Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Phar455 > Shevchuk Lectures- Influenza > Flashcards

Shevchuk Lectures- Influenza Flashcards

1
Q

how is influenza spread

A

inhalation of droplets (coughing/sneezing) and direct contact with contaminated objects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

2 classes of influenza

A
  • documented- tested and you have it

- diagnosis based on sx (looks like have it)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

3 ways to prevent it

A
  • stay home when sick and keep distance from sick
  • wash hands
  • immunization
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

when can it be spread from adults? kids?

A

1 days before sx to up to 7 days after onset- kids can spread for slightly longer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

when is normal flu season in North america and when does it peak

A

Nov-April

January and February (usually, but it varies)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what 3 things cover the lipid envelope on a virus, and what is it

A
  • haemagluttinin (HA)
  • neuraminidase (NA)
  • matrix 2 (M2) ion channels
  • it is the antigenic portion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Steps for invasion and replication:

A

1) HA molecule initiates infection by binding to receptors on host cells within respiratory tract (nose, throat, lungs), and endocytosis brings the virus into cell
2)viral RNA and other things are released into cytoplasm and go to nucleus
3/4) complimentary (+ strand) viral RNA is transcribed; then either gets exported to cytoplasm to be translated or stays in nucleus
5) new viral proteins (HA/NA, etc) are secreted through golgi apparatus onto cell surface, or back to nucleus to form new viral genome particles
6) viral RNA and important proteins leave nucleus and bulge out of host cell membrane
7) mature virus buds off from cell and cell dies
2)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what molecule initiates the infection?

A

HA- haemagluttinin by binding to receptors on host cells within the respiratory tract

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

if a variation happens in a subgroup, are you still immune to the new related strain? What is this called?

A

not necessarily, they can be very different. Immunity to one sub type does not protect against others.
“Antigenic Shift/Drift”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

define antigenic shift/drift, and why it is caused, and what it can cause

A

the appearance of influenza virus (usually A) with new HA or NA subtypes

  • caused by mutations during replication- viruses don’t have a proof reading system
  • can cause a pandemic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what are two reasons to get the influenza vaccine yearly

A
  • antibody response lasts on average 6-8 months

- virus undergoes constant mutations–> aren’t protected this year even if you were last year

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

with most pandemics, there is a first wave followed by a ____________ that has

A

second wave- a much bigger impact (more fatal and more hospitalizations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

signs and symptoms of influenza

A
  • ***SUDDEN onset of:
  • fever, usually chills first
  • cough
  • headache
  • malaise
  • myalgias and fatigue (that can be severe and linger for weeks)
  • is an acute respiratory tract infection, so can also cause loss of appetite, runny nose, watery eyes, sore throat, etc
  • N/V/D are possible, but more likely in kids
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

with a viral infection, what is more likely in kids?

A

seizures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

how long does fever typically last in a healthy person who gets influenza

A

7-10 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

how long might an influenza cough persist

A

2 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what happens to most people after the flu

A

recover with decreased SEs, except when its a pandemic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

examples of respiratory complications

A
  • pneumonia (most common), either viral or secondary
  • exaceration of chronic lung disease
  • croup or bronchitis (in young kids)
  • otitis media
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

when does death from influenza most often occur

A

due to exacerbation of underlying cardio pulmonary diseases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

examples of non respiratory complications

A
  • febrile seizures
  • Reyes syndrome - an abnormal accumulation of fat begins to develop in liver and other organs, and get increased pressure on brain
  • encephalitis
  • Guillain Barre syndrome (an autoimmune attack on the peripheral nervous system
  • myositis
  • myocarditis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what is reyes syndrome

A

abnormal accumulation on fat that affects liver and brain mostly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what is the most common respiratory complication of influenza

A

pneumonia- either viral or secondary bacterial pneumonia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what is guillain barre syndrome

A

autoimmune attach on PNS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

who is at risk for higher complications? They are the recommended high risk individuals to receive it

A

-heart/lung/kidney/rheumatologic disease
-cardiac or pulmonary disorders
-diabetes mellitus and other metabolic diseases
-dementia
-stroke
-cancer, immune compromised
-anemia or hemoglobinopathy
-conditions that compromise management of respiratory secretions or increase risk of aspiration
-PREGNANT, EXTREMES OF AGE (over 65 and 6 months to under five) AND IMMUNOSUPPRESSED INDIVIDUALS
-morbidly obese (BMI greater than or equal to 40)
-kids and adolescents with neurologic or neurodevelopmental conditions (seizure disorders, febrile seizures, and isolated developmental delay
-aboriginal
-children 2-4 years old and those providing regular care to them
people capable of transmitting influenza to those at high risk (health care providers, household contact of people at risk or less than 6 months or newborn), providing regular childcare, services in a closed setting to those at high risk ie cruise ship)
-provide essential community services
-in direct contact during culling operations with poultry infected with avian influenza (prevent mutations and cross genes)
-everyone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

what is the earliest age you can give the vaccine

A

6 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

who is targetted for the flu vaccine?

