Anti-influenza Meds

Question 1

Paxfather told us to memorize who is at high risk of influenza complications

Answer 1

• Children <5
• Patients <19 yo receiving long-term aspirin
• Adults >65
• Obese patients
• Women who are pregnant or <2 wks postpartum
• Persons of American Indian/Alaska Native heritage
• Residents of nursing homes
• Immunosuppressed pts

Question 2

Adamantanes/M2 Inhibitors, drugs and MOA

Answer 2

• Amantadine
• Rimantadine
• Blocks viral uncoating of Influenza A
• Significant resistance currently, minimally used

Question 3

What is the time frame of administration in order to be effective for Amantadine/Rimantadine

Answer 3

-Administer within 48 hours

Question 4

Two specific indications for Amantadine

Answer 4

• Parkinsonism

- drug induced EPS

Question 5

Amantadine/Rimantadine ADR

Answer 5

• teratogenic

- CNS ADRs: nervousness, anxiety, lightheadedness, confusion, insomnia

Question 6

Neuraminidase inhibitors

Answer 6

Old: Oseltamivir, zanamivir

New: Peramivir (Single dose IV)

Question 7

Oseltamivir MOA

Answer 7

-blocks NA from releasing the influenza virion

Question 8

Oseltamivir clinical use

Answer 8

• Chemoprophylaxis* of influenza A/B
• Treatment of Influenza A/B, swine, & avian influenza
• Approved for patients >2ks old*
• Need to start within 48 hours of illness onset

(review patients at high risk for influenza, that is who gets treatment!!)

Question 9

Examples of some of Paxfather’s examples of comorbidities that are at increased risk with influenza

Answer 9

• Previous list
• Cardiopulmonary disorders: COPD/HF
• DM, hepatic, renal dz
• Immunosuppression
• neurologic/neuromuscular conditions

*Can also use on previously healthy, nonhigh-risk patients when tx can be started within 48 hours

Question 10

Oseltamivir dosing/ADRs

Answer 10

• BID X 5 days
• tastes terrible!!!!
• ADRs: Well tolerated in adults
• Has potential to cause neuropsychiatric events in kids

Question 11

Zanamivir (powder inhalation)

Answer 11

• Same as Oseltamivir but MORE adverse events
• Nasal/throat discomfort
• Bronchospasm in asthma/COPD pts**

Question 12

Polymerase Acidic Endonuclease Inhibitors

Answer 12

• Baloxavir
• Cap-dependent endonuclease (CEN) is blocked which blocks viral replication
• Works against Influenza A/B, and NA-inhibitor resistant strands