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Respiratory II Exam 2 > Viral infections and treatment CIS > Flashcards

Viral infections and treatment CIS Flashcards

1
Q

influenza vs common cold

A

Flu: abrupt onset, fever, aches, chills, fatigue, chest discomfort, cough, headache
sometimes sneezing, stuffy nose , sore throat

Cold: gradual onset, sneezing stuffy nose sore throat common

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2
Q

missed the window for flu treatment (48 hours), what would you do?

A

just symptomatic treatment

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3
Q

how do we treat flu within 48 hours of onset?

A

oseltamivir

goal being to decrease duration of symptoms

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4
Q

most common side effect of osteltamivir?

A

diarrhea

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5
Q

Neuraminidase Inhibitors ADRs

A

Oseltamivir – nausea, vomiting, abdominal pain (5-10%), headache, fever, diarrhea, neuropsychiatric effects

watch out in kids

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6
Q

what do we use as prophylaxis for influenza?

A

oseltamivir

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7
Q

agents that inhibit uncoating of viral RNA

A

amantidine, rimantidine

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8
Q

agents that inhibit release of progeny viruses

A

neurominidase (oseltamivir)

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9
Q

agent that inhibits cell wall synthesis

A

beta lactam

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10
Q

agent that inhibit DNA polymerase

A

acyclovir, etc.

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11
Q

agent that inhibits ergosterol synthesis

A

-azoles, anti-fungals

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12
Q

oseltamivir blocks

A

release of new influenza A and B virions

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13
Q

Neuraminidase Inhibitors MOA and examples

A

Oseltamivir (PO), zanamivir (INH), peramivir (IV)

MOA: analogs of sialic acid, interferes with release of progeny influenza virus from infected host cell
Active against influenza A and B

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14
Q

how do rimantadine and amantadine work?

A

prevents uncoating of influenza A (not B) viral RNA within host cell

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15
Q

M2 Channel Blockers examples and MOA

A

Amantadine (PO), rimantadine (PO)
MOA: block M2 proton ion channels of virus inhibiting uncoating of viral RNA within host cell
Active against influenza A only

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16
Q

Caution should be exercised with administration of which drug in patients with underlying COPD or asthma?

A

Zanamivir – ADR: cough, bronchospasm, decrease in pulmonary function (reversible), nasal/throat discomfort, not recommended in underlying airway disease

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17
Q

Respiratory Syncytial Virus (RSV)- when to suspect, how to diagnose

A 
Suspected:
Age < 12 months
Lower respiratory tract disease
Winter season
Known circulation of RSV
Laboratory diagnosis:
Nasal wash
Bronchoalveolar lavage
Rapid assays (antigen capture technology) can now be performed in < 30 minutes
PCR
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18
Q

RSV treatment

A

Supportive care:
Fluid and respiratory support

Pharmacotherapy:
Bronchodilators (albuterol or epinephrine)
Used if patient wheezing, discontinue if there is not rapid improvement
Hypertonic saline
Has potential to reduce airway edema and mucus plugging but not recommended
Ribavirin
Routine use not recommended, efficacy not clearly proven

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19
Q

Ribavirin

A

Aerosol inhalation

MOA: nucleoside analog, inhibits replication of RNA and DNA viruses; inhibits viral protein synthesis

May be toxic to exposed healthcare workers and variably efficacious –> AAP recommends against routine use

Reserved for life-threatening disease

20
Q

Palivizumab (Synagis)

A

Monoclonal antibody (IM injection)

Used monthly throughout RSV season
Max of 5 doses per season

MOA: inhibits RSV replication via neutralizing and fusion inhibitory activity

Used for prophylaxis, NOT for treatment

Safety and efficacy established in:
Bronchopulmonary dysplasia (BPD)
History of premature birth (under 35 weeks gestational age)
Hemodynamically significant congenital heart disease (CHD)

21
Q

most likely etiology of retinitis in an HIV + person with CD4 count of 45 is

A

CMV

can also cause disease throughout the GI tract
Watery diarrhea
Colitis of colon with blood and inflammation

22
Q

Treatment of CMV

A

Ganciclovir initially if absorption a question with PO medications

Valganciclovir for 3-6 weeks
ART start after CMV retinitis excluded or two weeks after start of CMV treatment

23
Q

Pneumocystis Pneumonia

A

Ubiquitous fungus

Causes pulmonary disease in immunocompromised hosts

Before TMP-SMX use, incidence of PCP was 70-88% in lung-transplant recipients
With prophylaxis, this risk virtually eliminated

TMP-SMX prophylaxis continued 6 months to 1 year after organ transplant

24
Q

CMV

A

Most common opportunistic infection following solid organ transplant

Acquired from:
Donated allograft
Blood products transfused from a seropositive donor
Reactivation of endogenous virus

Occurs between 1-4 months after transplant without viral prophylaxis

Those at highest risk of CMV disease:
D+/R-
Those with latent CMV who require antilymphocyte antibodies as part of induction therapy

25
Q

CMV treatment

A

Historically, treatment was only given once CMV disease occurred
Signs and symptoms: fever, leukopenia, or organ involvement (hepatitis, pneumonitis, pancreatitis, colitis, rarely myocarditis)

This resulted in overall incidence of 20-60%

With prophylaxis, this has fallen to 5%

Prophylaxis generally given for 200 days

26
Q

What is the difference between valganciclovir and ganciclovir?

