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*B33VPI - Professionalism > OTC Antivirals > Flashcards

OTC Antivirals Flashcards

1
Q

What is varicella zoster? Epidemiology? 20:00

A

Highly infectious viral infection:

  • Chickenpox in babies, children, young adults
  • Shingles (herpes zoster) in adults
  • Most common in children U10; over 90% of adults immune as they’ve had the virus before
  • 13% will not develop sufficient immunity; liable to get it again
  • After primary infection, virus is dormant in nerves; VZV can reactivate many years later
  • Have had to had chicken pox to get shingles; secondary manifestation of VZV
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2
Q

What are the symptoms of VZV/chickenpox infection?

A
  • Flu-like symptoms
  • Fever
  • Itchy rash of red
  • Itchy spots that turn into fluid-filled blisters; fluid is v. infectious
  • Crust over to from scabs, which shed
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3
Q

How is varicella zoster treated?

A

Neonates:
- Parenteral antiviral

Healthy children (1 month - 12 years):

  • Symptomatic treatment (paracetamol, ibuprofen, topical agents e.g. calamine lotion)
  • Stops child scratching; scar prevention (or cotton mitts)

Adolescents/adults:
- Treat w/antiviral (aciclovir) within 24 hours to reduce duration and severity (less severe primary infection)

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4
Q

How infectious is varicella zoster?

A
  • Infectious af
  • Infectious from 3-4 days before blisters form (fluid inside v. infectious)
  • Thus patient must stay away from other people; particularly immunocompromised, high-dose steroids, pregnant women (1st trimester = risk)
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5
Q

What complications may arise from a pregnant lady being infected w/VZV?

A
  • Maternal pneumonia risk
  • 2% give birth to babies w/congenital varicella
  • From 5 days before to 2 days after delivery; greatest risk of death to newborn
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6
Q

What is the difference between Varilrix and Varivax vaccines for VZV?

A

Varilrix:
- Deep SC injection into deltoid region or anterolateral thigh

Varivax:
- Injection either IM or deep SC

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7
Q

What is the criteria for VZV administration under PGD for pre exposure vaccination?

A
  • Sero-negative HCPs at risk of developing chicken pox
  • Lab staff that may be exposed to VZV in their course of work
  • Contact of immunocompromised patients e.g. siblings of a child w/leukaemia
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8
Q

What is the criteria for VZV administration under PGD for post exposure prophylaxis?

A
  • Unvaccinated HCPs w/o definite history of chicken pox or zoster and having a significant exposure to VZV
  • ‘See Green Book’
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9
Q

Describe herpes zoster infection. How does it manifest?

A
  • Shingles
  • Infection of a nerve and the skin around it
  • Cause by VZV dormant in nervous tissue post-chickenpox
  • Reactivation by: old age, immunosuppressant therapy, HIV infection; risk & severity increases w/age
  • Shingles can re-occur
  • Possible to catch chickenpox from someone w/shingles
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10
Q

What are the symptoms of herpes zoster infection?

A
  • Last 2-4 weeks
  • Prodrome; then pain followed by rash
  • Pain: localised, mild-severe, tender skin, lasts after rash has gone (infection of nerve)
    »> 1 in 5 develop post-herpetic neuralgia (PHN); constant or intermittent burning, aching, throbbing, stabbing or shooting pain, allodynia, hyperalgesia
    »> These can last for years, sometimes permanent.
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11
Q

What are some complications of herpes zoster infection?

A
  • Ophthalmic shingles; when virus is reactivated in the trigeminal nerve (rash is right along the nerve)
  • Ramsay-Hunt syndrome; inner-ear, deafness etc.
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12
Q

How is herpes zoster managed/treated?

A

1) Self care; keep rash clean, dry; covered w/loose clothing, cool compress, don’t share towels
2) Antivirals; aciclovir 900mg 5x day for 7-10 days (S/Es)
3) Analgesia; paracetamol, NSAId, opioids, TCAs, gabapentin, pregablin

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13
Q

What are the goals of treatment of herpes zoster management?

