Anti-Viral Drugs: Influenza

Question 1

Guidelines for prevention and control of Seasonal influenza

Answer 1

• Annual Flu vaccine for everyone 6 months or older
  
  • no contraindications
• CDC does not recommend chemoprophylaxis for
  ​”healthy” after flu exposure
  
  • only. high risk patients with suspected or confirmed exposure

Question 2

Drugs for Influenza: Neuraminidase Inhibitors

• drugs
• Clinical Use
• MOA
• PK
• Side effects

Answer 2

Oseltamavir & Zanamavir

• Clinical use:
  
  • tx/prophylaxis for influenza A and B
  • <48 hours post exposure
• MOA:
  
  • interfere with release of progeny flu virus
    
    • competively and reversibly inhibits viral neuraminidase activity
    • causes virus particles to clump to cell membrane
    • NO BUDDING
• PK:
  
  • Oseltamavir
    
    • Oral
    • prodrug
  • Zanamavir
    
    • inhalation
    • directly delivered to respiratory tract
• Side effects:
  
  • Oseltamavir
    
    • headache
    • N & V (alleviated w/food)
    • Delirium
  • Zanamavir:
    
    • Bronchospasm
  • Pregnancy Category C

Question 3

New drugs for influenza:

-clinical use only

Answer 3

• Baloxavir marboxi (Xofluza)
  
  • Tx of acute uncomplicated influenza
  • 12 and older
  • symptomatic for less than 48 hours
• Peramivir (Rapivab)
  
  • Treatment (not prophylaxis) for influenza A and B

Question 4

Influenza: Antiviral options for:

• Hospitalize patients w/suspected or confirmed influenza
• Outpatients w/complications or progressive disease and suspected or confirmed influenza
• Outpatients w/suspected or confirmed uncomplicated influenza

Answer 4

• Hospitalized patients with suspected or confirmed flu:
  
  • Oseltamivir ASAP
    
    • oral or enterically administered
• Outpatients with complications or progressive disease and suspected or confirmed influenza:
  
  • Oral oseltamivir ASAP
• Outpatients w/suspected or confirmed uncomplicated influenza:
  
  • oral oseltamivir
  • inhaled zanamivir
  • IV peramivir
  • oral baloxavir

Question 5

Drugs for Respirator Syncytial Virus:

• clinical Use
• MOA

Answer 5

Ribavarin:

• Clinical Use:
  
  • Tx of severe RSV infection in children
  • Nebulizer=aerosol version
• MOA:
  
  • nucleoside analog
  • phosphorylated by host enzymes
  • interferes with synthesis of GTP to inhibit capping of viral mRNA and RNA-dependent polymerase

Palivizumab:

• Clinical use:
  
  • prevention of RSV infeciton in high risk infants and children
    
    • premature
    • congenital heart disease
  • Administered: IM
• MOA:
  
  • monoclonal antibody with potent fusion-inhibiting activity