ch 80 Flashcards
drug for Herpes simplex virus (HSV) and Varicella zoster virus (VZV) and CMV (cytomegalovirus)
Acyclovir for HSV only treat infections of gum and mouth
herpes face and oropharynx is usually what
HSV 2 ALSO HSV1
oral acyclovir can be used for treatment of HSV2 unless they are
immune compromised - they need IV acyclovir - because the infection can get severe
herpes labialis treatment
no treatment but oral acyclovir can be taken prophylactically to prevent episodes of recurrent episodes
herpes zoster (shingles) treatment in older adults
high doses of oral acyclovir - can also help with post herpetic neuralgia in shingles
varicella (chicken pox) in children adolescents and adults
oral acyclovir if begun early (within 24 hours of rash onset)
acyclovir in renal
renal dosing needed
adverse effects oral acyclovir
n/v/d
headache
vertigo
topical acyclovir
local burning
stinging
adverse effects IV acyclovir
renal failure
patients with preexisting renal disease and dehydration are at increased risk
pt ed acyclovir
only decreases symptoms - does not cure
apply topical with a finger cot or rubber glove to avoid transfer to other body sites and other people. some transient local burning or stinking may occur and this is not a reaction
acyclovir and children
approved for children as young as 3 months old
Valcyclovir approved for 2 and older
no foscarnet or famciclovir
pregnant and acyclovir
no for pregnancy
use of what drug in pregnancy is linked to depositing in tooth enamel and causes abnormal development of tooth enamel
foscarnet
breastfeeding and acyclovir
no
older adults and acyclovir
no contraindications
renal impairment need renal dosing
acyclovir and valacyclovir put them at greater risk for CNS effects
Valacyclovir (Valtrex) is a ______ form of acyclovir
prodrug
herpes labialis is a
cold sore
herpes simplex genitalis
genital herpes
Valacyclovir is approved for
1) herpes labialis
2) varicella (chickenpox)
3) herpes zoster (shingles)
4) herpes simplex genitalis (genital herpes)
adverse effect of valacyclovir in immunocompromised
thrombotic thrombocytopenic purpura/hemolytic uremic syndrome (TTP/HUS) - can be fatal)
only approved in this population for chronic suppressive therapy for recurrent genital herpes in pt with HIV
______ is a prodrug of penciclovir
Famciclovir
famciclovir is used to treat
acute herpes zoster and herpes simplex genitalis, can decrease the time to full crusting from 7 days down to 5 days - does not decrease the incidence of postherpetic neuralgia but can decrease from 112 days to 61 days
adverse effects of famciclovir
headache and nausea
if higher than rec doses, renal failure
topical drugs for herpes Labialis
penciclovir
docosanol
Penciclovir cream (denavir) - how often/how long how well does it work single adverse effect
applied every 2 hrs when awake for 4 days
only decreased it by a half a day
adverse effect is mild local erythema
Docosanol cream (abreva) for what? apply 5 times a day how well does it work adverse effect
topical for recurrent herpes labialis
apply 5 times a day
decreases from 4.8 days to 4.1 days
no effects
Trifluridine (Viroptic)
treats what
side effects
systemic?
for topical treatment of ocular infections caused by HSV1 and HSV2
given to treat acute keratoconjunctivitis and recurrent epithelial keratitis
most common side effects localized burning and stinking
minimal systemic absorption
Ganciclovir gel
what does it treat
adverse effects
acute herpetic keratitis (inflammation and ulceration of the cornea caused by HSV)
adverse effects - blurred vision, eye irritation and red eyes
no systemic affects
baseline data for acyclovir
liver enzymes
baseline data for valacyclovir
liver enzymes
baseline data for foscarnet
electrolytes
24 hr creatinine clearance
ecg
monitoring for acyclovir
serum creatinine with BUN (if clinically indicated)
CBC
Urinalysis sp. gravity for evidence of dehydration
urine output
liver enzymes
monitoring for valacyclovir
serum creatinine with BUN (if clinically indicated)
CBC
urinalysis
liver enzymes
monitoring for Foscarnet
serum creatinine with BUN (if clinically indicated) CBC Electrolytes calcium ionized calcium magnesium phosphorus
which antiviral causes QT
Foscarnet
adverse reactions for Foscarnet
QT prolongation hypocalcemia hyper/hypophosphatemia hypomagnesemia hypokalemia renal injury anemia granulocytopenia
common reactions include fever n/v/d anemia headache
if mom has genital herpes and is in labor, what is given
Acyclovir
which herpes is not treated for suppression
zoster
what is used in acyclovir resistant HSV or VZV
foscarnet
can you use foscarnet in pregnancy
no
who cannot take Foscarnet
heart failure (due to high sodium content of drug)
history of QT
renal impairment
preexisting electrolyte cardiac or neuro abnormalities
renal injury risk is increased when taking Foscarnet when taking
nephrotoxic drugs such as amphoteracin B
aminoglycosides (Gentamicin)
pentamidine
Prehydrate with IV saline to reduce risk
monitor renal function (creatinine clearance) closely
reduce dose if renal impairment develops
symptoms of low calcium
paresthesias
perioral tingling
monitor ionized calcium, serum may be normal
severe hypocalcemia can result in
dysrhythmias
tetany
seizures
the risk for hypocalcemia is increased if also taking _____ with Foscarnet
Pentamidine
flue symptoms begin _____ days after exposure and lasts _____
2-4 days
5-6 days
flu symptoms
fever cough chills sore throat headache myalgia
route of transmission flu
droplet
enters through mucous membranes
such as mouth nose eyes
replication in resp tract
what kinds are available
inactivated influenza vaccine (IIV)
recombinant hemagglutinin vaccine (RIV)
Live attenuated influenza vaccine (LAIV)
How many flu vaccines
one dose per year for ages 2-8 years who have not been vaccinated before require 2 doses given 1 month apart. protection is 1-2 weeks after and immunity lasts about 6 mos or longer
inactivated influenza adverse effects
soreness at site
myalgia, fever, malaise
Guillain Barre syndrome (paralytic illness)
live vaccine side effects (flu
congestion rhinorrhea lethargy headache sore throat decreased appetite
who cannot get live flu vaccine
pregnant immune compromised Guillain Barre flu vaccine reaction do not give if have moderate ot severe acute illness when going to give
who should get flu vaccine
children younger than 5 esp younger than 2 pregnant children 18 and younger receiving long term ASA therapy 65 and older morbidly obese nursing home or ltac residents native americans /alaskan natives immunosuppressed chronic med conditions neuro disorders cerebral palsy
best time to give flu vaccine
oct nov and as late as april
flu season is nov - march or april
tamiflu has to be taken with in the first
48 hours of symptoms
earlier the better
within 12 hours reduces by more than 3 days
within 24 hours reduces by 2 days
within 36 hours, reduces by 29 hours
within
if someone at home is sick with flu, and someone is high risk
use tamiflu prophylactically
tamiflu should be discontinued ___ weeks before giving LAIV
2
After dosing with LAIV wait ____ before starting tamiflu
2 weeks
