ID 3 - antivirals (NAPLEX)

When should neuraminidase inhibitors be started during flu?

Within 48 hours of symptom onset

Neuraminidase inhibitors (3)

Oseltamivir (PO tx and ppx for >12yo)

Zanamivir (inhaled tx for >7yo and ppx for >5yo)

Peramivir (IV tx for adult)

Oseltamivir drug formulations *(underlined in book) (2)

Capsules

Suspension

Oseltamivir dosing (tx vs ppx)

TX (>12yo): 75mg BID for 5 days

PPX (>12yo): 75mg daily for 10 days

Oseltamivir AE (3)

Neuropsychiatric events

Headache

N/V

Zanamivir formulation (1)

Inhaled aerosol powder

Zanamivir indications & ages

tx: >7yo

ppx: >5yo

Contraindication to zanamivir

asthma/COPD, any breathing problems

Peramivir indications & age

IV TX for adults

Endonuclease inhibitors (1)

Baloxavir (Xofluza) - po tx and ppx in >5yo

Baloxavir indication & ages

po tx and ppx for >5yo

How many 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

taking other nephrotoxic drugs

What is prodrome with cold sores?

Symptoms that occur before lesions appear

Docosanol cream dosing for cold sore

Apply 5x a day at first sign of outbreak

Acyclovir cream dosing for cold sore

Apply 5x a day for 4 days

What is the initial TX duration for herpes?

7-10 days

What are the 3 PO treatment options for herpes?

Acyclovir

Valacyclovir

Famciclovir

Dosed more frequently

A. Acyclovir

B. Valacyclovir

C. Famciclovir

A. Acyclovir

5x a day

how many times per day is acyclovir taken?

5x a day

A prodrug with less frequent dosing and higher concentrations

A. Acyclovir

B. Valacyclovir

C. Famciclovir

B. Valacyclovir

What is the most commonly cause of viral encephalitis?

HSV

Chickenpox vs. Shingles **

Varicella zoster virus causes chicken pox in childhood which can lay dormant without causing any sx

Recurrence of viral sx is called herpes zoster or shingles

Shingles TX + duration

Acyclovir, valacyclovir, or famciclovir

7 days

What is CMV?

(what, who, sx)

Cytomegalovirus in the herpes family

Happens in severely immunocompromised

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