Viruses Pharm Flashcards
How long do Herpes Simplex outbreaks last. Why should we rx if it is self limiting
1st and recurrent
10-20 d initial outbreak, 5-10 d recurrences. Rx to shorten duration and lessen severity.
Also prophylaxis option for those with frequent outbreaks.
Herpes - Symptomatic Relief only
Topical anaesthetics only
* dyclonine
* benzocaine
* Magic Mouthwash (benadryl, lidocaine, Maalox)
diclonine is like a cyclone that creates a temporary “storm”, of numbess in the affected area
Herpes Simplex, infection is on Tx
- Acyclovir (all forms)&cheap
- Famciclovir
- Valacylovir
can also use one of these prophylactically once a day
Ophtalmic HSV Keratitis Rx
penciclovir q2h (terrible)
docosanol OTC
Herpes Simplex antiviral MoA, Metabolism, adverse rxns
Inhibits herpes viral DNA replication.
* valacyclovir and famciclovir are prodrugs. Become active in GI to be absorbed.
* metabolized in the liver
* No interact w/ CYP 450
* Renal excretion
* SE: MC are GI, HA, dizzy, malaise, arthralgia.
* Severe SE- Leukopenia, thrombocytopenia. can have neurologic but less common.
Herpes viral
Val the warrior from valhala. Fam is val famility.
Think soft before they go into valhalla and then they activate. Think warriors bleed (thormbocyto, leukopen), and get worn down from impacts (joint pain)
Think getting stabbed in the gut and someone clubbing your head with a mallet.
HSV infection thats resistant to acyclovir, how would you rx?
Foscarnet
MC for CMV in AIDS pts
BBW- seizure, renal impairment, causing toxicity, carcinogenic, hematologic
CMV infection in HIV patient
ganciclovir, valganciclovir
BBW of seizure, renal impairment, hematologic, carcinogenic.
gang, valgang = a group of stronger warriors to fight off the serious infection. BBW b/c they do dmg to everything around it
Primary OR Recurrent GENITAL infection
- oral acyclovir TID
- Valacyclovir
- Famciclovir
*initial episode treated 7-10 d within 48 to 72 h onset
* Recurrences treated 3 to 5 d within 24 h onset
“Acyclo” = a sick blow
Val the warrior + fam + sick blow
triple threat to the groin
Primary & Recurrent HSV ON THE FACE infection
- oral acyclovir TID
Valacyclovir
Famciclovir
*initial episode treated 7-10 d within 48 to 72 h onset
Recurrences treated 3 to 5 d within 24 h onset
Also: - Topical 1% hydrocortisone, 5% acyclovir cream, penciclovir
- OTC docosanol
“Acyclo” = a sick blow
Val the warrior + fam + sick blow (the triple threat)
Docosanol + Penciclovir = Dock is like an eye socket and Penciclovir- imagine a pen drawing a circle around the eye
Recurrent HSV prophylaxis
- acyclovir qd
- valacylovir qd
- famiciclovir qd
pick one of these. instead of BID or TID its just once a day for prophylactic use
Tx. for HSV Keratitis Ophthalmology only
- Topical trifluridine opthalmic drops
- Oral acyclovir
Try- Flurescent (similar to the test that diagnoses it)
And A sick blow to the eye (a black eye)
A black eye with flurescent
Disseminated/ Neonate HSV
IV acyclovir
Disseminated Herpes
A sick blow to the whole body and now they are in the hospital
HSV flareup/transmission Prevention
- C section for women with active genital lesions
- Sunscreen
- barrier methods during sexual activity
Don’t want to pass to the baby
Sunlight causes hsv flares
it can pass both skin to skin and through intimate contact
Herpes Zoster rx
- Acyclovir
- Valacylovir
- Famiciclovir
Treatment should be started within 72 hours of onset of sx
shingles is 72 hrs
Triple threat
Herpes Zoster eye infection (Ophthalmicus)
Medical Emergency!
