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afsha - infections > herpesvirus infections > Flashcards

herpesvirus infections Flashcards

1
Q

herpes infection of the mouth and lips and in the eye is generally associated with….

A

HSV1

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2
Q

genital infection is most often associated with

A

HSV2, and also HSV1

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3
Q

what is prodromal phase

A

early signs or symptoms of an illness or health problem that appear before the major signs or symptoms

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4
Q

what to do if you suspect ocular herpes simplex infection

A

refer for urgent same day specialist referral

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5
Q

can you initiate treatment whilst awaiting review by specialist in pt suspected to have ocular herpes simplex

A

no, do not give treatment
specialist urgent same day referral

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6
Q

what do you do if same day review is not possible for a pt with suspected ocular herpes simplex infection

A

seek specialist advice
may include topical antiviral treatment in primary care

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7
Q

what to do if herpes simple infection in pregnancy

A

refer or seek specialist advice for treatment

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8
Q

what is a neonate

A

0-28 days

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9
Q

varicella (chickenpox) is caused by which virus

A

varicella zoster

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10
Q

management of chickenpox in neonates

A

seek specialist advice due to high er risk of severe disease and complications

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11
Q

is antiviral treatment recommended in children with chickenpox

A

no, not routinely as it is generally self limiting and complications are rare

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12
Q

who is chickenpox more severe in? (age)

A

adolescents (ages 14 and over) and adults

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13
Q

would you consider antivirals in pt 14 and over and adults who have chickenpox

A

chickenpox is more severe in this age range
antiviral treatment started within 24h of onset of rash may be considered, esp if severe infection or risk of complications
seek specialist advice on diagnosis and management of chickenpox in immunocompromised pt

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14
Q

treatment of chickenpox during pregnancy

A

immediate specialist advice
pregnant females with severe chickenpox may be at risk of complications, esp varicella pneumonia

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15
Q

Pregnant females who develop severe chickenpox may be at risk of complications, especially

A

varicella pneumonia

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16
Q

shingles is caused by this virus

A

herpes zoster

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17
Q

what is herpes zoster (shingles)

A

viral infection of individual nerve and the skin surface affected by the nerve

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18
Q

shingles infection is caused by reactivation of

A

varicella zoster virus (chickenpox virus)

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19
Q

what pt with shingles need oral antiviral treatment (4)

A
  • immunocompromised
  • non-truncal involvement (neck, limbs, perineum)
  • moderate to severe pain
  • rash
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20
Q

consider oral antiviral treatment for shingles for pt over 50 to reduce risk of

A

post herpetic neuralgia

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21
Q

consider oral antiviral treatment in this age range to reduce the risk of post herpetic neuralgia

A

over 50

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22
Q

when should you start treatment for shingles

A

within 72h of onset of rash

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23
Q

which patients with shingles would you admit to hospital or seek specialist advice?

A
  • immunocompromised with severe or widespread infection
  • severely immunocompromised
  • shingles in ophthalmic distribution of trigeminal nerve
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24
Q

a patient presents to the pharmacy with this. they say they felt tingling to begin with a few days and now have what appears to be a rash. they also have a headache. you diagnose them as having shingles and refer them because of the region it can affected. which nerve has been affected?

A

trigeminal nerve

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25
Q

where does shingles rash typically present

A

Usually you get the shingles rash on your chest and tummy, but it can appear anywhere on your body including on your face, eyes and genitals.

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26
Q

describe shingles rash

A

The rash appears as blotches on your skin, on 1 side of your body only.
A rash on both the left and right of your body is unlikely to be shingles.
The blotches become itchy blisters that ooze fluid.
A few days later, the blisters dry out and scab.
Skin remains painful until after the rash is gone

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27
Q

first signs of shingles

A

a tingling or painful feeling in an area of skin
a headache or feeling generally unwell

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28
Q

chronic pain which persists after the rash has healed is known as

A

post herpetic neuralgia (needs specific treatment)

29
Q

who is the shingles vaccine recommended for

A

70-79 yr olds

30
Q

a patient presents with an painful rash on their back. they are pregnant. what is it and what do you do

A

shingles
if you’re pregnant and get shingles, it’s mostly mild and there’s usually no risk to you or your baby.

But a GP should arrange for a specialist to advise on whether you need treatment.

31
Q

who is post exposure prophylaxis to attenuate varicella zoster disease and reduce risk of complications (e.g. pneumonitis) recommended for

A
  • increased risk of severe chickenpox e.g. neonates (esp in first 7 days of life)
  • children under one year
  • pregnant
  • immunosuppressed

(who have had a significant exposure to varicella-zoster virus during the infectious period and who are susceptible to the virus.)

32
Q

post exposure prophylaxis with this antiviral drug is recommended for most at risk individuals (except certain susceptible neonates and for individuals for whom antivirals are contra-indicated or otherwise unsuitable (e.g. if there are significant concerns about renal impairment or intestinal malabsorption))

A

acyclovir

33
Q

post exposure prophylaxis with this drug is recommended for certain susceptible neonates and for individuals for whom antivirals are contra-indicated or otherwise unsuitable (e.g. if there are significant concerns about renal impairment or intestinal malabsorption)

A

varicella zoster immunoglobulin VCIG

34
Q

Prophylactic intravenous aciclovir [unlicensed use] should also be considered in addition to VZIG for neonates whose mothers develop chickenpox 4 days before and up to 2 days after delivery as….

