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PHARMACOLOGY - Pulmonary > Treatment of Viral Pneumonia > Flashcards

Treatment of Viral Pneumonia Flashcards

1
Q 
How can you differentiate between viral and bacterial causes of pneumonia on the basis of: 
• Age
• Epidemic Situation
• History of Illness
• Clinical Profile
A

Age:
• younger than 5 - viral
• Adults - bacterial

Epidemic Situation:
• Ongoing viral epidemic
• Bacterial things usually aren’t epidemic

History of Illness:
• Slow onset - viral
• Rapid onset - bacterial

Clinical profile:
• Rhinitis, wheezing
• High fever, tachypnea

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2
Q

What parameters suggest either viral or bacterial etiology for each of the following biomarkers?
• WBC.
• C-reactive protein concentration in serum
• Pro-calcitonin concentrations in serum
• Chest Radiograph
• Respsonse to antibiotic Tx.

A

WBC:
Viral - less than 10 x 10^9
Bacterial - more than than 15 x 10^9

C-reactive Protein concentration:
Viral - less than 20 mg/L
Bacterial - more than 60 mg/L

Pro-calcitonin concentration in serum:
Viral - less than 0.1 µg/L
Bacterial - more than 0.5 µg/L

Chest radiograph:
Viral - bilateral and intersitial
Bacterial - lobar

Response to Abx:
Viral - non-responsive
Bacterial - rapid

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3
Q

What treatment and prevention methods do we have for Influenza A and B?
• MOA
• Metabolism
• Adverse Effects

A

Treatment:
Flu A ONLY:
• Amantadine (PO)
• Rimantadine (PO)

Flu A and B:
• Oseltamivir (PO)
• Zanamivir (inhalation)

Prevention:
• Vaccines - FLU A
• Oseltamivire, Zanamivir

MOA:
Amantadine/Rimantadine:
Inhibits the M2 ion channel preventing viral entry

Oseltamivir/Zanamivir:
Neuraminidase inhibitors that prevent release of the virus from the cell

Metabolism:
Amanatadine - no change in elimination by glomerular filtration and tubular secretion

Rimantadine - EXTENSTIVE HEPATIC metabolism with RENAL elimination of METABOLITES

Oseltamavir - Hepatically metabolized to the carboxylate active form of the drug, SYSTEMIC elimination by glomerular filtration and secretion

Zanamivir - Renally eliminated unchanged

Adverse Effects:
Amantadine - Nausea and orthostatic HTN, CONTRAINDICATED IN OPEN ANGLE GLAUCOMA and BREASTFEEDING

Rimantadine - minimal adverse effects

Oseltamavir - MINIMAL adverse effects - potential for fatal neuropsychiatric adverse effects in flu patients; serious skin reaction

Zanamivir - Headache, throat/tonsil pain, cough, viral infection, NOT to be used with underlying pulmonary disease - fatal bronchospasm

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4
Q

What methods of treatment and prevention do we have for RSV?
• MOA
• Metabolism
• Adverse Effects

A

Treatment:
• Ribavirin

Prevention:
• Palivizumab - (against adhesion protein F)

MOA:
• Ribaviron - Inhibition of viral nucleic acid synthesis

Metabolism:
• Ribaviron - non-CYP metabolism in nucleated cells with systemic elimination of drug and products in the urine

Adverse effects:
• Ribaviron - fatigue, headache, myalgia, nausea, fever BBW OF HEMOLYTIC ANEMIA and M/F TETROGENICITY

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5
Q

What methods of treatment and prevention do we have for Adenovirus?
• MOA
• Metabolism
• Adverse Effects

A

Treatment:
• Cidofovir (IV)

Prevention:
• Vaccine against types 4 and 7

MOA:
• Cidofovir - inhibition of viral DNA synthesis (DNA pols. inhibition)

Metabolism:
Cidofovir
• Metabolized via pyrimidine nucleosie monophosphate kinase to mono- and then diphosphate analogs and finally to the monophosphate-choline.
• SYSTEMICALLY eliminated by glomerular filtration and tubular secretion

Adverse effects:
• Cidofovir - Neurologic, hematologic, and tubular damage BBW OF RENAL IMPAIRMENT/TOXICITY

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6
Q

What methods of treatment and prevention do we have for Rhinovirus?
• MOA
• Metabolism
• Adverse Effects

