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howrie antivirals Flashcards

1
Q

how is HSV spread

A

person to person via secretions

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2
Q

herpes encephalitis

A

inflammatory process involving brain parenchyma: rapid onset fever, headache, seizure
most commonly HSV1

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3
Q

herpes encephalitis treatment

A

IV ONLY
acyclovir

if resistance documented: cidofovir, foscarnet

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4
Q

acyclovir is converted to acyclovir monophosphate by ____

A

viral kinase

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5
Q

acyclovir monophosphate is converted to di and triphosphate by ____

A

host kinases

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6
Q

acyclovir is activated in ____

A

only selectively in infected cells

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7
Q

how does acyclovir inhibit viral DNA synthesis

A

competes with deoxyGTP for viral DNA polymerase
irreversible binding
chain termination following incorporation into viral DNA

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8
Q

what kind of virus is HSV

A

DNA

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9
Q

1st line treatment for herpes encephalitis

A

acyclovir IV 10 mg/kg/dose q8h
infused over 1 hour

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10
Q

how to prevent renal damage with acyclovir

A

IV fluids
infuse over an hour

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11
Q

how can CMV be acquiried

A

community (saliva, genital secretions, urine)
via blood products (transplant from CMV donor)
congenital CMV at birth through intrauterine transmission

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12
Q

populations at risk for CMV

A

not previously exposed (CMV serology negative)
treatment with lymphocyte depleting agents (chemo)
transplant population (mismatch, lung/small intestine, immunosuppressants)
blood transfusion recipients
pregnant women & their fetuses
AIDS (CD4<50)

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13
Q

anti-CMV options

A

ganciclovir
-valganciclovir
cidofovir
foscarnet

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14
Q

ganciclovir mechanism

A

activated via triphosphorylation– inhibits viral dna polymerase– termination of viral dna elongation

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15
Q

ganciclovir adverse

A

severe penias: monitor WBC frequently
and handling precautions bc teratogenic and carcinogenic

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16
Q

when to hold ganciclovir

A

ANC<500
platelets <25,000
hemoglobin <8

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17
Q

valganciclovir dosing

A

900 mg PO BID= 5 mg/kg q12h of IV ganciclovir

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18
Q

when do we use valganciclovir for CMV

A

for prophylaxis or after initial IV ganciclovir

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19
Q

foscarnet mechanism

A

inhibits DNA polymerase & cleavage of pyrophosphate

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20
Q

foscarnet dosing precautions

A

IV only
adjusted renal
must administer with IV fluids– saline preloadfos

21
Q

foscarnet adverse

A

renal impairment– both chronic and AKI

22
Q

cidofovir mechanism

A

cytosine analog, inhibits DNA polymerase

23
Q

cidofovir dosing considerations

A

dosed with pre meds: probenecid 2 gm PO 3 hours before and 1 gm at hours 2 and 8 post administration

also requires aggressive hydration before and during

24
Q

how does probenecid help with cidofovir

A

organic anion transporter results in long half life to increase renal toxicity

probenecid inhibits the OAT to reduce injury

25
Q

letermovir is for ___ only

A

CMV

26
Q

letermovir mechanism

A

inhibits later stages of viral replication where the newly created viral DNA strands are packaged into shells: inhibits the terminases that do this

26
Q

maribavir drug interactions

A

increased levels of cyclosporine, tacrolimus, sirolimus

26
Q

when is maribavir used

A

treatment of post-transplant CMV resistant or refractory to 1st line
not for CNS or retinitis

26
Q

when is letermovir used

A

prophylaxis in hematopoietic stem cell transplant for CMV seropositive recipients

27
Q

maribavir mechanism

A

competitively inhibits protein kinase of CMV to inhibit protein phosphorylation

28
Q

CMV: life threatening/severe infection initial treatment

A

ganciclovir 5 mg/kg IV q12h
after clinical response can transition to PO valganciclovir

29
Q

CMV: non life threatening/mild to moderate initial treatment

A

valganciclovir 900 mg PO q12h

30
Q

CMV: 2nd line, intolerant to ganciclovir

A

foscarnet 60 mg/kg IV q12h x 7-14 days

31
Q

CMV: drug resistance w/ UL54 mutation

A

cidofovir 5 mg/kg IV
and probenecid PO once weekly

32
Q

COVID options: antivirals

A

ritonavir-boosted nirmatrelvir (paxlovid)
remdesivir
molnupiravir`

33
Q

COVID adjuncts

A

dexamethasone
tocilizumab

34
Q

when is remdesivir used

A

treatment of mild-moderate hospitalized or high-risk hospitalized patients
28 days or older

35
Q

remdesivir dosing

A

200 mg IV loading dose x 1
100 mg daily x 5 days or until hospital discharge

36
Q

remdesivir drug interactions

A

decreased efficacy due to chloroquine/hydroxychloroquine

increased concentrations of warfarin, tacrolimus

37
Q

remdesivir: pregnant, lactating

A

safe

38
Q

paxlovid boxed warning

A

drug interactions: CYP3A4

39
Q

when is molnupiravir used

A

ages 18+ high risk mild-moderate disease unable to take paxlovid

40
Q

molnupiravir: pregnancy/lactation

A

not recommended

41
Q

COVID: outpatient mild-moderate treatment
no O2 above baseline, risk factors for progression to severe disease, onset within 5 days

A

paxlovid if within 5 days onset

molnupiravir if older than 18, unable to take paxlovid, not pregnant

42
Q

COVID: hospitalized, mild to moderate, no O2 above baseline, within 5 days onset, risk for progression

older than 12 years

A

paxlovid

remdesivir if unable to take paxlovid

43
Q

COVID: hospitalized, mild to moderate, no O2 above baseline, within 5 days onset, risk for progression

younger than 12 years

A

remdesivir

44
Q

severe COVID: low flow

A

remdesivir + dexamethasone

45
Q

severe COVID: high flow or noninvasive ventilation

A

remdesivir
dexamethasone
tocilizumab
anticoagulation prophylaxis

46
Q

severe COVID: ECMO or mechanical ventilation, critical

A

dexamethasone
anticoagulation prophylaxis
tocilizumab CRP +

ID2 (13 decks)

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