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Non HIV viruses Flashcards

1
Q

Varicella zoster virus (vzv)

A
  • Alpha herpesvirus
  • DNA is singular, linear, double stranded molecule

Chicken pox
Shingles

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2
Q

Chicken pox (vzv)

A

Primary infection in child hood
Typically benign - maculopapular, vesicular, and pappular rash
Late winter to early spring

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3
Q

Shingles

A
  • Latent virus mainly in the elderly (sensory ganglia)
  • associated with significant pain - unilateral vascular rash
  • No seasonal predilection
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4
Q

Mild to moderate chicken pox treatment

A

No treatment

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5
Q

Moderate to severe chicken pox treatment
2-12 years old

A

Valacyclover 20 mg 1 kg po 3x daily

Acyclovir 20 mg kg po 4x daily (start within 24 hours of rash)

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6
Q

Moderate-severe Chickenpox
adolescent, young adults

A

-acyclovir 800 PO 5x daily ( start within 24 hours of rash)
-valacyclovir 1000mg PO 4x daily
-Famciclovire 500 PO 3x daily (effective data lacking)

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7
Q

risk factors for chickenpox

A

chronic cutaneous or pulmonary diseases
chronic salicylate treatment
( increased risk of reyes syndrome )

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8
Q

what is not clear for the treatment of shingles

A

benefits of antiviral therapy >72 hours of symptoms

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9
Q

treatment of Shingles for mild to moderate

A

-Valacyclovir
-Famciclovir

duration 7 days

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10
Q

treatment of shingles for severe (ocular or neurologic or disseminated disease)

A

Acyclovir IV* 7 - 10 day

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11
Q

Treatment for Post-herpetic neuralgia (PHN)

A

-observed frequently following herpers zoster ophthalmic and upper body involvement
-gabapentin
-lidocaine patch 5%
-opiod alagesic
-nortriptyline or amitriptyline

prednisone-added to acyclovir does nit reduce incidence or duration of PHN

-

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12
Q

Prevention Pre-exposure: Chickenpox

A

Varicella vaccine
-live attenuated virus
-two dose series first administration at 12 - 15 months and then 4-6 years

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13
Q

Prevention Pre-exposure: shingles

A

-Zostavax: live attenuated single shot

-Shingrix: for 50 years and older (new and preferred)
–non live subunit two shot given 2-6 months apart

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14
Q

Prevention Post exposure of shingles

A

high-titer varcrella-zoster immune globulin 125 units/ 10 IM for high risk patients to prevent infection
–ASAP <96 hours after exposure

if rash develops initiate with acyclovir within 24 hrs

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15
Q

Human a- herpesvirus (HSV)

A

-two types: HSV-1 & HSV-2
-large, double stranded, linear DNA genome

HSV-1: acquired more commonly and earlier than HSV-2

HSV-2 seroprevalence incidence is estimates at 23 million cases per year

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16
Q

HSV Manifestation

A

-healthy children and adults
- initial episode more severe than recurrent
-presentation varies by site, age, and immune status of host and HSV type

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17
Q

What is the most common and initial clinical manifestation of HSV-1?

A

orofacial infection (gingivostomatitis and pharyngitis)

latent infection–> recurrent lesions on the vermillion border of the lips (herpes labials)

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18
Q

what are clinially similar between HSV 1 and HSV 2

A

genital infections

reoccurrences are common with HSV 2

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19
Q

HSV: Treatment of Oral Lesions

A

Valacyclovir 2 gm x 1 day **
Famciclovir ( approved for HIV only)

Acyclovir x 5 days ( Not FDA approved)

Topical regimens (less preferred)
-Penciclovir cream
- Acyclovir cream

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20
Q

HSV: treatment of genital lesions
primary (initial episode)

A

acyclovir, valacyclovir, famciclovir
PO
7-10 days

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21
Q

HSV: treatment of genital lesions
subsequent recurrent episodes

A

immunocompetent
-acyclovir, valacyclovir, famciclovir
- PO x 5 days

immunocompromised, HIV
-acyclovir, valacyclovir, famciclovir
-PO x 5-10 days

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22
Q

HSV: treatment of genital lesions
severe

A

Acyclovir IV 5-7 days

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23
Q

HSV: treatment of genital lesions
acyclovir resistant HSV

A

Forcarnet IV x 7days

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24
Q

HSV: treatment of genital lesions
chronic suppression (daily)

A

immunocompetent
-acyclovir PO BID
-Famciclovir PO BID
-valacyclovir PO daily
—pts with <9 recurrences per year should use 500mg PO then 1000mg PO if breakthrough

immunocompromised
-acyclovir PO BID
-Famciclovir PO BID
-valacyclovir PO daily

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25
Q

what does suppression therapy do for genital herpes reccurance

A

reduce the frequency by 70-80% among pts that have frequent recurrences (>6/year)

