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Neonatal Pharmacology > Antivirals > Flashcards

Antivirals Flashcards

1
Q

HSV is causes some form of CNS dz in what fraction of neonatal HSV infections.

A

2/3

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2
Q

The risk of transmission of HSV in maternal primary infection is highest in which trimster of pregnancy?

A

3rd

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3
Q

What can decrease the risk of HSV transmission w/HSV isolated from maternal cervix or external genitalia near delivery?

A

C-Section

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4
Q

85% of neonatal HSV cases occur d/t?

10% d/t?

5% d/t?
(types of transmission)

A

Peripartum transmission

Post-natal transmission

In-Utero transmission

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5
Q

HSV in peri-partum or post-partum is categorized how (3 types)?

A
  1. SEM (Skin-eye-mouth)–no CNS involvement
  2. CNS (may have skin involvement but no other visceral systems)
  3. Disseminated (may involve CNS along w/multiple other organs including Liver, Adrenals, GI, & SEM)
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6
Q

Of all HSV infections 1/3 have CNS dz, and only 1/4 have?

A

Disseminated

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7
Q

Of cases of Disseminated HSV, how many have CNS involvement?

A

60-70%

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8
Q

Overall, ____% of neonatal HSV infection will have CNS involvement

A

50%

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9
Q

What medication is used to treat neonatal HSV and Varicella zoster dz?

A

Acyclovir

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10
Q

Have there been clinical trials of Acyclovir use in Varicella zoster Dz?

A

No, but experts recommend it’s use to tx varicella zoster.

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11
Q

What med is given to babies born to women who have Varicella Zoster w/in 48 hours of delivery?

A

ZiG (Zoster Immunoglobulin)

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12
Q

What is the time frame for babies to get Varicella when born to mom’s who get it w/in 48 hrs birth?

A

1-3 weeks.

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13
Q

How does Acyclovir work?

A

Prevents viral DNA synthesis by inhibiting viral DNA polymerase

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14
Q

True/False: Acyclovir has remarkable safety & efficacy for mild-moderate infections caused by HSV, VZV in both normal and immuno-compromised pts?

A

True

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15
Q

What is the duration of tx w/Acyclovir for SEM infections?

A

14 days

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16
Q

What is the duration of tx w/Acyclovir for CNS or Disseminated dz?

A

21 Days

17
Q

If the CSF is + for HSV DNA at the end of tx therapy, most experts recommend:

A

Continuing tx until the CSF is cleared of viral DNA

18
Q

Acyclovir is widely _____
Concentrations in CSF are about ____% of that in the plasma
More than ___% of it is eliminated in the urine

A

Distributed
50%
60%

19
Q

Acyclovir side effects:

A
  • Oral= GI upset, rash, headache
  • IV= Severe inflammation, phlebitis, vesicular eruption–>cutaneous necrosis, rash, sweating, nausea, headache, hematuria, hypotension
  • High doses/Prolonged therapy= a/w Neutropenia
20
Q

According to Neofax, use of Acyclovir results in Neutropenia in __% pts

A

20%

21
Q

What is the most serious s/e of Acyclovir?

A

Neurotoxicity (usually in pts w/compromised renal fxn)–difficult to detect in babies, goes away w/discontinuation of med

22
Q

When giving Acyclovir, Renal toxicty has been reported in pts receiving?

A

Other Nephrotoxic drugs

23
Q

What med is used w/Congenital CMV infection?

A

Ganciclovir

24
Q

What congenital infection is the most common human infection world-wide?

A

CMV: ~40% in adolesence, ~90% in adults w/poor socioeconomic status

25
Q

CMV is the most common congenital infection in the Developed/Undeveloped world?

A

Developed

26
Q

CMV occurs in __% live-born infants in the U.S.

It commonly occurs via which route?

A

1%

Intra-uterine transmission

27
Q

Can CMV be spread perinatally during delivery?

A

Yes; or postnatally via Breastmilk

28
Q

Death from CMV is usually r/t?

A

Hepatic dysfunction or bleeding

not CNS manifestation

29
Q

7-10% of infant’s born w/congenital CMV have clinically evident Dz at birth including:
(7 things)

A
  1. IUGR
  2. Hepatasplenomegaly
  3. Jaundice
  4. Thrombocytopenia
  5. Microcephaly
  6. Periventricular Calcifications
  7. Chorioretinitis
30
Q

True/False: 40-50% infants w/symptomatic CMV have permanent sequellae.

A

True

vs. 14% asymptomatic infants

31
Q

Name the permanent sequellae of CMV:

A 
Sensioneural hearing loss
MR
Seizures
Psychomotor and Speech Delays
Learning Difficulties
Chorioretinitis
Optic Nerve Atrophy
Defects in Dentition
32
Q

True/False: Ganciclovir was the 1st antiviral tx and prevention of infections from CMV. It is also valuable for immunocompromised ts w/congenital CMV infection.

A

True

33
Q

Ganciclovir has similar activity to Acyclovir against?

Greatest activity against?

A

HSV-1, HSV-2, VZV

CMV

34
Q

Is there an oral form of Ganciclovir?

A

No-no longer marketed

35
Q

How long is tx for symptomatic CMV?

A

6 wks

36
Q

What is the T2 of Ganciclovir?

Is it eliminated changed in the Urine?

A

2-3 hours

No, remains unchanged in Urine

37
Q

If you want to give Ganciclovir, when might you have to think of another med?

A

Pts w/renal compromise

38
Q

What is the most common adverse effect of Ganciclovir?

A

Myelosuppression

39
Q

Name the adverse effects of Ganciclovir.

A

Neutropenia
Thrombocytopenia
Anemia
Neuro signs:H/A, confusion, altered mental status…(all tough to detect in NB’s)

Neonatal Pharmacology (17 decks)

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