A

-kids (esp 2-4), over 65, aboriginal, pregnant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

when is your risk increased for influenza complications when you are pregnant

A

the further along you are

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

all strains of influenza were susceptible to these drugs, and resistant to this drug

A
  • Oseltamivir, zanamavir

- amantadine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

what is the best way to prevent influenza

A

vaccine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

what is the influenza vaccine based off of

A

the NA and NA of each virus subtypes that are the most common

31
Q

how many strains do vaccines contain per year

A

3 (2 A and 1 B) or 4 (2 of each- contains both lineages of B since there are only two)

32
Q

what are the trivalent inactivated influenza vaccines available this year in SK?

A

fluviral, and agriful

  • flumist can be through public health only
  • quadrivalent recommended is fluzone
33
Q

what is the adjuvant sometimes added to TIV for IM use?

A

MF-59- “fluad”- for over 65 and under 24 months. It is not publicly funded in SK this year

34
Q

why would you add an adjuvant to the vaccine

A

it stimulates the immune system to give a better and boosted immune response. Older and younger people usually have a decreased immune response

35
Q

what is the down side to adjuvant?

A

increased money, more complicated, and increased AEs (esp at injection site ie local reaction- still mild and tolerable though)

36
Q

what is flumist? Who is it for? Who is it not for?

A

a live, attenuated vaccine, for age 2-59, preferential use in children under 6.
-not for severe asthma, children under 24 months, children taking ASA, pregnant women, people with immune compromising conditions

37
Q

what can change the effectiveness of the vaccine

A
  • age (as we get older we have decreased immune systems)
  • immunocompetence
  • match of the vaccine to the circulating virus
38
Q

if you have HIV, cancer, immunocompromised, reduced AB response because elderly,, renal failure or other serious disease, should you still get the vaccine

A

yes! May not protect against all aspects, but will lessen severity, decrease risk of death and decrease rate of hospitalization/pneumonia

39
Q

who shouldn’t get the vaccine

A
  • developed anaphalactic reaction to previous dose
  • NOT if have egg allergy, determined to be perfectly safe now
  • have a serious infection with fever, wait for it to go down before give it (if mild infection/sx, give it)
  • developed Guillan Barre within 6 weeks of last vaccine
  • allergic to any components other than egg in vaccine
40
Q

if the vaccine is a good match, it prevents influenza in ___% of healthy people with a ___% Confidence interval

A

80

95

41
Q

the vaccine is ___% effective in preventing hospitalization for influenza and pneumonia among the elderly living in the community

A

70%

42
Q

immunizing school aged kids would do what

A

decrease mortality in older adults

43
Q

the vaccine decreases incidences of these in the elderly

A
  • pneumonia
  • hospital admission
  • death
44
Q

vaccine reduces _____ in COPD

A

exacerbations

45
Q

when does protection from vaccine start

A

about two weeks following administration and lasts about 6 months

46
Q

in the elderly, how long does protection last

A

about 4 months

47
Q

when is it best to get the vaccine

A

late fall (october/Nov) to provide antibodies throughout the flu season

48
Q

children receiving influenza for the first time under nine years old needs ____ doses within a minimum of ____ weeks

A

2

4

49
Q

half doses were previously recommended for age 6-35 months, but now

A

full dose (0.5) is recommended and they are all given IM

50
Q

what is recommended for children in terms of the vaccine

A

-flumist (works best in children), then quadrivalent then tricalent

51
Q

why can’t vaccines cause influenza

A

does not contain a live virus. Except flumist, which is live, but attenuated- also will only replicate at temperature of the nasal mucosa not the lung

52
Q

if you get fever, malaise, and myalgia after a vaccine, why is that? When does it start?

A
  • can start in 6-12 hours and last 1-2 days

- due to immune response (mounting it to the vaccine)

53
Q

what is the most common AE from a vaccine and how long does it usually last

A

soreness at injection site, up to 48 hours

54
Q

what is AOR? How serious is it? When does it happen?