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26
Q

influenza Virus

A

orthomyxlvirdae
-single stranded

caused by epidemic acute respiratory disease characterized by fever, cough, and sytemic symptoms
- primary viral pneumonia
-secondary bacterial pneumonia

Thee types: A, B, C

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27
Q

how is influenza virus transmitted

A

respiratory route –> large epidemics during winter in temperate climates

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28
Q

Influenza type A

A

moderate to sever
all age groups
human and animals

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29
Q

Influenza type B

A

milder
children
human

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30
Q

Influenza type C

A

non-epidemic
N/A
rarely in humans

31
Q

antigenic drift

A

antigenic variants created by point mutations on surface antigens–> small changes in hemagglutinin and/or neuraminidase

-basis for seasonal epidemics of influenza
-resaon for changes in annual influenza vaccine
-rationale for annual vaccination recommendation

32
Q

antigenic shift

A

influenza virus acuirei a new hemagglutinin or neuraminidase via genetic reassortment

  • results in emergence of novel influenza virus
    -potential for pandemic
33
Q

Influenza treatment

A

Oseltimavir (PO x 5days )
- peds= weight base dosing

Zanamir (inhalation x 5 days)

most effective when used early in illness within 48 hrs or no clinical benefit
- ideally within 12 hrs of infection

exception; critically ill or hospitalized
-starting up to 5 days after onset is associated w survival

34
Q

Corticosteroids and influenza

A

can cause excess mortality in pts with influenza pneumonia

AVOID!

35
Q

New Influenza agents

A

Peramivir ( Influenza A and B)
- 1 dose (FDA)
- longer in hospitalized (5 days, limited studies)

Baloxavir ( Influenza A and B)
- 12 years or older
- weight based
-1 dose

36
Q

Influenza treatment in critically illed

A

no benefit with 150 mg 2x daily dosing –> not recommended
-influeza B in 1 study show a trend towards benefit with higher dosing

37
Q

Prevention of pre exposure: influenza

A

influenza vaccine
hand hygiene
respiratory etiquette
contact avoidance- stay home
chemoprophylaxis

38
Q

influenza at risk population

A

-children age <2 years
-adults > 65 years

-chronic pulmonary, cardiovascular, renal, -hepatic, hematologic, metabolic, neurologic conditions, severe developmental delay, mental retardation

-immunosuppression, transplant, HIV
-pregnant or two weeks post partum

-<18 years who receive long term aspirin
-american indians/alaskan natives
-morbid obesity bmi >40
-residence of nursing homes and other chronic learning facilities

-high risk of complications in hSCT and organ transplant patients

39
Q

Influenza Prevention Pre: vaccination
Egg allergies

A

can receive any licensed recommended age appropriate vaccine and do not have to monitored for 30 mins after administration

severe allergies should be administered in a medical setting

flu bloc(recombinant influenza vaccine) is not produced on eggs

40
Q

egg-based vaccine update

A

A/Victoria

41
Q

cell or recombinant based vaccine update

A

A/wisonsin

42
Q

prevention pre-exprosure: vaccination

A

flumist intra nasal - live attenuated

live attenuated for health individuals between 2-29 who are not pregnant
-based on flu strain that does not cause disease
- still a living virus –> may cause infection with weaken immune system or underlying medical conditions
–ppl who have taken flu antiviral frugs within a certain amount of time \

within 48hrs - oselt, zana
past 5 days- peramivir
past 17 days- baloxavir

43
Q

prevention pre- exposure
chemoprophylaxis

A

CDC does not recommend widespread ore routine use
- only high risk pts
-control outbreaks in long term care facilities
-only when when can be used with 48 hrs of exposure

44
Q

Influenza Chemoprophylaxis

A

oseltamivir PO x 10 days
-peds weight based

zadnamivir inhaltion x 10 days

45
Q

rabies

A

zoonotic encephalitis caused by different species of neurotropic viruses in the rhabovidae family
- single stranded RNA enveloped virions

highly contagious through exposure to animal saliva or nervous system tissue
– bite
– scratches
– contamination of open wounds or mucous membranes

46
Q

Rabies treatment

A

no proven antiviral therapy

clean thoroughly with soap and water

human rabies immune globulin
-20 IU/kg on day 0
-infiltrated in and around the wounds and rest be administered at distant site IM
- do not give in same string as the vaccine
-do not give more than 7 days after the initiation of the vaccine