A

Valganciclovir is the L-valyl ester prodrug of ganciclovir.

Ester prodrug improves oral bioavailability from about 7  70%

27
Q

How is chicken pox spread?

A

respiratory droplets

28
Q

How is Varicella-zoster virus (VZV) prevented in adults?

A

Varicella Zoster Vaccine – Live attenuated vaccine

29
Q

What are the contraindications for Varicella-zoster Vaccine?

A

Vaccine contraindicated in hematologic malignant neoplasms, AIDS, HIV infection with CD4 count of 200/mm3 or lower, and in persons receiving high dose immunosuppressive therapy, or anti-tumor necrosis factor–α therapy.

30
Q

You would like to prescribe acyclovir for your patient. Why is acyclovir virus specific?

A

Initial phosphorylation step via virus specific thymidine kinase.

31
Q

What is a major limitation of acyclovir?

A

Very low oral bioavailability – must be given up to 5 times a day

32
Q

VZV treatment effectiveness

A

Treatment most effective when started within 72 hours of onset of rash

Antivirals decrease the duration of herpes zoster rash and severity of pain

Moderate reductions in development of postherpetic neuralgia  variable results in clinical trials

33
Q

Rubeola

A

Measles

spread by large respiratory droplets

Cough, coryza, and conjunctivitis

How long is the child infectious?

4 days prior to rash, until 4 days after rash appears

34
Q

What are some of the major complications of measles?

A

Pneumonia
Post-infectious encephalomyelitis
Subacute sclerosing panencephalitis

35
Q

prevention of measles?

A

MMR – live attenuated vaccine

Given at 12-15 months and 4-6 years

36
Q

mumps transmission and prevention

A

How is mumps transmitted?

Respiratory droplets

How is mumps prevented?

MMR vaccination

37
Q

Ebola

A

Non-segmented, negative-sense, single stranded RNA virus

Hemorrhagic fever virus

  • Coagulation defects
  • Capillary leak syndrome
  • Shock

Transmission

  • Ingestion
  • Inhalation
  • Breaks in skin
  • Contact with infectious body fluids (blood, feces, vomit, urine, saliva, tears)
  • Droplet inoculation of virus into mouth or eyes in nonhuman primates

Abrupt onset of symptoms 8-12 days after exposure (range 2-21 days)

S/S: nonspecific flu-like illness, rash, watery diarrhea, nausea, vomiting, hemorrhage (petechiae, ecchymosis, oozing from puncture sites, mucosal hemorrhage

38
Q

Ebola treatment

A

Supportive care:
Intravenous fluid repletion (up to 5-10 L per day)
Correction of electrolyte abnormalities (Na+, K+, Ca2+)
Nutrition support
Intensive nursing care (rapidly changing clinical picture)

Experimental therapy:
ZMapp: three monoclonal antibodies directed against Ebola viral glycoprotein
TKM-Ebola, RNA interference agent suppresses production of viral proteins, Phase I started Jan 2014

39
Q

Enterovirus D68

A

Transmitted from person to person through fecal-oral contact
Poliovirus is a prototypical enterovirus
Can cause bronchiolitis and pneumonia which can be severe and lead to mechanical ventilation
Low grade fever, wheezing, dyspnea, hypoxia, and perihilar infiltrates primarily in children with a history of asthma

40
Q

Enterovirus D68 Neurologic Manifestations

A

Children with acute limb weakness and/or cranial nerve dysfunction
Moderate lymphocytic pleocytosis in the CSF
Nonenhancing grey matter spinal cord lesion on MRI similar to polio
Enterovirus D68 was identified in nasopharyngeal specimens from a subset of these patients, but not from the CSF

41
Q

Dengue Fever

A

Mosquito Vector
Fevers, muscle pains, headache, and possible hemorrhage
No conjunctivitis

42
Q

Chikungunya

A

Mosquito Vector
High Fever, intense joint pains affecting hands, feet, knees, and back
Patients are in such severe pain that they can’t stand straight or walk
No conjunctivitis

43
Q

Parvovirus

A

Symmetric arthritis of hands, wrists, knees, and feet

Rash may or may not be present

44
Q

Rubella

A

Fever and coryza

Macular rash may or may not be present

45
Q

Zika Virus

A

Mosquito-borne flavivirus – Aedes mosquito
Africa, Southeast Asia, Pacific Islands, and Americas

Clinical Manifestations
Acute onset of low grade fever
Maculopapular pruritic rash
Arthralgias(hands and feet)
Conjunctivitis

Serious Clinical Manifestations
Congenital microcephaly
Fetal Loss
Guillain-Barre syndrome

Incubation
2-14 days

No specific treatment

Prevention
Protective measures to avoid mosquitos
Disease can be sexually transmitted
Men may carry disease for 6 months
Women may carry disease for 2 months

Respiratory II Exam 2 (21 decks)

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