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Non HIV viruses Flashcards

1
Q

Varicella zoster virus (vzv)

A
  • Alpha herpesvirus
  • DNA is singular, linear, double stranded molecule

Chicken pox
Shingles

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2
Q

Chicken pox (vzv)

A

Primary infection in child hood
Typically benign - maculopapular, vesicular, and pappular rash
Late winter to early spring

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3
Q

Shingles

A
  • Latent virus mainly in the elderly (sensory ganglia)
  • associated with significant pain - unilateral vascular rash
  • No seasonal predilection
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4
Q

Mild to moderate chicken pox treatment

A

No treatment

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5
Q

Moderate to severe chicken pox treatment
2-12 years old

A

Valacyclover 20 mg 1 kg po 3x daily

Acyclovir 20 mg kg po 4x daily (start within 24 hours of rash)

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6
Q

Moderate-severe Chickenpox
adolescent, young adults

A

-acyclovir 800 PO 5x daily ( start within 24 hours of rash)
-valacyclovir 1000mg PO 4x daily
-Famciclovire 500 PO 3x daily (effective data lacking)

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7
Q

risk factors for chickenpox

A

chronic cutaneous or pulmonary diseases
chronic salicylate treatment
( increased risk of reyes syndrome )

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8
Q

what is not clear for the treatment of shingles

A

benefits of antiviral therapy >72 hours of symptoms

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9
Q

treatment of Shingles for mild to moderate

A

-Valacyclovir
-Famciclovir

duration 7 days

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10
Q

treatment of shingles for severe (ocular or neurologic or disseminated disease)

A

Acyclovir IV* 7 - 10 day

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11
Q

Treatment for Post-herpetic neuralgia (PHN)

A

-observed frequently following herpers zoster ophthalmic and upper body involvement
-gabapentin
-lidocaine patch 5%
-opiod alagesic
-nortriptyline or amitriptyline

prednisone-added to acyclovir does nit reduce incidence or duration of PHN

-

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12
Q

Prevention Pre-exposure: Chickenpox

A

Varicella vaccine
-live attenuated virus
-two dose series first administration at 12 - 15 months and then 4-6 years

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13
Q

Prevention Pre-exposure: shingles

A

-Zostavax: live attenuated single shot

-Shingrix: for 50 years and older (new and preferred)
–non live subunit two shot given 2-6 months apart

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14
Q

Prevention Post exposure of shingles

A

high-titer varcrella-zoster immune globulin 125 units/ 10 IM for high risk patients to prevent infection
–ASAP <96 hours after exposure

if rash develops initiate with acyclovir within 24 hrs

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15
Q

Human a- herpesvirus (HSV)

A

-two types: HSV-1 & HSV-2
-large, double stranded, linear DNA genome

HSV-1: acquired more commonly and earlier than HSV-2

HSV-2 seroprevalence incidence is estimates at 23 million cases per year

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16
Q

HSV Manifestation

A

-healthy children and adults
- initial episode more severe than recurrent
-presentation varies by site, age, and immune status of host and HSV type

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17
Q

What is the most common and initial clinical manifestation of HSV-1?

A

orofacial infection (gingivostomatitis and pharyngitis)

latent infection–> recurrent lesions on the vermillion border of the lips (herpes labials)

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18
Q

what are clinially similar between HSV 1 and HSV 2

A

genital infections

reoccurrences are common with HSV 2

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19
Q

HSV: Treatment of Oral Lesions

A

Valacyclovir 2 gm x 1 day **
Famciclovir ( approved for HIV only)

Acyclovir x 5 days ( Not FDA approved)

Topical regimens (less preferred)
-Penciclovir cream
- Acyclovir cream

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20
Q

HSV: treatment of genital lesions
primary (initial episode)

A

acyclovir, valacyclovir, famciclovir
PO
7-10 days

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21
Q

HSV: treatment of genital lesions
subsequent recurrent episodes

A

immunocompetent
-acyclovir, valacyclovir, famciclovir
- PO x 5 days

immunocompromised, HIV
-acyclovir, valacyclovir, famciclovir
-PO x 5-10 days

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22
Q

HSV: treatment of genital lesions
severe

A

Acyclovir IV 5-7 days

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23
Q

HSV: treatment of genital lesions
acyclovir resistant HSV

A

Forcarnet IV x 7days

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24
Q

HSV: treatment of genital lesions
chronic suppression (daily)

