EXAM 1- SING

BASED OFF SGGGGGGGGGGGG

How is the flu spread?

• mainly through large-particle respiratory droplets

• touching contaminated surfaces

What is the period of contagiousness for influenza?

from day 1 of becoming infected—> to 5-7 days after symptoms begin

What are the typical presenting s/sx associated with the flu?

fever, chills, cough, sore throat, runny nose, muscle/body aches, HA, fatigue

• in kids—> v/d, otitis media

What are complications of influenza infection in ADULTS?

• bacterial pneumonia

• ear/sinus infections

• dehydration

• worsening comorbid conditions (HF, COPD, asthma, DM)

What are complications of influenza infection in CHILDREN?

• encephalopathy

• tranverse myelitis (spinal cord inflammation)

• myositis (muscle inflammation)

• myocarditis/pericarditis

• reye’s syndrome

What are the risk factors for complications of influenza infection?

• Age younger than 5

• Age 65 and above

• Age <19 yrs on long-term aspirin therapy

• Pregnant women

• Nursing home/LTCF resident

• American Indians and Alaskan natives

• Comorbid conditions (asthma, COPD, heart disease, immunocompromised, kidney/liver disease, DM, sickle cell, obesity)

What groups SHOULD be provided antiviral tx?

• with confirmed/suspected influenza who:

  • hospitalized

  • high risk of complications

  • severe, progressive, or complicated

What groups MAY be provided antiviral tx?

• Previously healthy outpatients not at high risk of complications WITHIN 48hrs after symptom onset

• Outpatients/healthcare provided who have contact with high risk ppl

What’s the difference between pre and post exposure prophylaxis?

• post-exposure: initiated within 48 hours of exposure to person infected with influenza virus

• pre-exposure: may be warranted in high risk individuals

does post or pre exposure prophylaxis replace the need for vaccination?

NO!

Who is a candidate for antiviral prophylaxis?

• pts. with VERY high risk of complications + exposed

• immunosuppressed + exposed

• institutionalized pts. with unvaccinated staff of an affected unit/ward during an influenza outbreak

  • outbreak? 2+ influenza cases within 72 hours

What is the meaning of the abbreviations for the main vaccine types?

• IIV

• RIV

• LAIV

• IIV= inactivated influenza vaccine

• RIV= recombinant influenza vaccine

• LAIV= live attenuated influenza vaccine

What do these numbers mean in terms of influenza vaccines?

• 3

• 4

• 3= trivalent vaccines

• 4= quadrivalent vaccines

What do these prefixes mean in terms of influenza vaccines?

• a

• cc

• HD

• SD

• a= adjuvanted inactivated influenza vaccine

• cc= cell culture based inactivated influenza vaccine

• HD= high-dose inactivated influenza vaccine

• SD= standard-dose inactivated influenza vaccine

Who is the annual influenza vaccine recommended for?

For all persons ≥6m without contraindications!!!

In WHAT population is there a vaccine preference? age?

What vaccines are preferred? examples?

• Usually no preferences EXCEPT for ≥65 years old

• vaccines preferred—> HIGH DOSE or ADJUVANTED

  • ex: HD IIV4, RIV4, or allV4, IIV3-HD, allV3, RIV3

What happens is a pt. has an egg allergy and wants the flu vaccine??

• 1st determine if the reaction is only hives or more severe side effects

• more severe= administer under medical supervision

• can also try egg free options—> RIV3, ccIIV3

What age is LAIV recommended for? route?

• age: 2-49

• route: intranasal

what is the MAIN contraindication for ALL flu vaccine types?

history of severe allergic reaction to influenza vaccine or any component

in addition to the main contraindication for all flu types, what additional contraindications are for the LIVE VACCINE?

• Concomitant salicylate therapy in those <19yrs old

• Children aged 2-4 yrs with asthma or wheezing episode within the last 12m

• Close contacts/caregivers of severely immunosuppressed pts.

• Pregnancy

What are the adverse effects of the LAIV?

runny nose, nasal congestion, respiratory distress

Some influenza vaccines contain thimerosal, a mercury containing preservative.

What are the possible adverse effects bc of this ingredient?

Has Thimerosal been linked to autism?

• may cause redness/swelling at injection site, allergic rxns possible

• NO evidence of link to autism

With influenza vaccines you need to have precaution because of GBS.

