Therapeutics - Viral 4

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Author:
kyleannkelsey
ID:
286775
Filename:
Therapeutics - Viral 4
Updated:
2014-10-23 12:03:30
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Therapeutics Viral
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Therapeutics - Viral
Description:
Therapeutics - Viral
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  1. When should Ganciclovir be dose adjusted?
    • Renal disease
    • SE are observed
  2. What are the INDUCTION doses of Ganciclovir indicated for renal impairment?
    • > Or = to 70 mL/min: No dose adjustment needed
    • > 50-69 mL/min: 2.5 mg/kg IV Q12H
    • > 25-49 mL/min: 2.5 mg/kg IV Q24H
    • > 10-24 mL/min: 1.25 mg/kg IV Q24H
    • <10 mL/min: 1.25 mg/kg IV 3x a week
  3. What are the MAINTENANCE doses of Ganciclovir indicated for renal impairment?
    • > Or = to 70 mL/min: No dose adjustment needed
    • > 50-69 mL/min: 2.5 mg/kg IV Q24H
    • > 25-49 mL/min: 1.25 mg/kg IV Q24H
    • > 10-24 mL/min: 0.625 mg/kg IV Q24H
    • <10 mL/min: 0.625 mg/kg IV 3x a week
  4. What is the spectrum of activity for Foscarnet?
    • All Herpesviruses
    • HIV
    • Most ganciclovir and acyclovir resistant strains
  5. What are the SE of Foscarnet?
    • Renal injury (33%)
    • Symptomatic electrolyte abnormalities (Ca, Phosphate, Mg)
    • N/V
    • HA
    • Seizures
  6. What are the risk factors for Renal injury when taking Foscarnet?
    High doses, rapid infusion, dehydration, prior renal insufficiency, concurrent nephrotoxins
  7. How can Symptomatic Ca imbalance in a patient taking Foscarnet be remediated?
    Slow infusion rate
  8. Is Foscarnet broad or narrow spectrum?
    Very broad
  9. What is the renal impairment dosing equivalent of an induction dose of 60 mg/kg for Foscarnet?
    • CrCl mL/min/kg:
    • <0.4: NR
    • > or = to 0.4: 50 mg/kg Q24H
    • >0.5-0.6: 60 mg/kg Q24H
    • >0.6-0.8: 40 mg/kg Q12H
    • >0.8-1.0: 50 mg/kg Q12H
    • >1-1.4: 45 mg/kg Q8H
    • >1.4: 60 mg/kg Q8H
  10. What is the renal impairment dosing equivalent of an induction dose of 90 mg/kg for Foscarnet?
    • CrCl mL/min/kg:
    • <0.4: NR
    • > or = to 0.4: 50 mg/kg Q24H
    • >0.5-0.6: 60 mg/kg Q24H
    • >0.6-0.8: 80 mg/kg Q24H
    • >0.8-1.0: 50 mg/kg Q12H
    • >1-1.4: 70 mg/kg Q12H
    • >1.4: 90 mg/kg Q12H
  11. What is the renal impairment dosing equivalent of a maintenance dose of 90 mg/kg for Foscarnet?
    • CrCl mL/min/kg:
    • <0.4: NR
    • > or = to 0.4: 50 mg/kg Q48H
    • >0.5-0.6: 60 mg/kg Q48H
    • >0.6-0.8: 80 mg/kg Q48H
    • >0.8-1.0: 50 mg/kg Q24H
    • >1-1.4: 70 mg/kg Q24H
    • >1.4: 90 mg/kg Q24H
  12. What is the renal impairment dosing equivalent of a maintenance dose of 120 mg/kg for Foscarnet?
    • CrCl mL/min/kg:
    • <0.4: NR
    • > or = to 0.4: 65 mg/kg Q48H
    • >0.5-0.6: 80 mg/kg Q48H
    • >0.6-0.8: 105 mg/kg Q48H
    • >0.8-1.0: 65 mg/kg Q24H
    • >1-1.4: 90 mg/kg Q24H
    • >1.4: 120 mg/kg Q24H
  13. What is the antiviral spectrum of Cidofovir?
    • HSV
    • HHV
    • CMV
    • HPV
    • Polyoma
    • Adenovirus
    • POX
    • Thymidine kinase independent
  14. What are the AE of Cidofovir?
    • Renal toxicity
    • Anemia
    • Neutropenia
    • Athenia
    • Alopecia
  15. How can Renal toxicity of Cidofovir be avoided?
    • Give probenecid 2 g 3H prior and 1 g 2-8H after each infusion
    • Give with saline hydration
  16. How do you dose adjust Cidofovir for Renal insuffienciency?
    • If serum creatinine increases 0.3-0.4 md/dL, reduce the dose to 3 mg/kg
    • If serum creatinine increases ≥ 0.5 mg/dL or development of ≥ 3+ proteinuria, discontinue therapy
  17. What are the AEs of CMV immune globulin?
    • Infusion rxn
    • Renal failure
    • Thrombotic events
  18. What are the DDIs of CMV immune globulin?
    • Live virus vaccine (avoid 14 days before and 3 months after admin of CMV-IVIG)
    • (Theoretical)
  19. What are the risk factors for CMV retinitis?
    • CD4 count <50/mm^3
    • Hx of prior opportunistic infection
    • High HIV RNA level
    • CMV viremia
  20. What drugs can be used to treat CMV retinitis?
    • Ganciclovir
    • Valganciclovir
    • Foscarnet
    • Cidofovir
  21. What is the dose of Ganciclovir for CMV retitinits?
    • Induction: 5 mg/kg IV Q12H x14-21D
    • Maintenance: 5 mg/kg IV Q24H
  22. What is the dose of Valganciclovir for CMV retitinits?
    • Induction: 900 mg PO Q12H x14-21D
    • Maintenance: 900 mg PO Q24H
  23. What is the dose of Foscarnet for CMV retitinits?
    • Induction: 60 mg/kg IV Q8H x14-21D
    • Maintenance: 90-120 mg/kg IV Q24H
  24. What is the dose of Cidofovir for CMV retitinits?
    • Induction: 5 mg/kg Q2Weeks
    • Maintenance: 5 mg/kg QOW
  25. What is the dose of Ganciclovir for the treatment of CMV pneumonitis?
    • Induction: 5 mg/kg IV Q8-12H x14-21D
    • Maintenance: 5 mg/kg IV Q24H x3-4 weeks
  26. What is the dose of Valganciclovir for the treatment of CMV pneumonitis?
    • Induction: 900 mg PO Q12H x14-21D
    • Maintenance: 900 mg PO Q24H x 3 months
  27. What is the dose of Foscarnet for the treatment of CMV pneumonitis?
    • Induction: 60 mg/kg IV Q8H
    • Maintenance: 90-120 mg/kg IV Q24H
  28. What is the dose of CMV-IVIG for the treatment of CMV pneumonitis?
    Dosing varies according to organ transplanted and indication
  29. What drugs are available for the treatment of CMV pneumonitis?
    • Ganciclovir
    • Valganciclovir
    • Foscarnet
    • CMV-IVIG

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