ch 80

Question 1

drug for Herpes simplex virus (HSV) and Varicella zoster virus (VZV) and CMV (cytomegalovirus)

Answer 1

Acyclovir for HSV only treat infections of gum and mouth

Question 2

herpes face and oropharynx is usually what

Answer 2

HSV 2 ALSO HSV1

Question 3

oral acyclovir can be used for treatment of HSV2 unless they are

Answer 3

immune compromised - they need IV acyclovir - because the infection can get severe

Question 4

herpes labialis treatment

Answer 4

no treatment but oral acyclovir can be taken prophylactically to prevent episodes of recurrent episodes

Question 5

herpes zoster (shingles) treatment in older adults

Answer 5

high doses of oral acyclovir - can also help with post herpetic neuralgia in shingles

Question 6

varicella (chicken pox) in children adolescents and adults

Answer 6

oral acyclovir if begun early (within 24 hours of rash onset)

Question 7

acyclovir in renal

Answer 7

renal dosing needed

Question 8

adverse effects oral acyclovir

Answer 8

n/v/d
headache
vertigo

Question 9

topical acyclovir

Answer 9

local burning

stinging

Question 10

adverse effects IV acyclovir

Answer 10

renal failure

patients with preexisting renal disease and dehydration are at increased risk

Question 11

pt ed acyclovir

Answer 11

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

Question 12

acyclovir and children

Answer 12

approved for children as young as 3 months old
Valcyclovir approved for 2 and older
no foscarnet or famciclovir

Question 13

pregnant and acyclovir

Answer 13

no for pregnancy

Question 14

use of what drug in pregnancy is linked to depositing in tooth enamel and causes abnormal development of tooth enamel

Answer 14

foscarnet

Question 15

breastfeeding and acyclovir

Answer 15

no

Question 16

older adults and acyclovir

Answer 16

no contraindications
renal impairment need renal dosing
acyclovir and valacyclovir put them at greater risk for CNS effects

Question 17

Valacyclovir (Valtrex) is a ______ form of acyclovir

Answer 17

prodrug

Question 18

herpes labialis is a

Answer 18

cold sore

Question 19

herpes simplex genitalis

Answer 19

genital herpes

Question 20

Valacyclovir is approved for

Answer 20

1) herpes labialis
2) varicella (chickenpox)
3) herpes zoster (shingles)
4) herpes simplex genitalis (genital herpes)

Question 21

adverse effect of valacyclovir in immunocompromised

Answer 21

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

Question 22

______ is a prodrug of penciclovir

Answer 22

Famciclovir

Question 23

famciclovir is used to treat

Answer 23

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

Question 24

adverse effects of famciclovir

Answer 24

headache and nausea

if higher than rec doses, renal failure

Question 25

topical drugs for herpes Labialis

Answer 25

penciclovir | docosanol

Question 26

``` Penciclovir cream (denavir) - how often/how long how well does it work single adverse effect ```

Answer 26

applied every 2 hrs when awake for 4 days only decreased it by a half a day adverse effect is mild local erythema

Question 27

``` Docosanol cream (abreva) for what? apply 5 times a day how well does it work adverse effect ```

Answer 27

topical for recurrent herpes labialis apply 5 times a day decreases from 4.8 days to 4.1 days no effects

Question 28

Trifluridine (Viroptic) treats what side effects systemic?

Answer 28

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

Question 29

Ganciclovir gel what does it treat adverse effects

Answer 29

acute herpetic keratitis (inflammation and ulceration of the cornea caused by HSV) adverse effects - blurred vision, eye irritation and red eyes no systemic affects

Question 30

baseline data for acyclovir

Answer 30

liver enzymes

Question 31

baseline data for valacyclovir

Answer 31

liver enzymes

Question 32

baseline data for foscarnet

Answer 32

electrolytes 24 hr creatinine clearance ecg

Question 33

monitoring for acyclovir

Answer 33

serum creatinine with BUN (if clinically indicated) CBC Urinalysis sp. gravity for evidence of dehydration urine output liver enzymes

Question 34

monitoring for valacyclovir

Answer 34

serum creatinine with BUN (if clinically indicated) CBC urinalysis liver enzymes

Question 35

monitoring for Foscarnet

Answer 35

``` serum creatinine with BUN (if clinically indicated) CBC Electrolytes calcium ionized calcium magnesium phosphorus ```

Question 36

which antiviral causes QT

Answer 36

Foscarnet

Question 37

adverse reactions for Foscarnet

Answer 37

``` QT prolongation hypocalcemia hyper/hypophosphatemia hypomagnesemia hypokalemia renal injury anemia granulocytopenia ``` ``` common reactions include fever n/v/d anemia headache ```

Question 38

if mom has genital herpes and is in labor, what is given

Answer 38

Acyclovir

Question 39

which herpes is not treated for suppression

Answer 39

zoster

Question 40

what is used in acyclovir resistant HSV or VZV

Answer 40

foscarnet

Question 41

can you use foscarnet in pregnancy

Answer 41

no

Question 42

who cannot take Foscarnet

Answer 42

heart failure (due to high sodium content of drug) history of QT renal impairment preexisting electrolyte cardiac or neuro abnormalities

Question 43

renal injury risk is increased when taking Foscarnet when taking

Answer 43

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

Question 44

symptoms of low calcium

Answer 44

paresthesias perioral tingling monitor ionized calcium, serum may be normal

Question 45

severe hypocalcemia can result in

Answer 45

dysrhythmias tetany seizures

Question 46

the risk for hypocalcemia is increased if also taking _____ with Foscarnet

Answer 46

Pentamidine

Question 47

flue symptoms begin _____ days after exposure and lasts _____

Answer 47

2-4 days | 5-6 days

Question 48

flu symptoms

Answer 48

``` fever cough chills sore throat headache myalgia ```

Question 49

route of transmission flu

Answer 49

droplet enters through mucous membranes such as mouth nose eyes replication in resp tract

Question 50

what kinds are available

Answer 50

inactivated influenza vaccine (IIV) recombinant hemagglutinin vaccine (RIV) Live attenuated influenza vaccine (LAIV)

Question 51

How many flu vaccines

Answer 51

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

Question 52

inactivated influenza adverse effects

Answer 52

soreness at site myalgia, fever, malaise Guillain Barre syndrome (paralytic illness)

Question 53

live vaccine side effects (flu

Answer 53

``` congestion rhinorrhea lethargy headache sore throat decreased appetite ```

Question 54

who cannot get live flu vaccine

Answer 54

``` pregnant immune compromised Guillain Barre flu vaccine reaction do not give if have moderate ot severe acute illness when going to give ```

Question 55

who should get flu vaccine

Answer 55

``` 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 ```

Question 56

best time to give flu vaccine

Answer 56

oct nov and as late as april flu season is nov - march or april

Question 57

tamiflu has to be taken with in the first

Answer 57

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

Question 58

if someone at home is sick with flu, and someone is high risk

Answer 58

use tamiflu prophylactically

Question 59

tamiflu should be discontinued ___ weeks before giving LAIV

Answer 59

2

Question 60

After dosing with LAIV wait ____ before starting tamiflu

Answer 60

2 weeks