47
Q

Treatment: Rabies
Vaccination schedule

A

Immunocomptent: 4 doses toal
- 1 dose on day 0,3,7, and 14

Immunocompromised: 5 doses
-1 dose on days 0,3,7,14,28

48
Q

If already been immunized for rabies

A

-local wound cleaning
-NO human rabies immune globulin
-vaccination on days 0 and 3

49
Q

Rabies pre exposure prophylaxis

A

3 doses
-1 dose on day 0, 7 and 21or 28

50
Q

Rabies prevention: pre-exposure
targeted high risk groups

A

vets
lab workers
certain travelers

51
Q

Covid 19

A

severe acute respiratory syndromee related corona virus

zoonotic (possible bat-borne)
spread via respiratory droplets

nesters human cells through angiotensin converting enzyme 2

symptoms after 2-14 weeks of exposure

viral shedding begin 5-6 days prior symptoms

52
Q

covid 19 presentation

A

SOB or diffuculty breathing**
cough
fever or chills
muscle or body aches
sore throat
loss of taste
diarrhea
headache new fatigue
N/V
congestion or runny nose

53
Q

Authorized treatment of Covid 19

A

out patient
-nirmatrelvir/ritonavir (paxlovid) within 5 days of sx onset
-Remdesivir ( within 7 days sx onset)
-alternative: molnupupiravir 18 yr and older ( with 5 days of sx onset)

inpatient
-remdesivir
-tocilizumab
-dexamethasone
-baricitinib

54
Q

prevention: Covid 19

A

vaccination
-Moderna
-pfozer

wash hand often
- avoid touching your eyes, nose, and mouth

avoid close contact with sick individuals or stay home

55
Q

analogs

A

purine
adenosine
n-hydroxycytidine

56
Q

analog: purines

A

acyclovir
famciclovir
valacyclovir

57
Q

analog: adenosine

A

remdesivir

58
Q

analog: n-hydroxycytidine

A

molnupiravir

59
Q

Inhibitors

A

neuraminidase
endonuclease activity
protease

60
Q

Inhibitors: neuraminidase

A

oseltamivir
zanamivir
peramivir

61
Q

Inhibitors: endonuclease activity

A

baloxavir

62
Q

Inhibitors: protease

A

nirmatrelvir

63
Q

purine analog acyclovir

A

synthesize purine nucleoside analog with inhibitory action against HSV and VZV

stops replication by competitive inhibition of DNA polymerase

64
Q

Acyclovir tidbits

A

low bioavailability
extensive renal elinination
high concentration= nephrotoxicity, due to
-rapid infusion
-dehydration
-renal insufficiency
-increase dose

SE: neurologic toxicity mechanism unknown (reversible)

65
Q

Other purine analogs

A

valacyclovir
-ester of acyclovir
- well absorbed 3-5 x better

FAmciclovir
-metablolized to penciclovir ( active)

66
Q

Adenosine analog: remdesiver

A

prodrug metabolized to nucleoside monophosphate intermediate

inhibitor of SAR-CoV-2 RNA polymerase

essential for vial replication

67
Q

adenosine alnalog tidbits

A

dosing
-inpatient: IV x 5 days
-outpatient: IV x 3 days

monitor
-Liver function test ( d/c if elevate alt )
-heat rate
-infusion rate

68
Q

n-hydroxcytidine analog: mulnupiravir

A

prodrug metabolized into n-hydroxytidine

phhosphylated to form active triphosphate
- incorporated in SARS-CoV-2 RNA

69
Q

neuraminidase inhibitors

A

block the function of viral neuraminidase
-preventing its reproduction by budding from the host cell

influenza a and b

70
Q

neuraminidase tidbits

A

toxic effects are minimal and difficult to distinguish from influenza
- Nausea, vomiting, diarrhea, HA

caution with potential for confusion in dosing oral suspension

71
Q

endonuclease activity inhibitor: baloxavir

A

inhibits replication of virus by interfering with cap snatching
-hijack the host mRNA transcription process
-5’methylated caps of the cellular mRNA are cleaved by the viral endonuclease and used to prime transcription of viral mRNA by viral RNA polymerase

72
Q

endonuclease activity inhibitor: baloxavir
TIDBITS

A

AE:
-N/D
-HA
-bronchitis
-nasopharyngitis

avoid coadministration of multivalent cation as it can interfere with absorption

73
Q

protease inhibitor: nirmatrelvir

A

-combined with ritinavir (paxlovid)
-is a peptidomimeti inhibitor of the SAR-CoV-2 main protease

74
Q

protease inhibitor: nirmatrelvir
tidbits

A

AE:
-diarrhea
-taste sense altered

recommended for high risk pts
-DM, BMI> 25, lung disease, immunocompromised, cancer, . 65 etc

ID (27 decks)

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