December 2018 Flashcards by Piotr J

What is the generic of Xofluza?

Baloxavir

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What is the brand of baloxavir?

Xofluza

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What is the indication for Xofluza?

-antiviral for treating influenza

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What can Xofluza be thought of as being an alternative to?

-Tamiflu (oseltamivir)

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What is the difference between Xofluza and Tamiflu?

-one oral dose
—compared to BID for 5 days for Tamiflu

-causes less N/V

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Does Xofluza have a new antiviral mechanism?

-yes

—first new oral antiviral for treating flu in 20 years

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By how many days do Xofluza and Tamiflu reduce flu symptoms in otherwise healthy patients?

-about a day

—if started within 48 hours of onset

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No or limited evidence exists for Xofluza in the high risk patients who benefit most from antivirals. Name them:

-under age 2 or 65 and older

-chronic conditions
—asthma, etc

-pregnant women

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What are experts concerned about with Xofluza?

-early suggestions of resistance

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What is the cost of Xofluza versus generic Tamiflu?

-$150
—some payers may not cover

-$100
—generic Tamiflu

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What should be recommended to treat flu in high risk or severely ill patients?

-stick with oseltamivir

—start ASAP after symptom onset

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What should be recommended to treat flu in otherwise healthy patients?

-no antiviral

—suggest rest, fluids, analgesics, etc

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When is it okay to suggest Xofluza over oseltamivir in otherwise healthy patients?

-age 12 and older

—if they can start within 48 hours of symptom onset

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What can interact with Xofluza?

-dairy

-products containing:
—calcium, aluminum, iron, etc

-these products may impair absorption of Xofluza

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Is there any evidence for combining antivirals?

-no

—also do NOT use another antiviral if the first doesn’t help

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What’s the best way to prevent the flu?

-flu vaccination

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Which antiviral is recommended for flu prophylaxis in high risk patients?

-oseltamivir

—Xofluza only indicated for treating flu

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Should adding Xarelto to aspirin in most chronic stable coronary or peripheral artery disease patients be recommended?

-no
—margin of benefit is small
—there are risks

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What is the “vascular” dose of Xarelto?

-2.5mg

—given BID with aspirin 81mg/day to reduce CV events in chronic CAD or PAD patients

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What are other doses and uses of Xarelto?

10mg
15mg
20mg
atrial fib
venous thromboembolism

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How many stable CAD patients taking combination Xarelto and aspirin for 2 years need to be treated to prevent 1 stroke, heart attack or CV death?

-71
—CV benefits are similar in PAD
—

What is the risk of major bleeding on combo Xarelto and aspirin therapy in CAD or PAD patients?

-1 in 80

—there isn’t evidence in patients at high bleeding risk or taking other antithrombotics (clopidogrel, warfarin, etc)

How much does Xarelto 2.5mg BID per month cost?

-$420

What should most stable CAD and PAD patients receive?

-aspirin 81mg per day

What risk factors should be managed in stable CAD and PAD patients?

-hypertension -dyslipidemia —ensure patients age 75 or younger are on a high intensity statin (atorvastatin 80mg/day, etc) -diabetes -smoking

What should be emphasized in stable CAD and PAD patients?

-medication adherence -encourage activity —cardiac rehab —structured exercise program —simply walking most days of the week

For what patient should Xarelto 2.5mg BID be used as an add-on?

-rare patient at high CV risk who has: —maximized lifestyle changes —adherent to optimized CV meds —low bleeding risk

Is there any evidence for using other direct oral anticoagulants (DOACs) like Eliquis in stable CAD or PAD patients?

-no

What age group is Gardasil 9 now approved to prevent human papillomavirus in?

-men and women 27-45 years old

What was the previous age group approval for Gardasil 9?

-males and females ages 9-26 | —goal of vaccinating before exposure to HPV

How effective is the HPV vaccine at preventing infection, genital warts, or lesions that may become cancer in older women up to age 45?

-88% effective —in woman not yet exposed to vaccine strains -about 47% effective in all women in this older group

Is there much evidence of efficacy of the HPV vaccine in men ages 27-45?

-no | —vaccination still seems most effective in patients under 27 years old

In what patient population should HPV vaccination be focused on?

-younger patients first | —half of adolescents aren’t fully vaccinated against HPV

When should the HPV vaccine be recommended in younger patients?

-boys and girls ages 9-14 | —usually ages 11-12

How many doses of the HPV vaccine are recommended in boys and girls ages 9-14?

-2 doses | —6-12 months apart

When should the “catch up” HPV vaccine be given in unvaccinated females?

-ages 15-26

When should the “catch up” HPV vaccine be given in unvaccinated males?

-ages 15-21

What is the unvaccinated “catch up” HPV vaccine schedule?

-three doses in patients 15 and older | —0, 2, and 6 months

What men and women ages 27-45 may want the added protection of the HPV vaccine?

-those with new or multiple sex partners

What is the cost of the 3 dose HPV series?

-about $615 dollars | —probably won’t be covered in patients over age 26 until CDC guidelines are updated in early 2019

What biologics are used to prevent migraines in adults?

-Ajovy —fremanezumab -Emgality —galcanezumab -Aimovig —erenumab

How often are the CGRP antagonists administered?

-once monthly —self administered SC injections -Ajovy —can be given as 3 injections once every 3 months

What benefit may CGRP antagonists have over oral preventative migraine medications?

- fewer interactions | - may have fewer side effects

What are examples of traditional oral preventative migraine medications?

- beta blockers - topiramate - valproate - etc

How many fewer migraine days per month versus placebo do CGRP antagonists provide?

-1 or 2 | —similar to oral first line options

How are CGRP antagonists tolerated?

-generally well tolerated —mild injection site reactions -long term safety data not yet available

How much do CGRP antagonists cost per year?

-about $6,900

When should migraine prophylaxis be suggested?

-if patients need acute meds more than 2 days/week or -if migraines significantly impact quality of life

When should a CGRP antagonist be considered?

- oral preventive meds aren’t enough or aren’t tolerated | - suggest the CGRP antagonist preferred by the payer

Can a CGRP antagonist be combined with oral preventive meds?

-it’s okay to add a CGRP antagonist to oral preventive meds if they gave some benefit —there’s no proof the combo works better

Can CGRP antagonists be used in patients with CV disease or CV risk factors?

-not much evidence exists | —if the patient can take a triptan, it’s likely okay for them to use a CGRP antagonist