A
  • oculo repiratory syndrome
  • presence of red eyes, resp sx (cough, sore throat, chest tightness, difficulty breathing, wheezing, facial edema, or combination) occuring within 24 hours of immunization and lasting less than 2 days
  • considered mild and self resolving, benefits outweigh risk, no fatalities, not a CI to future vaccinations
  • happened 1 year, went away, not very explanative
55
Q

why might the low rate of utilization of the vaccine be?

A
  • fear of SEs
  • believe vaccine is ineffective, unnecessary or causes the flu
  • don’t believe they will get sick
56
Q

if you do get the flu, how should you treat it

A

mostly symptomatically- fluids, bedrest, analgesics, cough suppressants, cool popsicle for throat, etc
-also antiviral medications: oseltamavir and zanamivir (both have antiviral activity against A and B)

57
Q

amantadine- effectiveness

A

-in last few years, every A strain has been resistant (it would only be good for influenza A anyway), so currently not recommended

58
Q

how does amantadine work

A

blocks influx of H+ ions through matrix 2 ion channels and interferes with viral uncoating inside the cell

59
Q

neuraminidase inhibitors- use and effectiveness

A
  • used in both prevention and treatment of influenza

- effective against A and B

60
Q

neuraminidase inhibitors MOA

A

destroys infected cell’s receptor for HA and virus doesn’t get released from infected cell (doesn’t kill virus, but contains it and prevents spread between cells) and decreases infection of surrounding cells
-will decrease sx severity, cause earlier resolution of sx by 1-1.5 days

61
Q

neuraminidase inhibitors examples

A

oseltamavir and zanamivir

62
Q

what is zanamivir, who is it for and what does it come as

A
  • in a diskhaler
  • for treatment and prophylaxis in patients 7 years and older
  • must start early in disease to have impact
  • very little (10-20% systemically absorbed, likely safe in pregnancy but not trialed)
63
Q

dosing regimen of zanamivir; tx and prophylaxis

A

T: -10mg (2 inhalations) BID for 5 days

  • start within 48 hours of sx
  • may be used longer in those with sever immunodeficiency who remain symptomatic
    p: inhale 10 mg (2 inhalations) OD for 10 days…but those who were most likely to benefit were excluded from the trial
64
Q

who is treatment with zanamivir indicated for

A
  • individuals with severe illness

- those most likely to develop complications or die prematurely

65
Q

use zanamivir cautiously in patients with

A

-lung disease (may exacerbate lung condition)

66
Q

what are the SEs of zanamivir

A

-lots reported, but all thought to be due to different factors
-few reports of nightmares and delirium and abnormal behaviour in kids but high fever might have caused this
not too much concern over SEs

67
Q

what is oseltamavir used for and what age

A

treatment and prophylaxis of flu in patients at least one year old

68
Q

dosing of oseltamavir for adults (tx and prophylaxis)

A
  • over 13: 75mg BID for 5 days, start within 36-48 hours of sx
  • p: 75mg daily for 7 days, unless have a child or are over the age of 65 then for 14 days
69
Q

dosing of oseltamavir for kids

A

BID for treatment and OD for prophylaxis, can be from 30mg to 75 mg depending on weight

70
Q

when would you adjust the dose for oseltamavir

A

if creatinine clearance is 10-30ml/min

71
Q

what are some AEs of oseltamavir

A
  • N/V -take with food to minimize

- headache

72
Q

drug interactions with oseltamavir

A
  • probenecid (increases exposure to active metabolite by 2x)

- clopidogrel- prevents conversion of drug to active metabolite

73
Q

when to use NA inhibitors for prophylaxis

A
  • control of outbreaks among high risk residents of institutions (give to all residents not already ill, unvaccinated staff, etc until minimum of 8 days after onset of last case)
  • unvaccinated people who provide care for people at high risk during outbreaks (unless CI, they should also be vaccinated and continue NA-I for 2 weeks)
  • an adjunct to late vaccination of people at high risk (continue for 2 weeks after vaccine)
  • seasonal prophylaxis in high risk people when vaccine is CI, unavailable or unlikely to be effective (may be taken each day for duration of virus activity- this is an off label use)
  • non vaccinated household contacts of index influenza cases
  • people who have been or will be exposed to avian flu
74
Q

role of the pharmacist in vaccine

A

-educate (vaccine doesn’t cause influenza, benefits of getting it, flus vs other illnesses, symptomatic tx), ID patients who should be immunized, host clinics, lead by example and get immunized

Phar455 (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions