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Therapeutics IV > HSV, Chickenpox, Shingles - Block 3 > Flashcards

HSV, Chickenpox, Shingles - Block 3 Flashcards

1
Q

What is the only known resevoir for HSV?

A

HUmans

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2
Q

How does the etiology of HSV1 and 2 differ?

A

HSV1: cold sores
HSV2: Genital ulceration

Can cause clinically indistinguishable infections in humans

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3
Q

Describe the cycle of HSV infection?

A
  1. Initial mucosal or dermal infection
  2. Ganglia infection
  3. Establishment of latency
  4. Reactivation
  5. Recurrent infection
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4
Q

Clinical presentation for facial HSV?

A
  1. Gingivostomatitis and pharyngitis (first episode of HSV1)
  2. Recurrent herpes labialis (reactivated HSV1)
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5
Q

Clinical presentation of genital HSV?

A
  1. Itching
  2. Discomfort
  3. Paresthesia
  4. Local lymphadenopathy
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6
Q

Intubation period for genital HSV?

A

2-14 days

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7
Q

Define first episode (primary) of HSV?

A

Initial genital infection in individuals who lack HSV-1 or HSV-2 antibodies

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8
Q

Define first episode (non-primary) of HSV?

A

Initial genital infection in individuals with clinical or serologic evidence of prior HSV infection (usually HSV-1)

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9
Q

Define recurrent HSV infection?

A

Genital lesions following the healing of 1st episode infection

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10
Q
A
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11
Q

Sx associated with first episode of genital hepres?

A
  1. Multiple painful pustular or ulcerative lesions on external genitalia over 7-10 days
  2. Flu-like sx
  3. Local itching, pain, discomfort, vaginal/urethral discharge, paresthesia
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12
Q

Severity of recurrent genital HSV are most common in what populations?

A
  1. Higher severity in females
  2. Higher severity and more prolonged in IC patients
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13
Q

How do you diagnose HSV?

A
  1. Viral culture
  2. PCR assay Preferred
  3. HSV subtyping should immediately follow HSV detection
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14
Q

Tx options for HSV? Out of the options which ones are preferred?

A

Acyclovir
Valacyclovir (prodrug of acyclovir)
Famciclovir (prodrug of penciclovir)

Valacyclovir and faiciclovir is more preferential due to superior PK/PD

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15
Q

ADR of Acyclovir?

A
  1. Acute kidney injury
  2. Neurotoxicity
  3. GI intolerance
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16
Q

Acyclovir interactions?

A

VZV vaccine: Avoid use of acyclovir within 24hrs prior to VZV vaccine and 14 days after vaccination
Zoster: Acyclovir may decrease effect

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17
Q

Counseling of Acyclovir?

A
  1. Take w or w/o food
  2. Avoid rapid IV infusion over 1 hr to prevent kidney damage
  3. Rotate injection sites to prevent phlebitis
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18
Q

Warnings of valacyclovir?

A
  1. Renal impairment
  2. Appropriate use: ASAP after 1st s/s
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19
Q

ADR of valacyclovir?

A
  1. Acute kidney injury
  2. Neurotoxicity
  3. GI intolerance
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20
Q

Valacyclovir interactions?

A

VZV vaccine: Avoid use of acyclovir within 24hrs prior to VZV vaccine and 14 days after vaccination
Zoster: Acyclovir may decrease effect

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21
Q

Counseling for valacyclovir?

A
  1. Take PO medication with or w/o food
  2. Maintain adequate hydration during therapy.
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22
Q

Warning of famicyclovir?

A

Renal impairment

23
Q

ADR of famicyclovir?

A

GI intolerance

24
Q

Interactions of famciclovir?

A

VZV vaccine: Avoid use of acyclovir within 24hrs prior to VZV vaccine and 14 days after vaccination
Zoster: Acyclovir may decrease effect

25
Counseling for famciclovir?
Take PO with or w/o food
26
When do you need to consider tx dc for HSV tx?
Suppressive therapy: Consider discontinuation of treatment after **one (1) year** to assess frequency of recurrence.
27
What is the difference between varicella and zoster?
**Varicella:** chickenpox **Zoster:** shingles
28
Incubation period of VZV?
10-21 days Infectious 48 hrs before onset vesicular rash, during vesicle fomration, untill all vescicles crust over
29
Complications of VZV?
1. Secondary bacterial SSTI 2. CNS involvment 3. Varicella pneumonia
30
How do we confirm VZV diagnosis?
1. Isolation of VZV from tissue culture 2. Demonstration of seroconversion or ≥4-fold increase in antibody titer 3. Detection of VZV DNA by PCR assay
31
What is the preferred diagnostic method for VZV?
PCR assay
32
What is the most frequently used & most-sensitive serology tests for assessing host response?
1. FAMA test 2. ELISA test
33
What OTC product should be avoided in children with VZV?
Aspirin due to Reye's syndrome
34
Tx for VZV?
1. Acyclovir 2. Valacyclovir 3. Famicyclovir
35
Tx for pedatric with VZV?
Acyclovir PO for 5 days
36
Immunocompromised patients with VZV ?
Acyclovir IV for 7 days
37
Who should get the VZV vaccine?
1. All children > 1 year old (up to 12 years old) who have NOT had chickenpox 2. Adults known to be seronegative for VZV. 2 doses SC
38
CI of VZV?
1. Pregnancy 2. Immunocompromised 3. Avoid aspirin 6 weeks affter vaccination to avoid Reye's syndrome
39
ADRs of live vac?
1. Fever 2. Inj site reaction 3. Rash
40
If a patient has recieved blood, plasma, Ig products , when can they get the VZV vaccine?
* Administered ≥2 weeks BEFORE receipt of blood product **OR** * Should be delayed 3–11 months AFTER receipt of blood product
41
When should VZIG be administered?
Within 96 hrs (preferablly within 72 hrs) but can be given up to 10 days
42
Who should recieve anti-viral prophylaxis?
1. Recommended for individuals at high-risk who are ineligible for vaccination 2. Beyond 96-hour time window after direct contact
43
When does VZV prophylaxis provide the most benefit?
7 days after exposure
44
Agents used fo VZV prophylaxis?
1. Acylovir 2. Valacylovir 3. Famciclovir
45
What population has the highest incidence for Zoster?
>60 YO
46
Presentations of Zoster?
1. Unilateral vesicular dermatomal eruption 2. Erythematous maculopapular rash -> vesicular lesions
47
Onset of zoster?
48-72 hrs Duration of dx: 7-10 days Skin healing: 2-4 weeks
48
Complications of Zoster?
1. Ophthalimicus 2. Post herpetic neuralgia
49
Tx for Zoster?
1. Acyclovir 2. Valacyclovir 3. Famiclovir
50
Tx for post herpatic neuralgia?
1. Systemic agents: gabapentin, pregabalin, amitriptyline 2. Lidocaine pathces
51
Who should get the Zoster vax?
1. Immunocompetent >50YO 2. Immunocompromised >19YO
52
Counselign for RZV use?
Do NOT administer RZV to patients who are experiencing an acute episode of herpes zoster, as it does NOT treat herpes zoster.
53
Dosing of RZV?
2 doses IM separated by 2-6 months

Therapeutics IV (39 decks)

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