Final: Anti-Viral Flashcards
What are the 2 topical anti-virals you will use in clinic?
1) Viroptic (triflouridine)
2) Zirgan (ganciclovir)
What are the 3 systemic (oral) anti-viral medications?
1) Acyclovir
2) Valacyclovir
3) Famcyclovir
What is the in-office treatment antiviral medication?
Betadine
What are the 5 viruses that are most common in clinic and can have significant ocular effects?
1) Herpes Simplex Virus
2) Vericella Zoster Virus
3) Adenovirus
4) Cytomegalovirus
5) Epstein-Barr Virus
If a patient does not have herpes virus and is given an antiviral, what happens? What drug is the exception?
If the patient does not have the virus, the medication will not activate so the patient should not have any side effects.
The exception is Viroptic.
What anti-viral can effect the patient even if they aren’t infected with a virus? What is the mechanism of action of this drug?
Viroptic ( 1% triflouridine)
Inhibits DNA synthesis of virus and host cells.
How would you dose Triflouridine (viroptic) to your patient?
1 drop every 2 hours for 7-10 days until ulcer heals, then 3 or 4 times for another week.
What are two disadvantages/adverse effects of triflouridine (viroptic)?
-You have to drop very frequently
-corneal toxicity and will cause SPK
-conj edema/hyperemia
-delayed wound healing
How would you prescribe Ganciclovir Gel (Zirgan)?
1 drop 5x a day, once the ulcer heals, 3x a day for 7 days
If you were to pick a topical antiviral, what is the better medication?
Ganciclovir (zirgan) is better than triflouridine (viroptic). Has less side effects and works just as good, it just cost more.
What is the initial primary treatment for HSK keratitis? (Med +dosing)
Acyclovir (Zovirax)
400mg 5x/day for 7-10 days
A patient is taking acyclovir for the HSK, how is that medication transported to their eye?
Medication is distributed to the cornea through the tears
True or False:
Using oral and topical anti-virals is more effective?
False; taking both has no additional benefit
What are the side effects of Acyclovir?
typically none, but can have a mild HA or upset GI
What has better GI absorption and bioavailability, Acyclovir or Valacyclovir?
Valacyclovir, 3-5x greater bioavailability.
What is the dosing if you prescribed a patient Valacyclovir for HSK?
500 mg tid for 7-10 days
What is the dosing if you prescribed a patient Famcyclovir for HSK?
250mg tid for 7-10 days
Dosing for acyclovir, valacyclovir, famcyclovir for HSK.
Acyclovir: 400mg 5x/day for 7-10 days
Valacyclovir: 500 mg 3x/day for 7-10 days
Famcyclovir: 250 mg 3x/day for 7-10 days
what is the prophylaxis dose for acyclovir for recurrent HSK?
400mg BID for 1 year
what is the prophylaxis dose for famcyclovir for recurrent HSK?
250mg bid for 1 year
what is the prophylaxis dose for valacyclovir for recurrent HSK?
500mg qd for 1 year
True or false:
Topical treatments are effective for Herpes Zoster Ophthalmicus (Vericella zoster)
False
When prescribing for zoster ophthalmicus, how do you prescribe the 3 anti-virals?
You double the dose for that is used for Herpes Simplex Virus.
Acyclovir: 800mg 5x/day for 7-10 days
Valacyclovir: 1000 mg 3x/day for 7-10 days
Famcyclovir: 500 mg 3x/day for 7-10 days
Dosing for prophylaxis of HSk using acyclovir, valacyclovir, famcyclovir for HSK.
Acyclovir: 400mg BID for 1 year
Valacyclovir: 500mg QD for 1 year
Famcyclovir: 250 mg BID for 1 year
When would anti-virals be contraindicated?
With patients with kidney dysfunction or on dialysis since anti-viral meds are eliminated by the kidneys
