Influenza

Question 1

Influenza A is divided into subtypes based on?

Answer 1

Hemagglutinin antigen (glycoprotein that allows virus to stick to epithelium) and Neuraminidase antigen (promotes viral release from host cell)

Question 2

Difference between antigentic drift and shift?

Answer 2

Drift is a small mutation that prevents antibodies from binding to antigens. (seen in A and B) A shift is when the virus undergoes a genetic change that allows it to pass from species to species and can eventually cause a pandemic. Only seen in Influenza A

Question 3

How is influenza normally spread?

Answer 3

Respiratory droplets after coughing or sneezing. Can last on objects for 24-48 hours.

Question 4

What does the body release in response to the virus?

Answer 4

Tumor necrosis factor, interleukin-6, and interferon alpha

Question 5

Symptoms of influenza?

Answer 5

Rapid onset. Fever (100-104), shaking chills, myalgias, toxic appearance, headache, mild sore throat, weakness, cough (mostly nonproductive)

Question 6

Clinical pearls for diagnosis influenza?

Answer 6

After holiday season and fever present, influenza in DD, patient will hurt everywhere, pinpoint exact time of infection, cough not their primary complaint.

Question 7

Physical exam findings for influenza?

Answer 7

Vital signs, toxic appearence, eyes may be red and watering, nasal discharge present, lymph nodes may be swollen, rhonchi or rales may be present

Question 8

Complications of influenza. Quick progression of cough, dyspnea, and hypoxemia could mean?

Answer 8

Primary influenza viral pneumonia

Question 9

Causes of secondary bacterial pneumonia? What is the course for the infection?

Answer 9

Streptococcus pneumonia, S. aureus. Patient will improve after initial influenza prodrome and then become symptomatic again

Question 10

When should anti viral therapy begin for influenza?

Answer 10

Within 48 hours of symptoms. Can decrease illness by 1/2 to 3 days.

Question 11

Name high risk patients that should be given anti viral immediately?

Answer 11

> 65yo, morbid obesity, chronic medication illnesses, immunosuppressed, nursing home residents, pregnant women, native americans and Alaska natives

Question 12

This medication works by inhibiting neuraminidase and is effective against influenza A and B. It is inhaled? Dosing?

Answer 12

Zanamivir (Relenza). Treatment 2 oral inhalations BID x 5 days in pts >/= 7. Prophylaxis: 2 oral inhalations QD x 10 days in pts >/= 7

Question 13

This medication works by inhibiting neuraminidase and is effective on A and B. May be less effective on B? Dosing?

Answer 13

Oseltamivir (Tamiflu): Treatment: 75mg BID x 5 days in pts >/= 13. Prophylaxis: 75mg QD x 10 days in pts >/= 13. Needs adjust for pts

Question 14

Medication is given IV and inhibits neuraminidase?

Answer 14

Peramavir (Rapivab): 600mg IV as single dose

Question 15

High dose trivalent or quadravalent should be given to what individuals?

Answer 15

Those over the age of 65 yo. Reduces rates of hospitalizations

Question 16

Intradermal and Afluria using Pharmajet injector is indicated in what individuals?

Answer 16

18-64 years old

Question 17

Intranasal live vaccine is indicated in what individuals?

Answer 17

2-49 years old

Question 18

What individuals cannot have an intranasal live vaccine?

Answer 18

Allergice to eggs or component of influenza vaccine, pregnant women, children on long term aspirin therapy, immunosuppressed individuals, children 2-4 w/ asthma or those with wheezing within 12 months, on antivirals within last 48 hours