A
  • Shorten the clinical course
  • Provide analgesia
  • Prevent complications
  • Decrease incidence of PHN (post-herpetic neuralgia)
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14
Q

How effective is the shingles (herpes zoster) vaccine?

A
  • Vaccination program for 70 and 79 y/o’s
  • Vaccines reduce shingles incidence by 38%, PHN by 67%
  • Zostavax; live attenuated vaccine that contains high antigen level of VZV
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15
Q

Describe herpes complex infection. What is it caused by?

A

Cold sores:

  • HSV-1 (and HSV-2) cause small blisters around and on lips
  • Initial infection asymptomatic, but highly contagious
  • Start w/a tingling, itching or burning sensation around mouth. Small fluid-filled sores then appear; most commonly on edges of lower lip
  • Once contracted, remains dormant mostly unless triggered
  • Self-limiting; clears up within 7-10 days
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16
Q

How is herpes simplex treated? Complications?

A

Aciclovir topical cream:

  • Antiviral
  • Reduces symptoms and length of symptoms; apply before blister formation (as soon as tingling sensations begin)

Complications:

  • Rare
  • Dehydration
  • Whitlows,
  • Keratoconjunctivitis
  • Skin infections
  • Encephalitis
17
Q

How does the HPV vaccine Cervarix differ from Gardasil?

A

Cervarix:
- Activity only against: Types 16, 18 (cause of most HPV-related cervical cancer)

Gardasil:
- Activity against Types 16, 18 as well as 6 and 11 (genital warts)

18
Q

Who is the HPV vaccine offered to? What is it (Gardasil)?

A
  • All girls in Year 8 in the UK (12/13 y/o’s; better immunological response)
  • Non-infectious recombinant quadrivalent vaccine prepared from purified virus-like particles (VRP) of the major capsid (L1) of HPV Types 6, 11, 16, 18
  • 6, 11 = 90% of genital warts
  • 16, 18 = > 70% of cervical cancer cases in the UK
19
Q

What are the barriers to HPV use?

A
  • Anti-vaccination movement scaremongering
  • > 80% of cervical cancer cases occur in developing countries; but HPV vaccines too expensive for too many
  • Immunological response higher if given pre-pubescence
  • Moral and ethical issues WRT vaccinations in prepubescents in some countries; worries it will encourage promiscuity
20
Q

What are some examples of viral upper respiratory tract infections (URTIs)? What is transmission caused by?

A
  • Caused by > 200 viruses
  • Sinusitis, rhinitis, otitis media, pharyngitis, laryngitis, tracheitis, common cold, headcold etc.
  • Transmission: hand-to-hand, hand-to-surface-to-hand
    »> Most common infectious illness, main reason for missing work and school (biggest impact of economic productivity)
21
Q

What are the symptoms of a common cold?

A
  • Blocked (congested)/runny nose, facial pressure, sneezing
    1) Clear discharge (mucus) at first from the nose; often becomes thick and yellow/green after 2-3 days
    2) Difficulty sleeping due to a blocked nose, malaise, mildly high temperature
22
Q

What are the main presenting symptoms in other URTIs aside from the common cold?

A
  • Cough; usually main symptom
  • Fever
  • Headache
  • Muscle aches and pains
  • Fatigue
    »> Cough can persist for 2-3 weeks
23
Q

How are viral URTIs (e.g. common cold) managed?

A
  • No effective cure or prevention
  • Herd immunity, seasonal nature, stress, malnutrition
  • Reduction in transmission: handwashing, tissues, not sharing utensils
  • Symptomatic treatment; analgesics, fluids, smoking cessation
24
Q

What is the efficacy of symptomatic treatments for URTIs?

A
  • Decongestants
  • Echinacea purpurea
  • Zinc
  • Vitamin C
    »> Negligible evidence
25
Q

What is the advice regarding cold remedies and children?

A
  • Don’t use cold remedies in children U6 (MHRA 2009)

|&raquo_space;> Excl. ibuprofen & paracetamol (okay for U6)

*B33VPI - Professionalism (2 decks)

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