Horace: Non-HIV Antivirals

what is a virus

intracellular parasite that is not capable of replication outside of a host, it relies on the host to do that

virion

virus particle

the virion is made of…

nucleic acid genome

capsid

± envelope

influenza has a _______ genome

RNA

highest rates of severe influenza infections occurs in…

> 65 years old

young children

underlying medical conditions

symptoms of the flu

rapid onset of fever

myalgia

HA

malaise

non-productive cough

sore throat

rhinitis

how is the flu transmitted

inhalation

how long is the infectious period of someone with the flu

about 8 days

how are outpatients diagnosed with the flu

rapid molecular assay

how are inpatientsdiagnosed with the flu

RT-PCR

how do you get the specimen for the flu test

nasopharyngeal (nose) is pref

complications of the flu

Exacerbation of any underlying disease

Primary viral pneumonia

Secondary bacterial pneumonia

Other respiratory illness

Encephalopathy

Pericarditis

Death

who should get tx for the flu?

pts who are hospitalized

outpts with severe or progressive illness

outpts with high risk of complications

children < 2 years old

adults> 65

preg ppl and those w/n 2 weeks post partum

which medications are indicated to treat the flue

oseltamivir (po)

zanamivir (inhalation)

peramivir (IV)

baloxavir marboxil

what meds should NOT be used for the flu?

amantadine and rimantadine

oseltamivir brand name

tamiflu

oseltamivir is active against…

influenza A and B

dosage of oseltamivir for the flu

75 mg PO BID x 5 days

prophylaxis with oseltamivir dosage for the flu

75 mg PO daily x 10 days

ADE of oseltamivir

N/V/D

flu like symptoms (lol)

zanamivir brand

relenza

zanamivir is active against….

influenza A and B

influenza tx with zanamivir dosage

two 5 mg inhalations BID x 5 days

influenza prophylaxis dosage with zanamivir

two 5 mg inhalations q24h x 10 days

ADE of zanamivir

Bronchospasms in patients with asthma / COPD

Cough

peramivir brand name

rapivab

peramivir is active against….

influenza A and B

treatment of influenza with peramivir dosage

600 mg IV one time

influenza prophylaxis with peramivir dosage

we dont do this #trickedyoass

ADE of peramivir

Diarrhea

Neutropenia

Hyperglycemia

Increased LFTs

Insomnia

brand name of baloxavir marboxil

Xofluza

baloxavir marboxil is active against…

influenza A and B

baloxavir marboxil can only be used within ____ of symptoms

48 hours

tx and prophylaxis of influenza with baloxavir marboxil dosing for a pt that weighs 40-80 kg

40 mg dose x 1

tx and prophylaxis of influenza with baloxavir marboxil dosing for a pt that weighs >80 kg

80 mg dose x 1

Baloxavir marboxil can be used in ages ____ and up

12

duration of baloxavir marboxil for influenza

one time dose

baloxavir drug interactions

avoid cations due to chelating issues

Baloxavir marboxil ADE

Diarrhea, bronchitis, nausea, nasopharyngitis, and increased LFTs

T/F: it was found that Baloxavir marboxil works better than oseltamivir

F, no bb they the same

Baloxavir shorted time to alleviation of symptoms by _____ compared to placebo (p < 0.001)

26.5 hours

pref tx for preg ppl with the flu

oseltamivir

Na and amantadine should be avoided in which pts?

breast feeding ones

baloxavir is not rec for which pts

preg or breast feeding

supportive care for pts with the flu

fluids

rest

APAP or NSAIDs

what are the only types of herpesviruses that have effective therapy

HSV1

HSV2

VZV (varicella zoster virus)

CMV (cytomegalovirus)

varicella zoster causes which two rashes

chicken pox and shingles

what is the initial rash due to VZV

chickenpox

what is the reactivation rash due to VZV

shingles

how is VZV transmitted

resp or contact with leasion

how is VZV reactivated?

