Antivirals Flashcards
HSV is causes some form of CNS dz in what fraction of neonatal HSV infections.
2/3
The risk of transmission of HSV in maternal primary infection is highest in which trimster of pregnancy?
3rd
What can decrease the risk of HSV transmission w/HSV isolated from maternal cervix or external genitalia near delivery?
C-Section
85% of neonatal HSV cases occur d/t?
10% d/t?
5% d/t?
(types of transmission)
Peripartum transmission
Post-natal transmission
In-Utero transmission
HSV in peri-partum or post-partum is categorized how (3 types)?
- SEM (Skin-eye-mouth)–no CNS involvement
- CNS (may have skin involvement but no other visceral systems)
- Disseminated (may involve CNS along w/multiple other organs including Liver, Adrenals, GI, & SEM)
Of all HSV infections 1/3 have CNS dz, and only 1/4 have?
Disseminated
Of cases of Disseminated HSV, how many have CNS involvement?
60-70%
Overall, ____% of neonatal HSV infection will have CNS involvement
50%
What medication is used to treat neonatal HSV and Varicella zoster dz?
Acyclovir
Have there been clinical trials of Acyclovir use in Varicella zoster Dz?
No, but experts recommend it’s use to tx varicella zoster.
What med is given to babies born to women who have Varicella Zoster w/in 48 hours of delivery?
ZiG (Zoster Immunoglobulin)
What is the time frame for babies to get Varicella when born to mom’s who get it w/in 48 hrs birth?
1-3 weeks.
How does Acyclovir work?
Prevents viral DNA synthesis by inhibiting viral DNA polymerase
True/False: Acyclovir has remarkable safety & efficacy for mild-moderate infections caused by HSV, VZV in both normal and immuno-compromised pts?
True
What is the duration of tx w/Acyclovir for SEM infections?
14 days
What is the duration of tx w/Acyclovir for CNS or Disseminated dz?
21 Days
If the CSF is + for HSV DNA at the end of tx therapy, most experts recommend:
Continuing tx until the CSF is cleared of viral DNA
Acyclovir is widely _____
Concentrations in CSF are about ____% of that in the plasma
More than ___% of it is eliminated in the urine
Distributed
50%
60%
Acyclovir side effects:
- 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
According to Neofax, use of Acyclovir results in Neutropenia in __% pts
20%
What is the most serious s/e of Acyclovir?
Neurotoxicity (usually in pts w/compromised renal fxn)–difficult to detect in babies, goes away w/discontinuation of med
When giving Acyclovir, Renal toxicty has been reported in pts receiving?
Other Nephrotoxic drugs
What med is used w/Congenital CMV infection?
Ganciclovir
What congenital infection is the most common human infection world-wide?
CMV: ~40% in adolesence, ~90% in adults w/poor socioeconomic status
CMV is the most common congenital infection in the Developed/Undeveloped world?
Developed
CMV occurs in __% live-born infants in the U.S.
It commonly occurs via which route?
1%
Intra-uterine transmission
Can CMV be spread perinatally during delivery?
Yes; or postnatally via Breastmilk
Death from CMV is usually r/t?
Hepatic dysfunction or bleeding
not CNS manifestation
7-10% of infant’s born w/congenital CMV have clinically evident Dz at birth including:
(7 things)
- IUGR
- Hepatasplenomegaly
- Jaundice
- Thrombocytopenia
- Microcephaly
- Periventricular Calcifications
- Chorioretinitis
True/False: 40-50% infants w/symptomatic CMV have permanent sequellae.
True
vs. 14% asymptomatic infants
Name the permanent sequellae of CMV:
Sensioneural hearing loss MR Seizures Psychomotor and Speech Delays Learning Difficulties Chorioretinitis Optic Nerve Atrophy Defects in Dentition
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.
True
Ganciclovir has similar activity to Acyclovir against?
Greatest activity against?
HSV-1, HSV-2, VZV
CMV
Is there an oral form of Ganciclovir?
No-no longer marketed
How long is tx for symptomatic CMV?
6 wks
What is the T2 of Ganciclovir?
Is it eliminated changed in the Urine?
2-3 hours
No, remains unchanged in Urine
If you want to give Ganciclovir, when might you have to think of another med?
Pts w/renal compromise
What is the most common adverse effect of Ganciclovir?
Myelosuppression
Name the adverse effects of Ganciclovir.
Neutropenia
Thrombocytopenia
Anemia
Neuro signs:H/A, confusion, altered mental status…(all tough to detect in NB’s)
