MCP Antivirals/Antifungals Flashcards
1
Q
Oseltamivir
A
Tamiflu®
2
Q
Docosanol
A
Abreva®
3
Q
Acyclovir
A
Zovirax®
4
Q
Valacyclovir
A
Valtrex®
5
Q
Famciclovir
A
Famvir®
6
Q
Miconazole
A
Monistat®
7
Q
Terconazole
A
Terazol®
8
Q
Tioconazole
A
Vagistat®
9
Q
Ketoconazole
A
Nizoral®
10
Q
Clotrimazole
A
Lotrimin®
11
Q
Fluconazole
A
Diflucan®
12
Q
Itraconazole
A
Sporanox®
13
Q
Voriconazole
A
VFEND®
14
Q
Terbinafine
A
Lamisil®
15
Q
Nystatin
A
Nystop®
16
Q
Griseofulvin
A
Grifulvin V® or Gris-PEG®
17
Q
Influenza: Morbidity/Mortality; Surface proteins targeted in treatment
A
- Greater than 30,000 deaths/year
- Hemagglutinin
- allows virus to enter host cells
- Neuraminidase
- Allows release of new viral particles from host cells
18
Q
Signs and Symptoms of Influenza
A
- Rapid onset of fever
- Myalgia
- Headache
- Non-productive cough
- Sore throat
- Rhinitis
- Symptoms resolve 3-7 days
- Cough and malaise may persist for >2 weeks
19
Q
Influenza: Pathogenesis
A
- Transmission via inhalation of respiratory droplets
- Incubation period 1-4 days (2 day average)
20
Q
Flu Prevention Strategies
A
- Vaccination
- Best way to prevent morbidity/mortality
- Hand Hygiene
- Respiratory etiquette
- Contact avoidance
21
Q
Tamiflu: MOA, take w/i…
A
- Oseltamivir
- Neuraminidase inhibitor to prevent release of virus from cell
- Take w/i 48 hours of start of symptoms or else benefits go down
22
Q
Tamiflu Treatment Benefits
A
- Viral replication decreased
- Reduces duration of illness by 1 day
- May reduce bronchitis, sinusitis, otitis media, antibiotic use, hospitalization, and pneumonia
- Reducation in societal costs associated with flu
23
Q
Who should get Tamiflu
A
- Very old: >75 yo
- Very young: <2 yo
- Hospitalized
- High risk patients
- Important to follow these guidelines, especially during shortages.
24
Q
Tamiflu SE
A
- Nausea
- Vomiting
- Neuropsychiatric events
- very rare
- confusion, delirium, self-injury
- younger kids of Japanese decent at higher risk
25
Dosing for Tamiflu: Treatment, prophylaxis, starting, dose adjustment
* Effective for Influenza A and B for patients age 1 and older
* Treatment: 75 mg PO BID x 5days
* Prophylaxis: 75 mg PO QD x10 days
* must be used within 48 hours of symptom onset
* Dose ajust for CrCL \<30mL/min and children \<40kg
26
Tamiflu Formulations/Administration
* Capsules
* Suspension: 6mg/mL
* Fridge (17 days)
* Room Temp (10 days)
* Shake well and may take with or without food
27
Current Flu Season
* Predominant Strain
* H3N2
* Suseptible to Oseltamivir and Zanamivir (Relenza)-oral inhalation
* Vaccination best way to prevent infection
* H1N1
* H3N2
* B strain
* CDC does not recommend quadravalent over trivalent, extra B not better
* This year 90% A and 10% B strain.
* 99% H3N2 and 1% H1N1
* 67% A strain has mutated
*
28
Herpes Simplex Virus 1
* Herpes labialis (cold sores)
29
Herpes Simplex Virus 2
* Herpes genitalis (genital herpes)
* acquired through sexual contact
* Can transmit infection while asymptomatic
30
Herpes Zoster Virus
* Primary infection--\>Varicella--\>Chickenpox
* Reactivation--\>herpes zoster--\>Shingles
* Vaccines available
31
MOA Abreva
* Docosanol
* Inhibits fusion of HSV envelope with cell membrane to stop spread of virus
* Take at start of symptoms
32
MOA Acyclovir
* Intracellulary phosphorylated by viral thymidine kinase, then converted to triphosphorylated acyclovir by host cell kinase
* Incorporated into viral DNA and causes strand termination and cell death
33
MOA Valacyclovir
* Prodrug of acyclovir
* Better bioavailability (3-5x)
34
MOA Famciclovir
* Prodrug converted to penciclovir (Denavir®)
* Denavir is an older topical cream
35
Herpes Antiviral Therapies
36
Herpes Genitalis: Dosing/Drug
* Acyclovir
* Initial:
* 200mg 5x/d for 7-10 days
* 400mg TID for 7-10 days
* Recurrent:
* 200mg 5x/d for 5 days
* 400mg TID for 5 days
* Chronic
* 400mg BID
* Valacyclovir
* Initial:
* 1g BID for 10 days
* Recurrent:
* 500mg BID for 5 days
* Chronic
* 500-1000mg QD
* Famyclovir
* Initial:
* 250mg TID for 7 days
* Recurrent:
* 200mg 5x/d for 5 days
* 400mg TID for 5 days
* Chronic:
* 400mg BID
37
Herpes Labialis: Dosing/Drug
* Acyclovir
