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CPR Exam 2 > Pharm: Influenza > Flashcards

Pharm: Influenza Flashcards

1
Q

What is the MOA of neuraminidase inhibitors?

A

Completely inhibit neuraminidase enzymes

Prevent viral reproduction by budding from host cell

Neuraminidase usually cleaves the sialic acid found on glycoproteins on human cells

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2
Q

What are the neuraminidase inhibitors?

A

oseltamivir (oral)

zanamivir (inhaled)

peramivir (IV)

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3
Q

When should you use oseltamivir?

A

Uncomplicated influenza A and B

Patients who report sx started within 48 hrs

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4
Q

What are the contraindications for oseltamivir?

A

hypersensitivity

End-stage renal dz

Suicidal thoughts, confusion, delirium

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5
Q

What are the warnings associated with oseltamivir?

A

Serious bacterial infections (may coexist with influenza infection)

Do not give live influenza vaccine (intranasal) within 2 weeks before or 48 hrs after oseltamivir is given –> interferes with vacceine effectiveness

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6
Q

What is the limitation of oseltamivir?

A

not a substitute for flu vacceine –> should continue to get annually

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7
Q

Can you give oseltamivir to really young or really old?

A

Not indicated in children younger than 2 weeks

Not given to prevent flu in children less than 1 yo

Can give to geriatric population

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8
Q

Can you give oseltamivir in women breastfeeding/pregnant?

A

Benefits may outweight risks in breastfeeding moms

No controlled data in human pregnancy, however, drug does cross placenta at high doses

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9
Q

Can you take oseltamivir with warfarin?

What about clopidogrel?

A

Warfarin: Yes

Evidence supports inhibition of activating enzyme when taking with clopidogrel, may decrease effectiveness

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10
Q

What is the active metabolite of oseltamivir?

Does this have an effect on CYP450 or UGT?

A

oseltamivir carboxylate = OC

Does not affect CYP450 or UGT enzymes

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11
Q

What is the indication for zanamiviruse?

A

influenza A or B infection within 48 hrs of sx onset

Benefits overall appear to be small (cost outweights benefits in most healthy patients)

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12
Q

What are contraindications for zanamivir?

A

Allergy to lactose or milk proteins

Brain dz

mental illness

Seizures - use with caution

Lung disease (asthma, COPD) - not recommended

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13
Q

What are some warnings of zanamivir?

A

Should not recieve live flu vacciene 2 wks before or 48 hrs after med given

Doesn’t prevent bacterial infections that present with flu-like sx

May cause SOB & bronchospasm in pts with lung dz

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14
Q

Can you use zanamivir in young kids or elderly?

A

Not recommended in kids younger than 12

Can give to elderly, however, monitor closely for side effects

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15
Q

Can you use zanamivir in breastfeeding/pregnant women?

A

Benefits may outweight risks

Relatively safe for use by pregnant and breastfeeding women

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16
Q

How is zanamivir eliminated from body?

A

almost exclusively eliminated by kidney

Not a substrate for CYP450 –> no clinically significant drug interactions

17
Q

What is the indication for peramivir use?

A

Tx of acute uncomplicated influenza patient 18 or older who have been symptomatic for no more than 2 days

given IV (peramIVir)

18
Q

What are the contraindications for peramivir?

A

hypersensitivity

More evidence for effectiveness against influenza type A

No efficacy established in serious flu cases requiring hospitalization

19
Q

What is the most common adverse effect of peramivir?

A

diarrhea (>2%)

20
Q

What are some warnings for peramivir?

A

Serious skin/hypersensitivity rxns: SJS, erythema multiforme

Neuropsychiatric events (increases risk of hallucinations, delirium and abnormal behavior)

Risk of bacterial infections

21
Q

Can you use peramivir in pregnant/breastfeeding women?

A

Pregnancy catergoy C

No evidence available

Use in pregnant women only if clearly needed

22
Q

Can you use peramivir in kids and elderly?

A

Dont use in those younger than 18

Not enough evidence to determine elderly response

Reduce dose in those with creatinine clearance below 50 mL/min

23
Q

How is peramivir metabolised?

A

Not significantly metabolized in humans - major route of elimitation is kidney but 90% of drug is elimiated unchanged

Not a CYP450 substrate

24
Q

What is the MOA of baloxavir?

A

inhibits virus mRNA replication

25
Q

What are the indications for baloxavir?

A

given in pts 12 or older who have been symptomatic for no more than 48 hrs

26
Q

What are the contraindications for baloxavir?

A

hypersensitivity

27
Q

What are some adverse effects of baloxavir?

A

diarrhea

bronchitis

nasopharyngitis

HA

nausea

28
Q

What are the warnings associated with baloxavir?

A

serious bacterial infections presenting with flu-like sx

29
Q

What are the metabolic pathways of baloxavir?

A

Prodrug that gets almost completely converted to active metabolite

UGT1A3

CYP3A4

80% excreted in feces

rest excreted in urine

30
Q

What is the MOA of amantadine?

A

Unknown

Inferfering with fxn of viral M2 protein?

31
Q

What are the indications for amatadine?

A

infection with influenza A

Parkinson’s dz

32
Q

What are some adverse effects of amatadine?

What are some side effects of withdrawl?

A

falling asleep during ADLs

Suicidality & depression

Hallucinations & psychotic behavior

Dizziness & orthostatic hypotension

Withdrawl:

Emergent hyperpyrexia & confusion

Impulse control & compulsive behaviors

33
Q

What are some warnings associated with amantadine?

A

Deaths reported from overdose (lowest lethal dose reported was 1 gram)

Increases seizure activity in those with history

Don’t give to pts with untreated angle closure glaucoma

Suicide attempts in pts who recieved short courses for flu tx or prophylaxis

Do not discontinue abruptly in pts with Parkinson’s (abrupt mental deterioration)

Accumulates in plasma of pts with renal dz

May elevate liver enzymes

34
Q

What is the half life of amantadine?

How does this change in pts with renal dz?

A

Mean t1/2: 10-14 hrs

Renal dysfuntion t1/2: 7-10 days!

CPR Exam 2 (8 decks)

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