Antivirals

Question 1

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

Answer 1

2/3

Question 2

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

Answer 2

3rd

Question 3

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

Answer 3

C-Section

Question 4

85% of neonatal HSV cases occur d/t?

10% d/t?

5% d/t?
(types of transmission)

Answer 4

Peripartum transmission

Post-natal transmission

In-Utero transmission

Question 5

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

Answer 5

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)

Question 6

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

Answer 6

Disseminated

Question 7

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

Answer 7

60-70%

Question 8

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

Answer 8

50%

Question 9

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

Answer 9

Acyclovir

Question 10

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

Answer 10

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

Question 11

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

Answer 11

ZiG (Zoster Immunoglobulin)

Question 12

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

Answer 12

1-3 weeks.

Question 13

How does Acyclovir work?

Answer 13

Prevents viral DNA synthesis by inhibiting viral DNA polymerase

Question 14

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

Answer 14

True

Question 15

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

Answer 15

14 days

Question 16

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

Answer 16

21 Days

Question 17

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

Answer 17

Continuing tx until the CSF is cleared of viral DNA

Question 18

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

Answer 18

Distributed
50%
60%

Question 19

Acyclovir side effects:

Answer 19

• 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

Question 20

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

Answer 20

20%

Question 21

What is the most serious s/e of Acyclovir?

Answer 21

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

Question 22

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

Answer 22

Other Nephrotoxic drugs

Question 23

What med is used w/Congenital CMV infection?

Answer 23

Ganciclovir

Question 24

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

Answer 24

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

Question 25

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

Answer 25

Developed

Question 26

CMV occurs in __% live-born infants in the U.S. It commonly occurs via which route?

Answer 26

1% Intra-uterine transmission

Question 27

Can CMV be spread perinatally during delivery?

Answer 27

Yes; or postnatally via Breastmilk

Question 28

Death from CMV is usually r/t?

Answer 28

Hepatic dysfunction or bleeding | not CNS manifestation

Question 29

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

Answer 29

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

Question 30

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

Answer 30

True | vs. 14% asymptomatic infants

Question 31

Name the permanent sequellae of CMV:

Answer 31

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

Question 32

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.

Answer 32

True

Question 33

Ganciclovir has similar activity to Acyclovir against? | Greatest activity against?

Answer 33

HSV-1, HSV-2, VZV CMV

Question 34

Is there an oral form of Ganciclovir?

Answer 34

No-no longer marketed

Question 35

How long is tx for symptomatic CMV?

Answer 35

6 wks

Question 36

What is the T2 of Ganciclovir? | Is it eliminated changed in the Urine?

Answer 36

2-3 hours | No, remains unchanged in Urine

Question 37

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

Answer 37

Pts w/renal compromise

Question 38

What is the most common adverse effect of Ganciclovir?

Answer 38

Myelosuppression

Question 39

Name the adverse effects of Ganciclovir.

Answer 39

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