not really known, latency in the dorsal root ganglia is the guess

how to confirm VZV diagnosis

Isolation of VZV in susceptible tissue cultures

VZV DNA by PCR Antibody detection / changes

chickenpox symptoms

• Cutaneous rash, low-grade fever, malaise

infectious period of chickenpox

48 hours before the onset of the rash

during the vesicle formation (4-5 days)

until all vesicles have crusted over

when is chickenpox no longer contagious

when all vesicles have crusted over

complications of chickenpox

Secondary bacterial infections

Extracutaneous involvement of CNS

Varicella pneumonia (more common in adults), corneal lesions, nephritis, hepatitis… and more

drugs for chickpix is NOT rec for pts under ___ years old

12

what is the supportive tx options for pts with chickenpox that has gone on for < 24 hours

Acyclovir 800 mg PO 5x daily (IV dosing for severe infection, immunocompromised patients)

Valacyclovir 1 g PO TID

Famciclovir 500 mg PO TID

Duration 7 days

symptoms of shingles

Unilateral, vesicular dermatomal eruption, super painful

how long does shingles last

7-10 days

how long can it take for skin to get back to normal after a pt has shingles

weeks

recurrent VZV is rare in all pts except…

immunocompromised

complications of shingles

Postherpetic neuralgia

CNS involvement

Ocular Involvement

drugs should be started within ____ of shingles rash onset

72 hours

tx options for shingles

Valacyclovir 1 g PO TID

Famciclovir 500 mg PO TID

Acyclovir 800 mg PO 5 times daily

duration of shingles tx

7-10 days

IV acyclovir is used for which pts with shingles?

severe infections and immunocompromised

acyclovir brand name

zovirax

acyclovir dosing for meningitis and encephalitis

(dose, admin, interval)

10 mg/kg (IBW) IV q8h

ADE of acyclovir

mainly with IV —> nephrotoxicity, crystallization (need to hydrate the pt)

valacyclovir brand name

valtrex

valacyclovir can transition to po to complete HSV meningitis but NOT for ______

encephalitis

famciclovir brand name

famivir

famciclovir is prodrug od

penciclovir

post herpetic neuralgia predictors

Age > 60

Immunocompromised

Presence of prodromal pain

Severity of pain during the acute phase

Extent of rash

supportive therapy for post herpetic neuralgia

Gabapentin

Pregabalin

Tricyclic Antidepressants

SNRIs

Lidocaine patches

Opioids

Glucocorticoids

what kind of genome does cytomegalovirus have

DS DNA

cytomegalovirus causes ____ infections in norm. immuno pts

asymptomatic

cytomegalovirus in immuno comp pts leads to

Colitis

Pneumonia

Hepatitis

Nephritis

Pancreatitis

Retinitis

tx options for cytomegalovirus

ganciclovir

valganciclovir

cidofovir

foscarnet

ganciclovir brand name

cytovene

ganciclovir is a nucleoside analog that is integrated into viral DAN to…

stop replication

dosage form of ganciclovir

IV only

ADE of ganciclovir and Valganciclovir

bone marrow suppression, renal dysfunction, and GI upset

brand name of Valganciclovir

Valcyte

Valganciclovir has better bioavailability than..

ganciclovir

brand name of Cidofovir

Vistide

Cidofovir has a BBW for ____

nephrotoxicity

Cidofovir caused nephrotoxicity can be prevented by…

IV hydration and probenecid

ADE of Cidofovir

bone marrow suppression

it is not rec to use cidofovir in pts that are….

preg

brand name of foscarnet

foscavir

MOA of foscavir

Pyrophosphate analog that acts as a noncompetitive inhibitor of the DNA and RNA polymerases in multiple viruses

when is foscarnet used

resistant CMV

pts that cant tolerate valganciclovir or ganciclovir

ADE of foscarnet

nephrotoxicity and electrolyte disturbances (so hydrate bitch)

antivirals for covid

Remdesivir (IV)

Nirmatrelvir/ritonavir (Paxlovid) (PO)

immune modulators for covid

Baricitinib

Tocilizumab