Questions from S 3 Flashcards
Exam question - printed out in folder
What is the viral target, and mechanism of action of this drug?
Maribavir
Maribavir
CMV
UL97 kinase inhibitor
Exam question - printed out in folder
NHs has stopped all respiratory testing.
NNUH asked by integrated are board to fund respiratory testing internally based on clinical needs pre-pandemic
medical director has stopped respiratory testing as each test is >£200 per sample
write brief notes on what evidence you would report to the consultant to convince them urgent respiratory virus testing is required, or any other assay should be maintained
business case
Gather evidence of burden of infection - e.g regional/ national data on infection prevalence
- Highlight consequences - High number of admissions with respiratory infections
more HAI
no treatment - higher morbidity/ mortality
higher healthcare costs - NNUH serves high risk population – paeds/ haematology/ oncology
- Diagnostics enable to cohort different patients together
- IPC benefits – prioritise side rooms, identify outbreaks
- Cost saving
try and negotiate costs with supplier
o Use 24-multiplex for high risk patients – Haem/Onc, Paeds, or returning travellers
o Have separate test for more common infections
o Have POC tests – although will need a confirmation method
o Have service on standby ready for winter use
o Reference lab – not an option due to cost and slow turnaround time
Laboratory networking to save money - similar to EPA
Do cost-benefit analysis, showing value for money
- Key benefits of keeping service
o Better diagnostics
o Better treatment – e.g reduced antibiotics, reduced hospital admission time, better IPC/ outbreak control
o Could streamline service to save costs e.g not all patients get 24 multiplex. Streamline testing during summer, and increase testing in winter
engage other team members to strengthen proposal - IPC, Haem/ onc, paeds, microbiology, ID
face-face meeting with medical director
Exam question - printed out in folder
What is the viral target, and mechanism of action of this drug?
What is dosing schedule
Cabenuva
Cabenuva
Cabotegravir + rilpivirine
To be used in HIV1 infection, with undetectable viral load, as long term suppressive therapy
Integrase strand transfer inhibitor + NNRTI second generation
oral lead in therapy
oral therapy for 1 month
IM injection months 2 and 3
maintenance injection at month 5 and every two months subsequently
or
IM therapy
IM injection month 1 and month 2
maintenance injection at months 4, 6, 8 etc
Exam question - printed out in folder
What is the viral target, and mechanism of action of this drug?
Letermovir
Letermovir
CMV
DNA terminase complex inhibitor
Exam question - printed out in folder
What is the viral target, and mechanism of action of this drug?
Bulevirtide
Bulevirtide
HDV
inhibits HBV/HDV hepatocyte entry by inactivating NTCP receptor
Exam question - printed out in folder
What is the viral target, and mechanism of action of this drug?
Pritelvir
Pritelvir
HSV 1/2
helicase primase (UL5) inhibitor- prevents uncoiling of viral DNA
used in patients who have aciclovir resistance - viral thymidine kinase resistance (UL23)
Exam question - printed out in folder
What is the viral target, and mechanism of action of this drug?
How is it administered?
Lenacapavir
Lenacapavir
HIV
primarily for drug resistant infection or use as PreP
capsid assembly inhibitor
oral loading on day 1, 2, 8
then subcutaneous injection at day 15
then subcutaneous injection every 6 months
Exam question - printed out in folder
What is the viral target, and mechanism of action of this drug?
Baloxavir
Baloxavir
Influenza A/B
inhibits cap-depdendent endonuclease
approved in 2018, shows 1 day reduction in symptoms. But in phase 3 trial, 10% had already developed drug resistance, so not used
Exam question - printed out in folder
What are the clinical implications of this profile?
Person who injects drugs
HBsAg neg
Anti-HBc pos
AntiHBc IgM neg
HBeAg neg
Anti-HBe pos
HBV DNA 112
Occult HBV infection
At risk of further reactivation if immunocompromised
risk of cirrhosis/ HCC/ extra-hepatic disease
Current risk of transmission to others - if blood transfusion
reactivation due to cccDNA in hepatocytes
Exam question - printed out in folder
Haemopoeitic stem cell transplant candidate
Outline the clinical management of this patient post-transplant
HBsAg neg
Anti-HBc pos
AntiHBc IgM neg
HBeAg neg
Anti-HBe pos
HBV DNA neg
Past HBV infection
High risk immunosuppression – at high risk of reactivation
Commence on tenofovir/ entecavir post-transplant
Continue for at least 12 months – 18 months? 6 months following immune reconstitution
Refer hepatology
Monitor LFTs/ HBV DNA every 3 months
Exam question - printed out in folder
orthopaedic surgeon
Provide advice for occupational health regarding management of this surgeon?
HBsAg pos
Anti-HBc pos
AntiHBc IgM neg
HBeAg neg
Anti-HBe pos
HBV DNA 201
Chronic HBeAg negative infection
HBV DNA >200 – cannot perform EPPs
Stop EPPs immediately - move to other duties
Repeat sample to confirm result
Hepatology referral – consider treatment for occupational reasons
Once negative, repeat sample 4 weeks later to ensure still negative
Exam question - printed out in folder
Pregnant 12 weeks booking blood sample
Outline clinical management of this patient and child once born
HBsAg pos
Anti-HBc pos
AntiHBc IgM neg
HBeAg pos
Anti-HBe neg
HBV DNA 8.2 log
Current HBV infection with high viral replication
High risk of transmission to baby
Mother – start on tenofovir to reduce viral load. Not not use entecavir in pregnancy. Can start immediately, or start at 3rd trimester. Carry on treatment for 12 weeks after delivery, and review if treatment still indicated
Baby – HBIG at birth with vaccine at 0, 4 weeks, 1 year in addition to routine childhood immunisation
Delivery – can be normal vaginal
Breastfeeding – allowed as long as no bleeding/ cracked nipples
Exam question
Where are HCV hotspots in the world?
Middle belt
North Africa
Middle-east
Eastern Europe/ Russia
China
Prevalence 2-3%
Actual exam question about HBV profiles
Describe the most common profiles
Acute HBeAg pos infection
Acute HBeAg neg infection
Chronic HBeAg pos infection
Chronic HBeAg pos hepatitis
Chronic HBeAg neg infection
Chronic HBeAg neg hepatitis
Chronic carrier - anti-HBc positive
Chronic is after 6 months, however can speculate this based on serological profile
Use correct EASL terminology.
Do not say active/ inactive infection
Acute exam question
What is the most common Parainfluenza virus?
Which one causes most disease?
Which one causes croup?
Parainfluenza 3 is most common
Parainfluenza 3 causes highest burden of severe disease
Parainfluenza 1 and 2 cause croup
