ID 3 - antivirals

When should neuraminidase inhibitors be started during flu?

Within 48hr of illness onset

Neuraminidase inhibitors (3)

• Oseltamivir (PO TX & PPX for >12yo)

• Zanamivir (inhaled TX ≥ 7yo & PPX ≥ 5yo)

• Peramivir (IV TX adult)

Oseltamivir drug formulations

• Capsules

• Suspension

Oseltamivir dosing (tx vs ppx)

• TX (> 12yo): 75 mg BID x 5d

• PPX (> 12yo): 75 mg QD x 10d

Oseltamivir AE (3)

• Neuropsychiatric events

• Headache

• N/v

Zanamivir formulation (1)

Inhaled aerosol powder

Zanamivir indications & ages

• TX: ≥7yo

• PPX: ≥5yo

Contraindication to zanamivir

COPD/asthma, any breathing problems

Peramivir indications & age

• IV TX in adults

Endonuclease inhibitors (1)

Baloxavir marboxil (Xofluza). - PO TX & PPX in ≥5 yo

Baloxavir indication & ages

• PO TX & PPX in ages ≥5 yo

How many total doses in baloxavir?

1

HSV-1

A. oropharyngeal

B. genital

A. oropharyngeal

HSV-2

A. oropharyngeal

B. genital

B. genital

What patients should you caution acyclovir and valacyclovir for HSV in? (3)

• Renal impairment

• Elderly

• Pts getting nephrotoxic agents

What is prodrome with cold sores?

Symptoms that occur before lesions appear

Docosanol (abreva) cream dosing for cold sore

Apply 5x daily at first sign of outbreak

Acyclovir cream (Zoviraz) dosing for cold sore

Apply 5x daily for 4 days

What is the initial TX duration for herpes?

7-10 days

What are the 3 PO treatment options for oral herpes?

• Acyclovir (IV, PO, buccal, topical)

• Valacyclovir

• Famciclovir

Dosed more frequently

A. Acyclovir

B. Valacyclovir

C. Famciclovir

A. Acyclovir

DOSED 5x/day

how many times per day is acyclovir taken?

5 times per day

A prodrug with less frequent dosing and higher concentrations

A. Acyclovir

B. Valacyclovir

C. Famciclovir

B. Valacyclovir

Drugs for tx of genital herpes in non-hiv pts

Acyclovir

Valacyclovir

Famiciclovir

What is the most commonly cause of viral encephalitis?

HSV

Chickenpox vs. Shingles **

• Varicella zoster virus can cause chickenpox infx during childhood which can be dormant in the nerves for decades without causing any SXS

• Recurrence of viral SXS is called herpes zoster or shingles.

Shingles TX + duration

• Acyclovir (Zovirax), valacyclovir (Valtrex), or famciclovir

• 7 days

What is CMV?

• Cytomegalovirus in the herpes family

• Happens in severely immunocompromised states (AIDs, TXP)

• Causes retinitis, colitits, esophagitis

Treatments options for CMV? (4)

• Ganciclovir **

• Valganciclovir **

• Cidofovir

• Foscarnet

Ganciclovir & valgan BW (1)

Myelosuppression

Foscarnet BW (1)

Renal impairment

When is letermovir used?

CMV PPX in select kidney and bone marrow recipients

What is EBV?

• Ebstein Barr Virus - member of herpes family

• MONO kissing virus

EBV treatmet

• NOTHING

• Symptoms resolve in 2-4 weeks

What valacyclovir (valtrex) a prodrug of

acyclovir

What is famicyclovir a prodrug of

penicyclovir

How to dose acyclovir in obese pts

Do not use TBW use IBW

HSV encephalitis tx

IV acyclovir

TX for HSV-1 HSV-2 and VZZ

Acyclovir

Valacyclovir

Famicyclovir

When to start antivirals for shingles

within 72 hrs

Neuropathic pain meds for shingles

Pregablin

Gabapentin

Duloxetine

TCAs

NSAIDs

Opioid

Postherapeutic neuralgia

long term chronic shingles pain

Who gets the shingles vaccine

Adults > 50 ys

Immunocompromised adults 19 yrs and older