Tieman Flashcards
herpes simplex virus (HS1/HS2) shape
large double stranded DNA
enveloped
HSV1 location
oral mucosa
HSV2 location
genital mucosa
HSV locations in immunocompromised patients
eye
skin
visceral organs
CNS
HSV1 establishes in what ganglia
trigeminal (sensory) ganglia
diagnosis of HSV1 how
PCR test and swab
HSV1 presentation
cold sores or ulcers in mouth
HSV2 presentation
bumps, blisters, ulcers around genitals or anus
HSV2 esablishes in what ganglia
sacral ganglia
diagnosis of HSV2 how
PCR and swab
HSV encephalitis usually caused by which HSV
HSV1
most adults are seropositive for what
HSV1
diagnosis of HSV encephalitis how
lumbar puncture and PCR testing
symptoms of HSV encephalitis
fever
confusion
personality changes
headache
seizure
focal neurological effects
acyclovir MOA
competitive inhibitor of viral DNA polymerase
incorporated into viral DNA causing chain termination
bioavailability of acyclovir
poor bioavailability
not affected by food
how is acyclovir eliminated
renally, need to dose adjust
adverse effects of acyclovir
N/V/D
rash
headache (oral)
nephrotoxicity
neurotoxicity
thrombophlebitis
renal consideration with acyclovir
need to renal dose adjust
high risk nephrotox
give IV fluids with
genital HSV treatment primary infection
acyclovir 400 mg TID x 7-10 days
acyclovir 200 mg 5x/day x 7-10 days
valacyclovir 1 g BID x 7-10 days
famciclovir 250 mg TID x 7-10 days
genital HSV treatment recurrent infection
acyclovir 800 mg BID x 5 days
acyclovir 800 mg TID x 2 days
valacyclovir 500 mg BID x 3 days
valacyclovir 500 mg 1 g daily x 5 days
genital HSV treatment for suppression in immunocompromised
valacyclovir 500-1000 mg daily (1 g if >10 epsidoes/year)
acyclovir 400 mg BID
famciclovir 250 mg BID
once daily preferred
genital HSV treatment for suppression in HIV patients
valacyclovir 500 BID
oral HSV treatment
acyclovir 400 mg TID x 5-10 days
valacyclovir 2 g BID x 1 day
famciclovir 1.5 g single dose
HSV encephalitis treatment
acyclovir 10mg/kg IV q8hr for 14-21 days
how is valacyclovir metabolized
rapidly absorbed and converted to acyclovir by intestinal and hepatic metabolism
valacyclovir bioavailability
3-5 times greate than acyclovir
valacyclovir elimination
renally
drug interaction with famciclovir
probenecid taken with will decrease renal clearance and increase serum concentrations
famciclovir side effects
well tolerated
headache
N/V/D
acute renal failure
how does varicella zoster virus stay in the body
becomes dormant in sensory nerve ganglia as latent infection
is varicella zoster contagious
highly contagious spread by direct contact or inhalation if not vaccinated
varicella (chickenpox) treatment
acyclovir x 5-7 days
valacyclovir 5-7 days
zoster (shingles) treatment
acyclovir 7-10 days
valacyclovir 7 days
famciclovir 7 days
what is CMV?
most people have it but its opportunistic so usually immunocompromised people get it
ganciclovir use
CMV
what is gancicloir
prodrug converted to active form by viral thymidine kinase
phosphorylated three times
ganciclovir interactions
avoid other cytotoxic drugs with risk of bone marrow suppression, and probenecid
adverse effects of ganciclovir
myelosuppression
bone marrow supression!!
- reversible
- increase risk w increase dose
- stop drug if ANC < 500 or platelet < 25,000
treatment for CMV retinitis
ganciclovir 14-21 days
valganciclovir x 21 days
foscarnet x 14-21 days
valganciclovir pearl
take with food, AUC increased with high fat meal
prevention of CMV in transplant patients at high risk
ganciclovir
valganciclovir
letermovir MOA
inhibits CMV terminase complex by binding pUL56
inhibits CMV replication and prevents CMV infection
letermovir adverse effects
N/V/D
peripheral edema
cough
headache
letermovir drug interactions
CYP3A4 inhibitor and OATP1B1
not preferred due to the drug interactions!
foscarnet adverse effect
nephrotoxicity - major dose limiting side effect
give hydration with
what to give in CMV retinitis resistance to gamciclovir/valgamciclovir?
foscarnet
neuramidase inhibitors
zanamivir
oseltamivir
peramivir
zanamivir dosage forn
DPI
peramavir dosage form
IV
oseltamivir, zanamivir, peramivir given when
in flu but those who have been symptomatic for 2 days or less
neruamidase inhibitor consideatiions
do not give live vaccine within 2 weeks before or 48 hours after oseltamivir administratiion
caution with zanamivir in who
those with COPD or reactive airway disease
age range for oseltamivir and zanamivir
oseltamivir - > 2 weeks
zanamivir > 7 years
peramivir indication
acute UNCOMPLICATED flu in pts 18+ who have been symptonatic for no more than 2 days
peramivir age
> 18
peramivir dosing
600 mg IV infusion over > 15 minutes
only single dose
baloxavir considerations
avoid co-admin with dairy, metals, antacids
avoid with live vaccine
baloxavir age
> 12
amantadine + rimantadine use
not used in clinical practice due to high resistance rates
acyclovir spectrum
HSV 1/2
VZV
valacyclovir spectrum
HSV1/2
VZV
ganciclovir spectrum
HSV1/2
VZV
CMV
EBV
valganciclovir spectrum
HSV 1/2
VZV
CMV
EBV
famciclovir spectrum
HSV 1/2
VZV
letermovir spectrum
CMV
foscarnet spectrum
HSV 1/2
VZV
CMV
EBV
which flu drug works best for Flu B
zanamivir
amantadine and rimantidine spectrum
flu A