Admit!
IV acyclovir and topical steroids
Shingles
KO + steroids
Post Herpetic Neuralgia
Pain management only. you can’t cure viral damage.
Opiods, TCAs, gabapentin
GOT
Herpes Zoster Prevention
shingles
50 and up. 2 vaccines
2-6 mo. apart. Shingrix or RZV.
Doesn’t matter if they had Zostavax.
4 & 4. Protection lasts 4 years and reduces incidence by 85% for four years.
Shingrix for younger population - age?
only for IC 19 and up
EBV
NO ABX or Antivirals
Fluids, antipyretics
Supportive
It’s just mono and it reacts to shit really bad so don’t give it any shit to react to, k?
When should EBV be hospitalized?
Severe splenomegaly, hepatitis, CNS invovlement, severe thrombocytopenia
Basically, when do we actually start treating mono?
lymphocytosis can cause hematologic abnormalities so you see problems with the spleen getting bigger, platelets getting smaller. higher LFT because liver gets affected
CMV tx- when, and what
Only for serious CMV complications like retinitis and encephalitis.
- Ganciclovir or valganciclovir
- foscarnet
The gang drugs + fooos go rah
HPV Condyloma acuminata tx
Chemical - podophyllin or imiquimod
Cryotherapy
For severe, laster or surgical
If systemic, interferon
podophyllin “podium filling” like a wart being filled with chemicals
“imiquitmod” image quit mod- the image of a wart is being deleted
HPV Cervical cancer Tx
Laster ablation, cone biopsy, surgery
HPV prevention
Gardasil 9 for females 9yrs old through 45 yrs old
Education
Severe Seasonal Influenza antivirals
1st - Neuraminidase inhibitor B & A coverage
-oseltamivir oral, zanamivir inhalation, peramivir IV
-must be started within 48 hrs of onset
2nd - NMDA receptor antagonists only cover A
- Amantadine
- Rimantadine
growing resistance to NMDA
Oscar’s (Oseltamivir - Oral)
Zen (Zanamivir - Inhalation, breathe in and out for relax)
Prom IV Year
+
AR
Oscar’s Zen 4th prom year, antiviral remedy!
Dosage of adult patient for tamiflu
75 mg BID for 5 d
Influenza tx
supportive care including fluids, analgesics, antiviral medicadtions
Neuraminidase inhibitors MoA
Stop replication release. don’t kill.
Neuraminidase inhibitors pharm
oseltamivir - can be used in all ages.
can only be used in prophylaxis ages 3 mo. +
Zanamivir - inhalation ages 7+ except CI in lung pathology
peramivir IV for hospital pts, 18 yo. +
SIDE EFFECTS OF THESE MEDS ARE POTENT.
BAD headache. BAD GI upset.
few DDI.
Can prescribe to pregnant!
renal excreted.
Oscar meyer weiners are fun for everyone
Zen = “Z” looks like “7”
Prom IV Year
Bad N/V/D and HA like a bad hangover after a party.
Influenza vaccine indications
6 mo old and higher.
REALLY important for:
- young kids, above 50 y/o, cardio path, IC, preg, healthcare workers, or caretakers
Two types of Flu shots
IIV - Inactivated influenza vaccine
LAIV - Live Attenuated Influenza Vaccine. can be intranasal too
Viral pneumonia tx and how do you know its viral
The chest X ray will be nondiagnostic (no lobes or walls) and rhonchi. Rhonchi sounds like congestion, and when the patient coughs it clear up.
Supportive treatment only.
Rhinovirus tx
its the common cold
self limitiing
Adenovirus
the common cold
self limiting
West Nile Tx
Supportive
La Crosse Virus tx
supportive
Rabies Tx
Post Exposure Prophylaxis
* wash wound
* report to ED
* start PEP
* 1 dose at site of bite
* 4 doses over 14 d
* 1-3-7-14
* delivered to deltoid
