Therapeutics - Influenza Flashcards
seasonal influenza is a respiratory viral infection that peaks between…..
december and march
true or false
not a lot of patients are asymptomatic with seasonal influenza
FALSE - 1/3 of patients are – but they can still transmit to those at increased risk
between influenza A and B, which is most problematic because it mutates so often?
A
how is the majority of influenza spread
by aerosolized droplets or by direct contact
briefly differentiate between symptoms of the common cold vs the flu
the flue has more severe symptoms, has muscle aches and pains, and SUDDEN onset
for cold - mild symptoms, mild fatigue, gradual onset
name some medical risk factors for being hospitalized from influenza
pulmonary conditions (inc asthma), chronic CV, renal, hepatic blood, metabolic diseases, immunocomp
most viral reproducing occurs within ________
what does this mean regarding therapy
within 48-72 hours
therefore, this is when antivirals are most effective
1ST 48 HOURS IS CRITICAL
after 48 hours of viral infection, the symptoms experienced are due to ______
inflammation
which class of influenza anti virals are NOT recommended anymore and why
M2 channel blockers (amantadine and rimantadine) due to the rapid development of resistance
of all the antivirals approved for influenza, which are the ONLY 2 that are active ONLY against type A
amantadine and rimantadine
which 2 antivirals approved for influenza are the only 2 that CANT be used for prophylaxis
peramivir and baloxivir
route administration zanamivir
inhalation
route administration peramivir
IV
route administration baloxavir
oral
route administration rimantadine/amantadine
oral
explain the MOA (briefly) of neuraminidase inhibitors
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
true or false
for antivirals to work for treatment, they work best when given within 2 days of symptom onset
TRUE
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
if someone is hospitalized - we will give an antiviral regardless of the duration of their symptoms
true or false
neuraminidase inhibitors do not have prophylactic benefit
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
oseltamivir is a NA inhibitor for what age? how is it available? any side effects?
precautions?
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!!)
true or false
oseltamavir cannot be used in pregnancy
FALSE - it is category c but treatment IS recommended by the CDC
explain what zanamivir is
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
can zanamavir be used in pregnant/nursing?
not well studied
explain what peramavir is
is it effective??
NA inhibitor given IV
very effective and also tolerated well (but rare cases of allergy)
true or false
baloxavir is an NA inhibitor
FALSE - has diff moA
inhibits polymerase acid endonuclease (enzyme involved in viral reproduction)
true or false
baloxavir is NOT FDA approved for prophylaxis
true - only treatment
how is baloxavir adminisrerd
orally - only 2 tabs!!!!
do not administer with cationic agents
true or false
healthy patients who develop suspected influenza and appear to be recovering do NOT need any antiviral treatment
true
a patient has suspected influenza AND warning signs of lower respiratory tract infection (tachypnea, dyspnea, oxygen desaturation)
should they receive antiviral therapy?
YES
should also be evaluated for pneumonia
true or false
ALL hospitalized patients with confirmed or suspected influenza should receive antivirals
true
true or false
no outpatients should receive antivirals for influenza
FALSE - those with higher risk for complications should
-younger than 2 years
-65 and older
-pregnancy
-chronic compromising disorders
for exam purposes****
if pt has had symptoms of influenza for 5 days, what is therapy
NOTHING
(in reality dr’s prescribe anyway)
antiviral prophylaxis is only to be considered within ____ of exposure
and only for persons…..
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