A

as they are at the highest risk of fatal outcome despite VZIG prophylaxis

35
Q

this combination should be considered for neonates whose mothers develop chickenpox 4 days before and up to 2 days after delivery, as they are at the highest risk of fatal outcome despite VZIG prophylaxis.

A

prophylactic intravenous aciclovir [unlicensed use] should also be considered in addition to VZIG

36
Q

alternative to aciclovir for post exposure prophylaxis

A

valaciclovir (unlicensed use)

37
Q

post exposure prophylaxis for individuals on long term acyclovir or valaciclovir

A

may require dose to be temporarily increased

38
Q

Individuals who develop chickenpox despite post-exposure prophylaxis require treatment with ..

A

antiviral

39
Q

During outbreaks in nurseries and pre-school settings where chickenpox is co-circulating with group A streptococcus infections (such as scarlet fever), post-exposure prophylaxis with ….. can be given to certain non immune individuals in these settings

A

chickenpox varicella-zoster vaccine

40
Q

this antiviral drug is active against herpesvirus but does not eradicate them

A

acyclovir

41
Q

uses of aciclcovir include

A

systemic treatment of varicella-zoster
the systemic and topical treatment of herpes simplex infections of the skin and mucous membranes

42
Q

acyclovir eye ointment is license for

A

HSV infections of the eye

43
Q

famciclovir is a prodrug of

A

penciclovir

44
Q

famciclovir is a prodrug of

A

penciclovir

45
Q

femciclovir is a prodrug or penciclovir and is similar to this drug

A

aciclovir

46
Q

femciclovir is a prodrug of penciclovir and is similar to acyclovir and may be used in the treatment of (2)

A

herpes zoster
genital herpes

47
Q

valaciclovir is an ester of this drug

A

aciclvoir

48
Q

valaciclovir may be used in the treatment of

A

herpes zoster and herpes simplex infections of the skin and mucous membranes (including genital herpes)

49
Q

this antiviral is licensed for preventing cytomegalovirus disease following solid organ transplantation.

A

valaciclovir

50
Q

IV foscarnet sodium is licensed for

A

mucocutaneous herpes simplex virus infection unresponsive to aciclovir in immunocompromised patients

51
Q

oral ionising pranobex is licensed for

A

mucocutaneous infections due to the herpes simplex virus.

52
Q

is cytomegalovirus a member of which virus group

A

member of the herpesvirus group

53
Q

in immunocompetent patients, cytomegalovirus infection is often…

A

asymptomatic and self-limiting therefore treatment is not always required.

54
Q

in immunocompromised pt e.g. AIDS and transplant recipients, cytomegalovirus manifests

A

more severely causing diseases associated with greater morbidity and mortality

55
Q

these is a possibility of resistance with this antiviral drug in those who have repeatedly have a poor treatment response or when viral excretion continues despite treatment (for CMV infection)

A

ganciclovir

56
Q

does CMV infection cause symptoms

A

usually asymptotic and self limiting therefore treatment not usually required (in immunocompetent patients)

57
Q

aciclovir dose for herpex simples treatment non genital

A

200mg 5 times a day usually 5 days
longer if new lesions appear during treatment or if healing incomplete

58
Q

acyclovir dose of herpes simplex treatment non genital in immunocompromised or if absorption impaired

A

400mg 5 times a day usually 5 days
longer if new lesions appear during treatment or if healing incomplete

59
Q

herpes simplex dose of aciclvoir for prophylaxis in immunocompromised

A

200-400mg FOUR times a day

60
Q

acyclovir dose for post exposure prophylaxis of varicella zoster infection

A

800mg FOUR times a day for 7 days
start course on day 7 after exposure
if pt presents after this, course may be started up to 14 days after exposure

61
Q

dose of VZ (chickenpox) treatment and HZ (shingles) treatment - acyclovir

A

800mg 5 times a day for 7 days

62
Q

treatment of first episode of genital herpes simplex - acyclovir dose (2 options)

A

200mg 5 times a day usually 5 days - longer if new lesions appear during treatment or if healing incomplete
alternatively 400mg TDS usually 5 days - longer as above

63
Q

which high risk drug does aciclovir and valaciclovir severely interact with and what is the interaction

A

theophylline/aminotheophylline - aciclovir increases exposure, monitor and adjust dose

64
Q

acyclovir is …. toxic

A

nephrotoxic

65
Q

when using antivirals in renal impairment, ensure pt maintain…

A

adequate hydration

66
Q

valaciclovir dose of post-exposure prophylaxis of varicella zoster infection

A

1000 mg 3 times a day for 7 days, start course on day 7 after exposure
if the patient presents after this, the course may be started up to day 14 after exposure

67
Q

valaciclovir dose of HZ infection treatment

A

1g TDS 7 days

68
Q

valaciclovir dose of prevention of cytomegalovirus disease following solid organ transplantation when valganciclovir or ganciclovir cannot be used

A

2g QDS usually 90 days
pref start within 72h of transplantation

afsha - infections (48 decks)

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