OTC Anti-Virals (Rachel Elliot) Flashcards
What is Varicella zoster?
VZV is a highly infectious virus that causes chicken pox in babies, children, young adults; shingles (herpes zoster) in adults
What are the symptoms of Varicella zoster (chicken pox)?
Flu-like symptoms, fever, itchy rash of red, itchy sports that turn into fluid filled blisters. They can crust to form scabs (no longer infectious).
Can you get chicken pox again?
13% don’t develop enough immunity and so can get it again
If you get it again it is known as Congenital Varicella Syndrome
How are chicken pox and shingles related?
Chicken pox is the primary infection, then the virus can enter the nerves and remain dormant. If the virus reactivates in the nerves it is known as shingles
Treatment of chicken pox?
Neonates, parenteral antiviral
Healthy children (1 month - 12 years) symptomatic treatments, paracetamol, ibuprfen, calamine lotion. Stop the child scratching to prevent scarring.
Adolescents and adults, antiviral (aciclovir) within 24 hours to reduce the duration and severity.
Infectious from days 3-4 before blisters appear to agter scabs form
What does the Varicella zoster PGD entail?
Valirix - deep SC injection in the deltoid or anterolateral thigh
Varivax - IM or deep SC injection also
Pre-exposure vaccination for:
Sero- negative healthcare workers at risk of developing chicken pox
Lab staff thay may be exposted to virus during work
Contacts of immunocompromised patients i.e. sibling of a patient with leukaemia
What is Herpes zoster?
Shingles
Infection of the nerve and the area of skin around it
Caused by dormant VZV after chicken pox
What can cause the reactivation of VZV in nerves?
Old age, immunosuppressant therapy, HIV infection, risk and severity increases with age
Shingles can reoccur
What are the symptoms of Herpes zoster
(Shingles)
2-4 weeks, prodrome, then pain followed by a rash
The pain is localised, mild-severe, tender skin and lasts once the rash has gone
Can also get opthalamic shingles when it is activated in the trigeminal nerve
What is post-herpetic neuralgia?
PHN is constant or intermittent burning, aching, throbbing, stabbing or shooting pain, allodynia, hyperalgesia can last for years and sometimes be permanent.
A lasting affect of the Herpes zoster virus.
How can Herpes zoster be managed? What are the goals of treatment?
Minimise the clinical course
Provide analgesia
Prevent complications
Decrease the incidence of PHN
1. Self-care (keep clean dry rash covered with loose clothing, cool compress, don’t share towels)
2. Antivirals (aciclovir 800mg 5 x day for 7-10 days)
3. Analgesia (paracetamol, NSAIDs, opioids, TCAs, gabapentin, pregabalin)
Is there a vaccine against Herpes zoster?
Shingles vaccine is for people aged 70-79 years old in the UK
Vaccine reduces shingles virus by 38% and PHN by 67%
Zostavax
Pharmacists can adminster by PGD
What is Herpes simplex?
Cold sores
HSV-1 (and 2) cause small blisters around and on the lips
Start with a tingling, itching, burning sensation
Small fluid filled sores then appear
Once contracted, remains dormant most of the time unless triggered
7-10 days clear up on their own
Treatment for Herpes simplex (HSV-1 and 2)?
Aciclovir cream (Zovirax 2g) reduces symptoms and duration Cream should be applied as soon as tingling begins
What are the rare complications with cold sores?
Dehydration Whitlows Keratoconjuctivitis Skin Infections Encephalitis
What is HPV?
Human Papilloma Virus
Who is offered the HPV vaccine?
All girls aged 12-13 (Yr8)
What does Cervarix vaccine protect against?
In girls of Yr8 age, it protects against HPV types 16 and 18
It is a recombinant, bivalent vaccine
What is Gardisil? When was it made available?
It is the more recent vaccination from 2012
A non-infectious recombinant quadrivalent vaccine
Protects against HPV 16 and 18 but also HPV 6 and 11 that cause genital warts.
How is Gardisil formulated?
From purified virus-like particles of the major capsid protein of HPV types 6, 11, 16 and 18 adsorbed on preformed aluminium containing adjuvant.
What are the barriers to use of the HPV vaccine?
Anti-vaccine movement scaremongering
HPV vaccine too expensive in some of the most affected areas of the world
Immunological response higher if given pre-pubescence
Vaccination of adolescents raises moral / ethical issues in countries where pre-marital sex is not socially acceptable. Should men be vaccinated?
What are viral URTIs?
Viral upper respiratory tract infections
Caused by >200 viruses (rhinovirus etc)
Common cold symptoms; sinusitis, rhinitis, otitis media, pharyngitis, laryngitis, tracheitis, head cold etc
Hand to hand, hand to surface transmission
How can URTIs be managed?
No effective treatment or cure or prevention
Herd immunity, seasonal nature, stress, malnutrition
Reduction in transmission
Symptomatic treatment