A

Treatment:
• none

Prevention:
• Alfa Interferon (intranasal)
• Ribavirin (off-label)

MOA:
• Ribaviron - Inhibition of viral nucleic acid synthesis

Metabolism:
• Ribaviron - non-CYP metabolism in nucleated cells with systemic elimination of drug and products in the urine

Adverse effects:
• Ribaviron - fatigue, headache, myalgia, nausea, fever BBW OF HEMOLYTIC ANEMIA and M/F TETROGENICITY

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7
Q

What method of treatment and prevention do we have for Human metapeumovirus?
• MOA
• Metabolism
• Adverse Effects

A

Treatment:
• Ribaviron

Prevention:
• None

MOA:
• Ribaviron - Inhibition of viral nucleic acid synthesis

Metabolism:
• Ribaviron - non-CYP metabolism in nucleated cells with systemic elimination of drug and products in the urine

Adverse effects:
• Ribaviron - fatigue, headache, myalgia, nausea, fever BBW OF HEMOLYTIC ANEMIA and M/F TETROGENICITY

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8
Q

What method of treatment and prevention do we have for Hantavirus?
• MOA
• Metabolism
• Adverse Effects

A

Treatment:
•Ribaviron

Prevention:
• None

MOA:
• Ribaviron - Inhibition of viral nucleic acid synthesis

Metabolism:
• Ribaviron - non-CYP metabolism in nucleated cells with systemic elimination of drug and products in the urine

Adverse effects:
• Ribaviron - fatigue, headache, myalgia, nausea, fever BBW OF HEMOLYTIC ANEMIA and M/F TETROGENICITY

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9
Q

What method of treatment and prevention do we have for Varicella-zoster virus?
• MOA
• Metabolism
• Adverse Effects

A

Treatment:
• Acyclovir (IV)
• Valacyclovir (PO)

Prevention:
• Vaccine

MOA:
• Acyclovir - Inhibition of viral DNA synthesis (DNA pols. inhibition)

• Valacyclovir - pro-drug for acyclovir

Metabolism:
• Acyclovir - Infected cells change it to its active triphosphate form. SYSTEMIC elminated unchanged in the kidney

• Valacyclovir - Coverted to acyclovir (and L-valine) by 1st-pass metabolism. Systemic elimination of acyclovir is done by glomerular filtration

Adverse effects:
• Acyclovir - Headache, nausea, neurotoxicity (confusion, seizures) MUST hydrate to PREVENT RENAL precipitation. USE CAUTIOUSLY in renal impairment

• Valacyclovir - same as above + THROMBOCYTOPENIA

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10
Q

Rimantadine
MOA
Metabolism
Adverse Effects

A

MOA
Rimantadine - EXTENSTIVE HEPATIC metabolism with RENAL elimination of METABOLITES

Metabolism
Rimantadine - EXTENSTIVE HEPATIC metabolism with RENAL elimination of METABOLITES

Adverse Effects
Rimantadine - minimal adverse effects

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11
Q

Amantadine
MOA
Metabolism
Adverse Effects

A

MOA
Amantadine/Rimantadine:
Inhibits the M2 ion channel preventing viral entry

Metabolism
Amanatadine - no change in elimination by glomerular filtration and tubular secretion

Adverse Effects
Amantadine - Nausea and orthostatic HTN, CONTRAINDICATED IN OPEN ANGLE GLAUCOMA and BREASTFEEDING

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12
Q

Oseltamavir
MOA
Metabolism
Adverse Effects

A

MOA
Oseltamivir/Zanamivir:
Neuraminidase inhibitors that prevent release of the virus from the cell

Metabolism
Oseltamavir - Hepatically metabolized to the carboxylate active form of the drug, SYSTEMIC elimination by glomerular filtration and secretion

Adverse Effects
Oseltamavir - MINIMAL adverse effects - potential for fatal neuropsychiatric adverse effects in flu patients; serious skin reaction

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13
Q

Zanamavir
MOA
Metabolism
Adverse Effects

A

MOA
Oseltamivir/Zanamivir:
Neuraminidase inhibitors that prevent release of the virus from the cell

Metabolism
Zanamivir - Renally eliminated unchanged

Adverse Effects
Zanamivir - Headache, throat/tonsil pain, cough, viral infection, NOT to be used with underlying pulmonary disease - fatal bronchospasm

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PHARMACOLOGY - Pulmonary (30 decks)

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