetent host?
- Primary or secondary disease
- Severity of symptoms
- Site of infection
- Frequency of reoccurance
What medications are indicated for primary orolabial HSV in an immunoCOMPETENT host and what are their doses?
- Acyclovir 400 mg PO TID x7-10 days OR 5 mg/kg IV Q8
- Famicilovir 500 mg PO TID x7 days
- Valacyclovir 1g PO BID x7 days
How is Orolabial HSV reactivation disease usually treated?
No treatment for most immunocompetent hosts w/ minimal symptoms
When should chronic suppressive therapy be used for Orolabial HSV reactivation disease?
- Frequent bothersome occurances
- Associated with systemic effects (Erythemia multiforme, Aseptic meningitis)
- ImmunoCOMPRIMISED host
- Patients without prodromal symptoms
What drugs are available for Herpes labialis reactivation disease?
- Penciclovir cream
What is the dose for Acyclovir in the treatment of Herpes Labialis reactivation disease?
- PO = 400 mg PO 5x/day x5 days
- Topical 5% cream = 5 times per day x4 days
- Chronic suppression:
- 400 mg PO bid
What is the dose for Famciclovir in the treatment of Herpes Labialis reactivation disease?
- Episodic: 1500 mg PO x 1 dose
- Chronic suppression: 500 mg PO BID
What is the dose for Valacyclovir in the treatment of Herpes Labialis reactivation disease?
- Episodic: 2 grams PO BID x 1 day
- Chronic Suppression: 500-1000 mg PO QD
What is the dose for Penciclovir 1% cream in the treatment of Herpes Labialis reactivation disease?
Q2H during the day for 4 days
Single-day dosing with either ____________ or _____________affords greater patient convenience and overall lower cost when compared with 5 days of acyclovir
famciclovir or valacyclovir
Randomized trials of patients with sporadic recurrences of HSV-1 infection showed _____________therapy with creams or ointments are of modest benefit.
What age cut off determines whether you should or should not treat for VZV?
> or = to 13 should usually be treated (Also says >12)
What are the S/S of Varicella?
- Vesicular rash
- Low grade fever
What would you like to do?
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