What is GBS?

• rare, autoimmune disorder (bodies immune system attacks nervous system)

• can cause: muscle weakness, tingling, paralysis

• MEDICAL EMERGENCY

For Oseltamivir:

• what are the adverse effects?

• does it need renally adjusted?

• ADRs: HA, n/v, nerve pain, confusion/delirium

• Yes, renal adjustments

What antiviral is PREFERRED in PREGNANCY?

Oseltamivir

For Zanamivir:

• what are the adverse effects?

  • avoid in WHAT patients?

• does it need renally adjusted?

• route?

• ADRS: HA, sore throat, viral infection, nasal symptoms, tonsil discomfort, cough, chills, myalgia, fever, confusion/delirium, bronchospasm

  • avoid in: asthma/COPD

• No renal adjustments

• INHALATION ROUTE

For Peramivir:

• what are the adverse effects?

• does it need renally adjusted?

• route?

• ADRS: HTN, insomnia, hyperglycemia, d, c, neutropenia, increased LFTs, increased CPK

• Yes, renal adjustment

• IV route

For Baloxavir:

• what are the adverse effects?

• does it need renally adjusted?

• ADRS: diarrhea

• No renal adjustments

What is a drug interaction with ALL ANTIVIRALS?

may diminish therapeutic effects of LAIV (the live influenza vaccine)

REVIEW:

Which of the following antivirals needs renal adjustments? SATA

a. Oseltamivir

b. Zanamivir

c. Peramivir

d. Baloxavir

a, c

What antivirals are indicated for prophylaxis?

Oseltamivir, Zanamivir

Most commonly prescribed influenza antiviral?

Oseltamivir

Who may be a candidate for Zanamivir?

SATA

a. post exposure prophylaxis for community

b. post exposure prophylaxis for institutional outbreak

c. post exposure prophylaxis for community outbreak

d. treatment

a, b, c, d

Who may be a candidate for Peramivir?

SATA

a. post exposure prophylaxis for community

b. post exposure prophylaxis for institutional outbreak

c. post exposure prophylaxis for community outbreak

d. treatment

d

Who may be a candidate for Baloxavir?

SATA

a. post exposure prophylaxis for community

b. post exposure prophylaxis for institutional outbreak

c. post exposure prophylaxis for community outbreak

d. treatment

d

What is the treatment duration for Oseltamivir? (note: difference between tx and prophylaxis duration)

a. 5 days

b. 7 days

c. 14 days

d. 1 dose

a

What is the treatment duration for Zanamivir?

a. 5 days

b. 7 days

c. 14 days

d. 1 dose

a

What is the treatment duration for Peramivir?

a. 5 days

b. 7 days

c. 14 days

d. 1 dose

d

What is the treatment duration for Baloxavir?

a. 5 days

b. 7 days

c. 14 days

d. 1 dose

d

What is POST EXPOSURE prophylaxis duration for Oseltamivir?

• community

• institutional outbreak

• community- 7 days if vaccinated, 14 days if unvaccinated

• institutional outbreak- at least 14 days and until 7 days after onset in last pt.

What is POST EXPOSURE prophylaxis duration for Zanamivir?

• community

• institutional outbreak

• community- 7 days after last known exposure

• institutional outbreak- at least 14 days and until 7 days after onset in last pt.

What is PRE EXPOSURE prophylaxis duration for Oseltamivir?

for duration of influenza activity or 2 weeks after vaccination

What is PRE EXPOSURE prophylaxis duration for Zanamivir?

up to 28 days or until influenza activity subsides

REVIEW:

List the duration for each of the following scenarios with OSELTAMIVIR:

• treatment duration

• postexposure duration (community vs. instit.)

• preexposure duration

• tx: 5 days

• post:

  • community- 7 days if vaccinated, 14 days if unvaccinated

  • institutional outbreak- at least 14 days and until 7 days after onset in last pt.

• pre: for duration of influenza activity or 2 weeks after vaccination

REVIEW:

List the duration for each of the following scenarios with ZANAMIVIR:

• treatment duration

• postexposure duration (community vs. instit.)

• preexposure duration

• tx: 5 days

• post:

  • community- 7 days after last known exposure

  • institutional outbreak- at least 14 days and until 7 days after onset in last pt.

• pre: up to 28 days or until influenza activity subsides