Superficial Viral Infections

Question 1

Herpes Simplex Labialis

Answer 1

HSV1 and 2, infected for life, results in cold sores/fever blisters
Contagious, painful, recurrent
Latent resides in trigeminal ganglia
Reactivation with triggers, recurs in same location with a prodrome before.
Resolves in 10-14 days
Treat with topicals or systemic

Question 2

Docosanol

Answer 2

IND: Treatment of cold sores/fever blisters on face or lips
MOA: Prevents viral entry and replication; inhibits fusion of plasma membrane and HSV envelope
BOX: n/a
CON: n/a
ADR: Incidences of hypersensitivity
TOPICAL cream OTC, EXTERNAL use only. Can apply during prodrome to prevent outbreak

Question 3

Acyclovir Cream/Ointment

Answer 3

IND: Herpes labialis, mucocutaneous HSV infections
MOA: Inhibits viral replication via inhibition of viral DNA polymerase
BOX: n/a
CON: n/a
ADR: Localized reactions
ROUTES: Cream for Herpes Labialis in immunocompetent kids and adults. (older than 12).
Ointment for mucocutaneous HSV infections in immunoCOMPROMISED pts

Question 4

Penciclovir

Answer 4

IND: Herpes Labialis
MOA: Inhibits viral DNA polymerase
BOX: n/a
CON: Only for herpes labialis on lips and face
ADR: Localized erythema

Question 5

Acyclovir Systemic

Answer 5

IND: HSV and VZV first line agent
MOA: Inhibition of viral DNA polymerase
BOX: n/a
CON: n/a
ADR: Infusion site reactions (if IV required),
Acute Kidney Injury; interstitial nephritis/renal tubular necrosis
Neurotoxicity; confusion, agitation, hallucination (particularly the olds)

Question 6

Valacyclovir

Answer 6

IND: First line (more than Acyclovir) for HSV and VZV d/t better dosing intervals from better absorption
MOA: Pro-drug that is converted into acyclovir
BOX: n/a
CON: n/a
ADR: TTP/HUS in immunocompromised pts only

Question 7

Famciclovir

Answer 7

IND: HSV, VZV
MOA: Inhibits viral DNA synthesis and replication
BOX: n/a
CON: n/a
ADR: Headache, nausea

Question 8

Foscarnet

Answer 8

IND: HSV and CMV, last line
MOA: Inhibits multiple RNA and DNA polymerases, good spectrum of activity in acyclovir resistance
BOX: Renal impairment requiring frequent monitoring of serum creatinine and adequate hydration
Seizures; related to plasma minerals and electrolytes, monitor and supplement PRN
Appropriate use; only for CMV retinitis and mucocutaneous acyclovir-resistant HSV
CON: n/a
ADR: Hypokalemia, calcemia, magnesemia, phosphatemia
GI distress, anemia/granulocytopenia
Renal insufficiency

Question 9

Herpes Zoster (Shingles) VZV

Answer 9

Targets dermatomes: pain, burning, tingling, followed by a red rash in a few days
Fluid filled blisters and vesicles are contagious
systemic effects
Increased risk over 50
Begin therapy within 72 hours for optimal efficacy
Acyclovir, valacyclovir, famciclovir

Question 10

Zoster Vaccine (Shingrix)

Answer 10

IND: Prevention of Herpes Zoster in pts 50 or older, recommended for anyone who had stupid zostavax
MOA: Stimulates active immunity. 97% effective in 50-70, 91% in 70+
BOX: Yes
CON: n/a
ADR: Systemic reactions similar to shingles infection. Injection site reactions.

Question 11

Salicylic Acid

Answer 11

IND: Removal of warts, calluses, or corns
MOA: Keratolytic; desquamation of hyperkeratotic epithelium
BOX: n/a
CON: Hypersensitivity to salicylates
ADR: Local reactions

Question 12

OTC Cryotherapy

Answer 12

Follow instructions
Vary
Pressurized can and forms a blister under the wart to make the wart fall off in 10-14 days
Repeat every 2 weeks, max of 4 treatments, don’t reuse applicator pads
Flammable
In-office = liquid nitrogen, slightly stronger

Question 13

Cantharidin

Answer 13

IND: NOT approved in US. Common in Canada and elsewhere for warts
MOA: Vesicant (irritation) to cause wart exfoliation
BOX: n/a
CON: Caution in pts with diabetes or poor peripheral circulation. Do not use near eyes, on face, mucous membranes, anogenital, intertriginous, or axilla areas
ADR: PAIN especially when combined with Cimetidine

Question 14

Podofilox

Answer 14

IND: External and perianal genital warts
MOA: Keratolytics; necrosis of visible wart tissue. Apply directly to wart
BOX: n/a
CON: Mucous membrane warts. Near them is still ok with caution
ADR: n/a

Question 15

Trichloroacetic Acid

Answer 15

IND: Elimination of anogenital warts
MOA: Keratolytic. Apply and allow to dry to white frost before pt moves. Repeat weekly PRN
BOX: n/a
CON: n/a
ADR: Serious injuries including skin damage, swelling, and pain if not properly applied

Question 16

Imiquimod

Answer 16

IND: External genital and perianal warts
MOA: Immune response modifier; TLR 7 agonist, activates immune cells
BOX: n/a
CON: n/a
ADR: Photosensitivity, vulvar swelling, urinary retention

Question 17

Sinecatechins

Answer 17

IND: External genital and perianal warts
MOA: Unknown
BOX: n/a
CON: n/a
ADR: Localized reactions and photosensitivity