Antivirals (M2) Flashcards
What is the primary site of antiviral action?
on genome replication; to kill the virus you must kill the host cell
Where does the varicella zoster virus lay dormant?
- in dorsal root of spinal cord
2. sensory ganglia of cranial nerves
Where is the Zoster virus creating inflammation in herpes zoster ophthalmicus?
CN V1
What is it called when the zoster virus scarring is seen on the nose? 1. Why does this increase the likelihood of ocular involvement? 2
- Hutchinson’s sign
2. nasociliary nerve is a branch off of the nerve that goes to the eye
What is the best topical therapy for Zoster? 1. Why? 2
- erythromycin ointment BID
2. keep moist, prevent scabbing, and provide prophylactic barrier
What are the acute pain management treatments for Zoster?
- oral narcotics
2. capzasin topical pain creams
What are the chronic pain management treatments for Zoster?
- Elavil (amitriptyline)
- Neurontin (gabapentin)
- capzasin topical pain creams
What are the symptoms of zoster uveitis? 1. What is the treatment? 2
- unilateral red eye with pain and photophobia
2. antivirals, steroids, and cycloplegic
What is the sign associated with Zoster that has local areas of epithelial thickening appearing in a dendrite-like pattern? 1. How should this be treated? 2
- corneal pseudodendrite
2. steroids
What is the vaccine that was developed for adults to take to prevent shingles/zoster episodes?
Zostavax
What are the ocular conditions associated with the herpes simplex virus?
- simplex blepharodermatitis
- simplex conjunctivitis
- dendritic keratitis
- disciform (stromal herpetic) keratitis
- simplex uveitis
What are lesions around the adnexa of the eye similar to cold sores that are associated with herpes simplex? 1. What is the treatment options for this? 2
- herpes simplex blepharodermatitis
2. observation, oral treatment or topical antibiotic
What are the topical treatments for herpes simplex blepharodermatitis?
- erythromycin BID
2. Zirgan TID
What are the signs of herpes simplex conjunctivitis?
- follicles in palpebral conj
2. mild diffuse injection
What steroids strongly contraindicated to treat?
epithelial simplex keratitis or simplex conjunctivitis
What are the two topical antiviral agents that are only available in Canada and Europe?
- Vidarabine
2. 3% acyclovir
What were the results of the Herpetic Eye Disease Study II (HEDS II)?
- For simplex epithelial keratitis, adding oral acyclovir to topical antiviral DID NOT prevent stromal or uveitis
- For simplex epithelial keratitis, adding oral acyclovir to topical antiviral DID prevent recurrences
What were the results of the Herpetic Eye Disease Study I (HEDS I)?
- For stromal herpetic disease, adding topical steroids to topical antiviral DID improve outcome
- For stromal herpetic disease, adding oral acyclovir to topical steroids and topical antiviral DID NOT improve outcome
- For simplex keratitis, adding oral acyclovir to topical steroids and topical antiviral DID improve outcome
What are the primary therapies for Herpetic stromal/disciform keratitis?
- Zirgan QID
2. Lotemax or Pred Forte QID
What is the rule of 8’s for EKC?
- Adeno serotype 8
- 8 day latent period until signs and symptoms
- first 8 days of signs limited to conjunctiva
- second 8 days of signs have corneal infiltrates
What are the major symptoms of EKC?
- rapid spread to other eye so present bilateral
- profound inflammation to point of lid edema and conj chemosis
- petechial hemes throughout bulbar conj
- profuse tearing
- pseudomembrane on palpebral conj
What is used to test for all types of adenovirus present on the eye?
RPS adenovirus detector
What is the Thomas and Melton Betadine procedure for the treatment of EKC?
- 1 gt 0.5% proparacaine
- 2 gt topical NSAID
- 4-6 gts ophthalmic Betadine solution
- close eyes and roll around for 60-90 secs
- rinse with sterile saline
- 2 gts topical NSAID
- Lotemax QID x 4d
What is the illness script for bacterial conjunctivitis?
- epi: anyone
- TP: acute
- SS: unilateral red eye, burning, FB sensation, goopy mucopurulent discharge especially when wake up with eyelid stuck shut, darker red in inferior portion of eye, inferior palpebral papillae
What is the illness script for marginal keratitis?
- epi: anyone
- TP: acute, recurrent
- SS: staph overgrowth so hypersensitivity reaction. Usually have bleph, photophobia, clear zone between the limbus and keratitis, and localized injection
