Zoster

Question 1

• when should antivirals be started relative to rash onset?

If antivirals started within __ hrs, can:
○ Reduce acute ____
○ Accelerate _____
○ Reduce period of __________

They don’t CURE INFECTION, but helpful cuz blocks replication that contributes to worse sx.

Answer 1

72 hrs.

If antivirals started within 72 hrs, can:
○ Reduce acute pain
○ Accelerate rash healing
○ Reduce period of viral shedding

They don’t CURE INFECTION, but helpful cuz blocks replication that contributes to worse sx.

Question 2

do antivirals PREVENT PHN?

Answer 2

NO!

Question 3

what are herpes zoster red flags?

• age < what?
  or ____________.
• _______ changes, what 2 other organ involvement ?, _____ sx.

Answer 3

• age < 12 or immunocomporomosied
• neurologoic changes, ocular or aurical invovlemnt, systemic sx.

Question 4

Wht are the 2 preferred antiviral drugs used?

Answer 4

Famciclovir and Valacyclovir (both superior to acyclovir and have better dosing).

Question 5

waht isthe dosing for Famcyclovir and Valavyclovir?

• how eliminated?

Answer 5

Famciclovir 500 mg TID x 7 days

Valacyclovir 1000 mg TID x 7 days

• renally!

Question 6

waht isthe dosing for Famcyclovir and Valavyclovir?

• how eliminated?

Answer 6

Famciclovir 500 mg TID x 7 days

Valacyclovir 1000 mg TID x 7 days

• renally!

Question 7

Who should receivie antivirals?

Answer 7

pts presenting < 72 hrs since rash onset.
–> OPTIONAL for younger pts with only mild pain and limited skin einvovled.

Question 8

when would you consider antivirals for a pt presenting > 72 hrs since rash onset? (2)

Answer 8

• after > 72 hrs, No longer beneficial. But may consider if:
• If continuing to get new vesicles = means continuing viral replication and could consider antivirals.
• If person is immunocompromised , may also benefit from trying an AV (but you’d refer anyway).
• or has complications. refer anyway.

Question 9

Acute Herpes Zoster Pain:

what would you revommend for….
- mild pain?
- mod pain?
- more severe pain?

Answer 9

nsaids, acetaminophen

• tramadol + adjuvant gabapetnitn or TCA
• opioids, steorids

Question 10

What are the top 3 optiosn for PHN pain?

• what is a good comboa that may yield greater pain releif thatn eitehr agent alone?

Answer 10

TCAs (amitriptyline, nortriptyline), SNRIS (vnelafaxine, duloxetine), Gabapentin/pregabalain, opiodsi, lidocaine, cnanboind.

• gabapenting + nor or
• gaba and morphine. {think: NOOR and MOR shapiro- have guys that are GAGA over them}