Therapeutics - Viral 3

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Author:
kyleannkelsey
ID:
286774
Filename:
Therapeutics - Viral 3
Updated:
2014-10-23 12:02:37
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Therapeutics Viral
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Therapeutics - Viral
Description:
Therapeutics - Viral
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  1. What are the potential complications of Varicella?
    • 2ndary bacterial infection
    • Cerebellar ataxia
    • Encephalitis
    • Pneumonitis
    • Congenital varicella
    • Reyes
  2. What are the main complications of Herpes Zoster?
    • Post-herpetic neuralgia
    • Herpes zoster ophthalmicus
    • Encephalitis
    • Cerebral angiitis
    • Motor paralysis
    • Bell’s palsy
    • Transverse myelitis
  3. What antiviral therapies indicated for Varicella-zoster?
    • Acyclovir (Zovirax)
    • Valacyclovir (Valtrex)
    • Famciclovir (Famvir)
    • Penciclovir (Denavir)
  4. How is most Varicella treated?
    • Symptomatic/supportive care
    • No antivirals indicated for routine disease
  5. What supportive therapies exist for Varicella?
    • Pruritis: antihistamine
    • Fever: APAP
  6. What risk factors can cause complications and when present indicate treatment?
    • >12 years
    • Immunocomprimised
    • Chronic cutaneous lesions or pulmonary disease
    • Chronic salicylate therapy: risk for Reye syndrome
  7. What are the doses recommended for acyclovir in the treatment of Varicella?
    • Children (2-12 years): 20 mg/kg PO QID x5 days (Maximum: 3200 mg/day)
    • >12 years: 800 mg PO 5x/day x5-7 days
    • Begin w/in 24 hours of the rash
  8. What is the dose recommended for Valacyclovir in the treatment of Varicella?
    • 1 gram PO TID x 5 days
    • For > 12 years
  9. What is the dose recommended for Famciclovir in the treatment of Varicella?
    • 500 mg PO TID x 5 days
    • Lacking data to support use
  10. What are the doses recommended for acyclovir in the treatment of Varicella in pregnant or pneumonia?
    • PO 800 mg PO 5x/day x 5 days
    • 10 mg/kg IV Q8H x5 days
  11. What are the doses recommended for acyclovir in the treatment of Varicella in immunocomprimised?
    10-12 mg/kg IV Q8H x7 days
  12. Is Acyclovir more active against Varicella or Herpes Zoster?
    Herpes Zoster
  13. What groups benefit the most from Herpes Zoster antiviral therapy?
    • Persons > 50 years
    • <50 years with symptom onset < 72 hours
  14. What is the dose of acyclovir for the treatment of Herpes Zoster in an immunoCOMPETENT patient?
    800 mg PO 5x a day x7-10 days
  15. What is the dose of Famciclovir for the treatment of Herpes Zoster in an immunoCOMPETENT patient?
    • 500 mg PO TD
    • 750 mg PO TID
  16. What is the dose of Valacyclovir for the treatment of Herpes Zoster in an immunoCOMPETENT patient?
    1 gram TID x 7 days
  17. What is the dose of acyclovir for the treatment of Herpes Zoster in an immunoCOMPRIMISED patient?
    • Severe: 10-12 mg/kg IV Q8H x7-14 days
    • Non-severe: 800 mg PO 5x/day for 7 days
    • Start therapy w/in 72 hours of symptom onset
  18. What is the dose of Famciclovir for the treatment of Herpes Zoster in an immunoCOMPRIMISED patient?
    • 750 mg PO QD or 500 mg PO BID or 250 mg PO TID
    • X 7 days
  19. What is the dose of Valaciclovir for the treatment of Herpes Zoster in an immunoCOMPRIMISED patient?
    1 gram PO TID x 7 days
  20. What is the dose of Foscarnet for the treatment of Herpes Zoster in an immunoCOMPRIMISED patient?
    • 40 mg/kg IV Q8H
    • X14-26 days
  21. Which Herpes Zoster treatment is not FDA approved?
    Valacyclovir
  22. Which Herpes Zoster treatment is used for acyclovir resistant VZV and why?
    • Foscarnet
    • Due to Toxicity
  23. What are the complications of Cytomegalovirus?
    • Brain / Neuro: Guillan-Barre syndrome, meningoencephalitis, radiculopathy
    • GI: Hepatitis, colitis, esophagitis, hepatic failure
    • Pulmonary: Insterstitial pneumonitis
    • CV: Myocarditis, pericarditis, atherosclerosis, venous thrombosis
    • Ocular: Retinitis (AIDS associated)
    • Hematologic: Thrombocytopenia, hemolytic anemia
    • Integumentary Maculopapular, rubelliform rashes
  24. What treatment is usually indicated for CMV mononucleosis?
    None
  25. How can youdifferentiate CMV from EBV?
    • Heterophil agglutination:
    • (+) = EBV
    • (-) = CMV
    • Exudative pharyngitis = EBV
  26. What is the name of the antigen present in CMV?
    Pp65
  27. What are the antiviral medications used to treat Cytomegalovirus?
    • Ganciclovir (Cytovene)
    • Valganciclovir (Valcyte)
    • Foscarnet (Foscavir)
    • Cidofovir (Vistide)
    • Fomivirsen (Vitravene)
    • CMV immunoglobulin (CytoGam)
  28. Which CMV antiviral therapies are reserved for severe or refractory disease?
    • Cidofovir (Vistide)
    • Fomivirsen (Vitravene)
  29. What are the SE for Ganciclovir?
    • Myelosupression (dose dependant and reversible)
    • Neutropenia
    • Thrombocytopenia
    • Anemia
    • CNS (Confusion/Convuslion/Dizziness/HA)

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