* 400mg 5x/d for 5 days
* Valacyclovir
* 2g BID for 1 days
* Famcyclovir
* 1500mg x 1 dose
38
Herpes Zoster: Dosing/Drug
* Acyclovir
* 800mg 5x/d for 7-10 days
* Valacyclovir
* 1g TID for 7 days
* Famciclovir
* 500mg TID for 7 days
39
Varicella: Dosing/Drugs
* Acyclovir
* 800mg QID for 5 days
40
Herpes Antiviral Therapies Dosing
41
Herpes Antiviral Therapies: Counseling Pearls
* Docosanol (Abreva)-OTC cream indicated for herpes labialis
* Use at first sign of reactivation
* Apply 5 times a day (max 10 days)
* Acyclovir, valacyclovir, famciclovir
* Take with full glass of water/drink plenty of fluids
* Prevents crystals from forming in kidneys
* Initiate therapy within 24 hours of symptom onset (genitalis/varicella)
* Initiate 48-72 hours after sign of rash (herpes zoster)
* Higher doses for treatment of herpes zoster could cause N/V/D, constipation, headache
* Chronic suppressive therapy for herpes genitalis
* Recommended for individuals with 6 or more outbreaks per year
* Decreases reoccurence by 70-80%
* Stress safe sex practices
* Disease can be transmitted in absence of symptoms
* Reassure patients that minimal risk with long term therapy
* Encourage adherance to daily suppressive therapy
* Valacyclovir QD dosing vs. acyclovir BID times a day dosing.
42
Vulvovaginal Candidiasis: Overview
* Most common vaginal infection affecting women of childbearing age
* Up to 75% of women-1 episode (50% more than 1 episode)
* Normal vaginal flora (Candida) can become pathogen during a change in the vaginal environment
* Antibiotic therapy
* High levels of estrogen
* Immune status
* Vaginal pH
* Pregnancy
* Candida albincans is responsible for 80-90% of all infections
43
Vulvovaginal Candidiasis: Complicated/Uncomplication
* Uncomplicated:
* Sporadic episodes
* Mild symptoms
* Majority of episodes are considered uncomplicated
* Complicated
* Reurrent (4 or more episode/yr)
* Severe symptoms
* Non-albican species
* Immunocompromised
* Pregnancy
* Unconrolled diabetes
44
Vulvovaginal Candidiasis: Treatment
* Uncomplicated:
* Topical antifungal x 1 dose, 3 days, or 7 days
* All regiments equally effective
* Price varies
* Topical preferred over PO
* Oral fluconazole: 150mg x 1dose
* Complicated:
* Severe Infection:
* Topical antifungal x 7-14 days
* PO Fluconazole 150mg x 3 doses
* Pregnancy:
* Topical antifungal x 7days
* Uncontrolled Diabetes:
* Topical or PO x 7-14days
* Recurrent:
* Topical or PO x 7-14days
* Maintenance fluconazole 150mg weekly times 6 months
45
Vulvovaginal Candidiasis Therapies
46
Oropharyngeal and esophageal candidiasis
* Infection can spread from oral mucosa into esophagus
* Risk factors; inhaled corticosteroids, antibiotics, smoking, immunocompromised.
47
Dermatophytes
Ring-shaped, erythematous; well demarcated, scaly to vesicular region accomplished by puritis
48
Antifungal Medications: Organized by MOA
* Damage Fungal Cell Wall
* Azole Antifungals
* Ketoconazole
* Clotrimazole
* Fluconazole
* Itraconazole
* Voriconazole
* Terbinafine
* Nystatin
* Inhibit mytosis
* Griseofulvin
49
Antifungal Medication Formulations
Focus on which are OTC and what are topical
50
Antifungal Indication and Treatment Durations
Focus on Duration of Therapy
51
Counseling Pearls: Azole Antifungals
* Adverse reactions: N/V/D
* Drug interactions: strong CYP3A4 and 2C9 inhibitor
* oral contraceptives
* Simvastatin
* Warfarin
* Take voriconazole 1-2 hours before meal
* Ketoconazole and itraconazle need acid for absoroption (separate by antacide by 2 hours)
* Monitor liver function
52
Counseling Pearls: Terbinafine
* Improvement in nailbeds may take months; cure rate approximately 40-75% of patients
* Adverse reactions:
* N/V/D, disorder of taste, indigestion, headache
* Monitor liver function: report persistent nausea, fatigue, vomiting, dark urine, right upper abdominal pain, or jaundice
53
Counseling Pearls: Griseofulvin
* Drug of choice for tinea capitis
* Adverse effects:
* Rash, headache, photosensitivity, N/V/D, dizziness, drowsiness
* Interactions:
* Birth control pills: decreases effectiveness
* Alcohol: flushing, tachycardia
* Take with fatty meal to increase absorption
