Antivirals

Question 1

Influenza

Answer 1

Flu A and Flu B,
surface antigens H (hemagglutinin) and N (neuraminidase)
Changes yearly (antigenic drift- yearly, antigenic shift- crazy mutation)
droplet
symptoms 2-4 days after expo.

Question 2

Flu vaccine

Answer 2

1. Inactivated flu vaccine (IFV)
2. Recombinant hemagglutinin vaccine (RIV)
3. Live, attenuated flu vaccine

yearly, 6 months +, not if febrile

Severe (rare): Guilliain-Barre

Question 3

Flu Antiviral: Oseltamivir

Answer 3

Tamiflu
prophylaxis and tx
neuroaminidase inhibitor: prevents budding
No later than 2 days after symptoms
Well tolerated
(rare: neuropsych in young)
discontinue 48 hours before LAIV
Prophylaxis: <10 days

Question 4

Hep B transmission

Answer 4

Blood, sperm, bodily fluids

Question 5

Hep C transmission

Answer 5

Blood, sperm, bodily fluids

Question 6

Hep B treatment:

Answer 6

not needed unless active liver disease

• no good treatment
• Vaccine available (kids should get before starting school)

Question 7

Hep C tx.

Answer 7

• based on genotype
• Cure rate 95-99%
• 8-12 weeks to cure
• EXPENSIVE
• lots of drug-drug interactions (antacids, lipid lowering, anti-seizure, antiretroviral)

Question 8

Herpes: Drugs of choice

Answer 8

Acyclovir, Valcyclovir

Question 9

Acyclovir:

Answer 9

Prophylaxis & Tx
Oral, topical, IV (infuse over 1 hour)
Safe during pregnancy
IV: phlebitis, reversible nephrotoxicity

Question 10

Valacyclovir

Answer 10

55% bioavailability
Prodrug of acyclovir
Added risk of TTP/HUS

Question 11

Topical for Herpes

Answer 11

-acyclovir
-penciclovir
-docosanol
stinging sensation, apply with cot or glove, viral shedding and transmission

Question 12

CMV (cytomegaly virus)

Answer 12

-direct contact with body fluids
-50-85% of americans 40+ harbor virus
Can remain dormant
Immunosuppressed pt- high risk for reactivation of dormant virus
-CMV Retinitis–> vision loss

Question 13

CMV Tx:

Answer 13

Ganciclovir/Valganciclovir

Question 14

Ganciclovir/Valganciclovir

Answer 14

-MOA: suppresses replication of viral DNA
-Valgan–prodrug of gan
-Bioavail: 9% vs 60%
-Prevent or tx CMV (take it forever)
Bone marrow suppression, reproductive toxicity/mutagenesis
-IV, oral, Ocular implants, ocular gel
Administer over 1 hour

Question 15

Ganciclovir / Valganciclovir

Answer 15

Don’t take while pregnant