ID - exam 4 - Influenza and HSV Flashcards by Ryan Slade

Influenza virus classification

RNA virus
Single stranded
Negative sense
Enveloped
Helical

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High risk groups for Influenza (H1N1)

Age: <5 (especially <2), and >65)
Pregnant women

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Secondary complications of seasonal influenza (Listed in prevalence)

Sinusitis
Bronchitis
Otitis Media
Pneumonia
Rhinitis

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Order of Influenza replication

1 - Penetration
2 - Uncoating
3 - Reverse Transcription
4 - Integration
5 - Transcription
6 - Translation
7 - Assembly
8 - Packing
9 - Release

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What step of Influenza replication does an M2 (matrix protein 2) Inhibitor work at?

M2 Inhibitors prevent step 2 from occurring (Uncoating)

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What are examples of M2 Inhibitors

Amantadine
Rimantadine

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What step of Influenza replication does a VP (Vasopeptidase) Inhibitor work at?

VP inhibitors prevent Transcription from occurring (Step 5)

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What are some examples of VP inhibitors

Favipiravir
Baloxavir

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What step of Influenza replication does an NA Inhibitor work at?

NA inhibitors work to prevent the release of the newly replicated virus in step 9

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What are some examples of NA (Neuraminidase) inhibitors

Oseltamivir
Peramivir
Zanamivir
Laninamivir

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Zanamivir brand name

Relenza

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Zanamivir treatment conditions

Pt must be at least 5 years for prophylactic treatment and at least 7 years old for treatment
Must have a positive influenza test

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Zanamivir dosage form

Intranasal or oral inhalation therapy

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Zanamivir dosing

Inhale 10mg bid x5d
- Must initiate within 48 hours of developing symptoms

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Zanamivir cautionary statement

Use caution in patients with COPD/asthma - deteriorates respiratory function

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Zanamivir viral targeting

Targets both Influenza A + B

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Oseltamivir brand name

Tamiflu

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Oseltamivir viral targeting

Targets both Influenza A + B

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Oseltamivir treatment conditions

Must be at least 1yr old for both prophy and Tx

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Oseltamivir adverse reactions

Nausea, vomiting, diarrhea
Abdominal pain
Headache, dizziness, vertigo
Cough, insomnia

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Oseltamivir dosing for CrCL < 30

CrCL < 30 –> decrease to 75mg QD instead of BID

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Oseltamivir dosing for CrCL < 10

If CrCL is this low, use extreme caution as the drug has not been studied in these conditions

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Oseltamivir dosing

Take 1 75mg capsule po bid ud

Oseltamivir drug interactions

No dose adjustments required but increases Probenecid active metabolites two fold.

Peramivir brand name

Rapivab

Peramivir treatment conditions

At least 6 months old - Symptoms for at least 2 days

Peramivir dosing

600mg IV for adults infused over 15-30mins

Peramivir adverse reactions

- CNS depression - Diarrhea, constipation - Difficulty swallowing (Dysphagia)

Peramivir drug interactions

Limits vaccine effectiveness

What antiviral class is seeing growing resistance

NA inhibitors (Neuraminidase) is seeing small percents of increasing viral resistance

M2 inhibitors mechanism of action / antiviral usage

Interferes with replication of Type A Influenza (no effect on B)

M2 inhibitors indication (from symptom onset)

Administer within 48 hours to reduce severity and shorten the duration of the illness

Amantadine treatment conditions

Can be used in children and adults (within 48 hours of onset of symptoms)

Rimantadine treatment conditions

Can be used in adults as long as administered within 48 hours of symptom onset

M2 inhibitor adverse events

Prevalence of both insomnia and dizziness - 5-10% in Amantadine - 1-3% in Rimantadine

Why should m2 inhibitors be avoided in the current day?

Rapidly growing resistance in the early 2000s where we saw an exponential growth from 2003 flu season to 2005/6 - (1.7%, 1.9%, 14.5% and 92.3% resistance each year)

Baloxavir brand name

Xofluza

Baloxavir dosing

80mg po QD (40mg if less than 80kg)

Baloxavir drug interactions

Magnesium and other metal chelators - Also interacts with efficacy of vaccines

HSV-1 infection location

Trigeminal ganglia

HSV-2 infection location

Sacral Ganglia

Acyclovir targeting

Herpes > Varicella > CMV

Acyclovir dosing

- 20% bioavailability for 200mg dose - 10% for 800mg dose

Acyclovir adverse reactions

CNS depression Renal dysfunction Bone marrow

Acyclovir drug interactions

Probenecid Zidovudine

Valacyclovir targeting

Targets all HSV-1/2, VZV, and CMV (including shingles and recurrent)

Valtrex adverse reactions

TTP and HUS - Thrombotic Thrombocytopenic Purpura - Hemolytic Uremic Syndrome

Valtrex drug interactions

CYP450 enzymes Probenecid

Gancyclovir targeting

CMV > Herpes and Varicella

Gancyclovir dosing

IV only - biooavailability <20%

Gancyclovir adverse reactions

90% renal elimination - Bone marrow - CNS depression - Pancreatitis and multiple organ failure

Gancyclovir drug interactions

Probenecid Zidovudine Nephrotoxicity

Cidofovir targeting

CMV > Herpes - Mainly for retinitis in AIDS

Cidofovir adverse events

Renal elimination - Need fluid pre and post infusion - Administered IV only

Foscarnet targeting

CMV and HSV - Effective against acyclovir resistant HSV - IV only

Foscarnet drug interactions

nephrotoxic

Foscarnet adverse reactions

bone marrow and renal Hypokalemia and magnesia