Influenza Treatments Quiz

Question 1

Today’s patient is a 41 year old otherwise healthy woman presenting with fever, myalgia, and cough that began the day before. Rapid antigen testing is positive for influenza A. Which statement about antiviral treatment for this patient is correct?

A) Treatment with oseltamivir could be considered since onset of symptoms was <48 hours ago
B) Treatment is not recommended because her symptoms began >24 hours ago
C) Treatment with amantadine could be considered sicne onset of symptoms was <48 hours ago
D) Otherwise healthy persons should not receive antiviral treatment for influenza

Answer 1

A

Question 2

The preferred antiviral drug for treatment of seasonal influenza in hospitalized patients is:

A) Peramivir
B) Oseltamivir
C) Zanamivir
D) Rimantadine

Answer 2

B

Question 3

Antiviral prophylaxis can be considered for which of the following persons exposed to influenza:

A) A 75 year old man with severe immune deficiencies
B) All are correct
C) A 4 year old child with asthma who received the influenza vaccine one week ago
D) A 29 year old pregnant woman

Answer 3

B

Question 4

Paxlovid is a combination product containing two antiviral medications. What are these two medications, and what is their mechanism of action against SARS-CoV-2? Express this response using your own words please.

Use the NNT to describe the efficacy of Paxlovid for hospitalization and for mortality. The reported 89% relative improvement is misleading, which is why I am asking you for the NNT.

Answer 4

Ritonavir inhibits the protease enzyme used by HIV-1 and is also a very potent inhibitor of the cytochrome CYP3A enzyme used to metabolize and clear many medications. Protease is an important enzyme involved in viral replication. Ritonavir is not active against SARS-CoV-2, but by inhibiting the metabolism of nirmatrelvir Ritonavir acts to amplify the activity of nirmatrelvir.

Nirmatrelvir binds directly to the active site for the protease enzyme on SARS-CoV-2 and halts the processing of protein precursors, which essentially prevents viral replication.

Efficacy in unvaccinated adult outpatients having at least one risk factor for severe illness

See what I mean about relative benefits being misleading?

Outcome: Hospitalization
–> Absolute improvement = 5.5%
–> NNT = 18

Mortality
–> Absolute improvement = 1.1%
–> NNT = 63