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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
Q

Counseling for famciclovir?

A

Take PO with or w/o food

26
Q

When do you need to consider tx dc for HSV tx?

A

Suppressive therapy: Consider discontinuation of treatment after one (1) year to assess frequency of recurrence.

27
Q

What is the difference between varicella and zoster?

A

Varicella: chickenpox
Zoster: shingles

28
Q

Incubation period of VZV?

A

10-21 days

Infectious 48 hrs before onset vesicular rash, during vesicle fomration, untill all vescicles crust over

29
Q

Complications of VZV?

A
  1. Secondary bacterial SSTI
  2. CNS involvment
  3. Varicella pneumonia
30
Q

How do we confirm VZV diagnosis?

A
  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
Q

What is the preferred diagnostic method for VZV?

A

PCR assay

32
Q

What is the most frequently used & most-sensitive serology tests for assessing host response?

A
  1. FAMA test
  2. ELISA test
33
Q

What OTC product should be avoided in children with VZV?

A

Aspirin due to Reye’s syndrome

34
Q

Tx for VZV?

A
  1. Acyclovir
  2. Valacyclovir
  3. Famicyclovir
35
Q

Tx for pedatric with VZV?

A

Acyclovir PO for 5 days

36
Q

Immunocompromised patients with VZV ?

A

Acyclovir IV for 7 days

37
Q

Who should get the VZV vaccine?

A
  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
Q

CI of VZV?

A
  1. Pregnancy
  2. Immunocompromised
  3. Avoid aspirin 6 weeks affter vaccination to avoid Reye’s syndrome
39
Q

ADRs of live vac?

A
  1. Fever
  2. Inj site reaction
  3. Rash
40
Q

If a patient has recieved blood, plasma, Ig products , when can they get the VZV vaccine?

A
  • Administered ≥2 weeks BEFORE receipt of blood product OR
  • Should be delayed 3–11 months AFTER receipt of blood product
41
Q

When should VZIG be administered?

A

Within 96 hrs (preferablly within 72 hrs) but can be given up to 10 days

42
Q

Who should recieve anti-viral prophylaxis?

A
  1. Recommended for individuals at high-risk who are ineligible for vaccination
  2. Beyond 96-hour time window after direct contact
43
Q

When does VZV prophylaxis provide the most benefit?

A

7 days after exposure

44
Q

Agents used fo VZV prophylaxis?

A
  1. Acylovir
  2. Valacylovir
  3. Famciclovir
45
Q

What population has the highest incidence for Zoster?

A

> 60 YO

46
Q

Presentations of Zoster?

A
  1. Unilateral vesicular dermatomal eruption
  2. Erythematous maculopapular rash -> vesicular lesions
47
Q

Onset of zoster?

A

48-72 hrs

Duration of dx: 7-10 days
Skin healing: 2-4 weeks

48
Q

Complications of Zoster?

A
  1. Ophthalimicus
  2. Post herpetic neuralgia
49
Q

Tx for Zoster?

A
  1. Acyclovir
  2. Valacyclovir
  3. Famiclovir
50
Q

Tx for post herpatic neuralgia?

A
  1. Systemic agents: gabapentin, pregabalin, amitriptyline
  2. Lidocaine pathces
51
Q

Who should get the Zoster vax?

A
  1. Immunocompetent >50YO
  2. Immunocompromised >19YO
52
Q

Counselign for RZV use?

A

Do NOT administer RZV to patients who are experiencing an acute episode of herpes zoster, as it does NOT treat herpes zoster.

53
Q

Dosing of RZV?

A

2 doses IM separated by 2-6 months

Therapeutics IV (39 decks)

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