Therapeutics - Influenza

Question 1

seasonal influenza is a respiratory viral infection that peaks between…..

Answer 1

december and march

Question 2

true or false

not a lot of patients are asymptomatic with seasonal influenza

Answer 2

FALSE - 1/3 of patients are – but they can still transmit to those at increased risk

Question 3

between influenza A and B, which is most problematic because it mutates so often?

Answer 3

A

Question 4

how is the majority of influenza spread

Answer 4

by aerosolized droplets or by direct contact

Question 5

briefly differentiate between symptoms of the common cold vs the flu

Answer 5

the flue has more severe symptoms, has muscle aches and pains, and SUDDEN onset

for cold - mild symptoms, mild fatigue, gradual onset

Question 6

name some medical risk factors for being hospitalized from influenza

Answer 6

pulmonary conditions (inc asthma), chronic CV, renal, hepatic blood, metabolic diseases, immunocomp

Question 7

most viral reproducing occurs within ________

what does this mean regarding therapy

Answer 7

within 48-72 hours

therefore, this is when antivirals are most effective

1ST 48 HOURS IS CRITICAL

Question 8

after 48 hours of viral infection, the symptoms experienced are due to ______

Answer 8

inflammation

Question 9

which class of influenza anti virals are NOT recommended anymore and why

Answer 9

M2 channel blockers (amantadine and rimantadine) due to the rapid development of resistance

Question 10

of all the antivirals approved for influenza, which are the ONLY 2 that are active ONLY against type A

Answer 10

amantadine and rimantadine

Question 11

which 2 antivirals approved for influenza are the only 2 that CANT be used for prophylaxis

Answer 11

peramivir and baloxivir

Question 12

route administration zanamivir

Answer 12

inhalation

Question 13

route administration peramivir

Answer 13

IV

Question 14

route administration baloxavir

Answer 14

oral

Question 15

route administration rimantadine/amantadine

Answer 15

oral

Question 16

explain the MOA (briefly) of neuraminidase inhibitors

Answer 16

they inhibit the cleavage of sialic acid bonds, which prevents the virus from leaving the cell and infecting other cells

ONLY EFFECTIVE WHEN GIVEN WITHIN 48 HOURS OF SYMPTOMS!!!!!!!!!

decreased viral spread and lessened symptoms. high risk patients are less likely to have to be hospitalzied

Question 17

true or false

for antivirals to work for treatment, they work best when given within 2 days of symptom onset

Answer 17

TRUE

Question 18

as mentioned, in community settings we need to give the antivirals within 48 hours of symptom onset for them to work properly

what is an exception

Answer 18

if someone is hospitalized - we will give an antiviral regardless of the duration of their symptoms

Question 19

true or false

neuraminidase inhibitors do not have prophylactic benefit

Answer 19

false – they do - whether its before or after exposure (70-90% effective in preventing disease whether before or after exposure!!!)

HOWEVER, the CDC doesnt recommend them for prophylaxis bc of resistance, however it IS FDA approved for this purpose

Question 20

oseltamivir is a NA inhibitor for what age? how is it available? any side effects?
precautions?

Answer 20

1 year and older

capsules or as suspension

side effects - nausea, vomiting (neuropsych events in japan)

precautions - reduce dose in kidney disease, category C in pregnant/nursing (treatment IS recommended by the CDC!!)

Question 21

true or false

oseltamavir cannot be used in pregnancy

Answer 21

FALSE - it is category c but treatment IS recommended by the CDC

Question 22

explain what zanamivir is

Answer 22

orally inhaled powder - neuraminidase inhibitor

do NOT use in patients with an underlying airway disease or chronic respiratory disease

side effects are wheezing and breathing difficulty

Question 23

can zanamavir be used in pregnant/nursing?

Answer 23

not well studied

Question 24

explain what peramavir is

is it effective??

Answer 24

NA inhibitor given IV

very effective and also tolerated well (but rare cases of allergy)

Question 25

true or false

baloxavir is an NA inhibitor

Answer 25

FALSE - has diff moA

inhibits polymerase acid endonuclease (enzyme involved in viral reproduction)

Question 26

true or false

baloxavir is NOT FDA approved for prophylaxis

Answer 26

true - only treatment

Question 27

how is baloxavir adminisrerd

Answer 27

orally - only 2 tabs!!!!

do not administer with cationic agents

Question 28

true or false

healthy patients who develop suspected influenza and appear to be recovering do NOT need any antiviral treatment

Answer 28

true

Question 29

a patient has suspected influenza AND warning signs of lower respiratory tract infection (tachypnea, dyspnea, oxygen desaturation)

should they receive antiviral therapy?

Answer 29

YES

should also be evaluated for pneumonia

Question 30

true or false

ALL hospitalized patients with confirmed or suspected influenza should receive antivirals

Answer 30

true

Question 31

true or false

no outpatients should receive antivirals for influenza

Answer 31

FALSE - those with higher risk for complications should

-younger than 2 years
-65 and older
-pregnancy
-chronic compromising disorders

Question 32

for exam purposes****

if pt has had symptoms of influenza for 5 days, what is therapy

Answer 32

NOTHING

(in reality dr’s prescribe anyway)

Question 33

antiviral prophylaxis is only to be considered within ____ of exposure
and only for persons…..

Answer 33

48 hours

ONLY at higher risk for complications and are a close contact. also health care and public health workers and 1st responders who have had unprotected close contact