A

immunocompetent
-acyclovir PO BID
-Famciclovir PO BID
-valacyclovir PO daily
—pts with <9 recurrences per year should use 500mg PO then 1000mg PO if breakthrough

immunocompromised
-acyclovir PO BID
-Famciclovir PO BID
-valacyclovir PO daily

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25
what does suppression therapy do for genital herpes reccurance
reduce the frequency by 70-80% among pts that have frequent recurrences (>6/year)
26
influenza Virus
orthomyxlvirdae -single stranded caused by epidemic acute respiratory disease characterized by fever, cough, and sytemic symptoms - primary viral pneumonia -secondary bacterial pneumonia Thee types: A*, B*, C
27
how is influenza virus transmitted
respiratory route --> large epidemics during winter in temperate climates
28
Influenza type A
moderate to sever all age groups human and animals
29
Influenza type B
milder children human
30
Influenza type C
non-epidemic N/A rarely in humans
31
antigenic drift
antigenic variants created by point mutations on surface antigens--> small changes in hemagglutinin and/or neuraminidase -basis for seasonal epidemics of influenza -resaon for changes in annual influenza vaccine -rationale for annual vaccination recommendation
32
antigenic shift
influenza virus acuirei a new hemagglutinin or neuraminidase via genetic reassortment - results in emergence of novel influenza virus -potential for pandemic
33
Influenza treatment
Oseltimavir (PO x 5days ) - peds= weight base dosing Zanamir (inhalation x 5 days) most effective when used early in illness within 48 hrs or no clinical benefit - ideally within 12 hrs of infection exception; critically ill or hospitalized -starting up to 5 days after onset is associated w survival
34
Corticosteroids and influenza
can cause excess mortality in pts with influenza pneumonia AVOID!
35
New Influenza agents
Peramivir ( Influenza A and B) - 1 dose (FDA) - longer in hospitalized (5 days, limited studies) Baloxavir ( Influenza A and B) - 12 years or older - weight based -1 dose
36
Influenza treatment in critically illed
no benefit with 150 mg 2x daily dosing --> not recommended -influeza B in 1 study show a trend towards benefit with higher dosing
37
Prevention of pre exposure: influenza
influenza vaccine hand hygiene respiratory etiquette contact avoidance- stay home chemoprophylaxis
38
influenza at risk population
-children age <2 years -adults > 65 years -chronic pulmonary, cardiovascular, renal, -hepatic, hematologic, metabolic, neurologic conditions, severe developmental delay, mental retardation -immunosuppression, transplant, HIV -pregnant or two weeks post partum -<18 years who receive long term aspirin -american indians/alaskan natives -morbid obesity bmi >40 -residence of nursing homes and other chronic learning facilities -high risk of complications in hSCT and organ transplant patients
39
Influenza Prevention Pre: vaccination Egg allergies
can receive any licensed recommended age appropriate vaccine and do not have to monitored for 30 mins after administration severe allergies should be administered in a medical setting flu bloc(recombinant influenza vaccine) is not produced on eggs
40
egg-based vaccine update
A/Victoria
41
cell or recombinant based vaccine update
A/wisonsin
42
prevention pre-exprosure: vaccination
flumist intra nasal - live attenuated live attenuated for health individuals between 2-29 who are not pregnant -based on flu strain that does not cause disease - still a living virus --> may cause infection with weaken immune system or underlying medical conditions --ppl who have taken flu antiviral frugs within a certain amount of time \ within 48hrs - oselt, zana past 5 days- peramivir past 17 days- baloxavir
43
prevention pre- exposure chemoprophylaxis
CDC does not recommend widespread ore routine use - only high risk pts -control outbreaks in long term care facilities -only when when can be used with 48 hrs of exposure
44
Influenza Chemoprophylaxis
oseltamivir PO x 10 days -peds weight based zadnamivir inhaltion x 10 days
45
rabies
zoonotic encephalitis caused by different species of neurotropic viruses in the rhabovidae family - single stranded RNA enveloped virions highly contagious through exposure to animal saliva or nervous system tissue -- bite -- scratches -- contamination of open wounds or mucous membranes
46
Rabies treatment
no proven antiviral therapy clean thoroughly with soap and water human rabies immune globulin -20 IU/kg on day 0 -infiltrated in and around the wounds and rest be administered at distant site IM - do not give in same string as the vaccine -do not give more than 7 days after the initiation of the vaccine
47
Treatment: Rabies Vaccination schedule
Immunocomptent: 4 doses toal - 1 dose on day 0,3,7, and 14 Immunocompromised: 5 doses -1 dose on days 0,3,7,14,28
48
If already been immunized for rabies
-local wound cleaning -NO human rabies immune globulin -vaccination on days 0 and 3
49
Rabies pre exposure prophylaxis
3 doses -1 dose on day 0, 7 and 21or 28
50
Rabies prevention: pre-exposure targeted high risk groups
vets lab workers certain travelers
51
Covid 19
severe acute respiratory syndromee related corona virus zoonotic (possible bat-borne) spread via respiratory droplets nesters human cells through angiotensin converting enzyme 2 symptoms after 2-14 weeks of exposure viral shedding begin 5-6 days prior symptoms
52
covid 19 presentation
SOB or diffuculty breathing** cough fever or chills muscle or body aches sore throat loss of taste diarrhea headache new fatigue N/V congestion or runny nose
53
Authorized treatment of Covid 19
out patient -nirmatrelvir/ritonavir (paxlovid) within 5 days of sx onset -Remdesivir ( within 7 days sx onset) -alternative: molnupupiravir 18 yr and older ( with 5 days of sx onset) inpatient -remdesivir -tocilizumab -dexamethasone -baricitinib
54
prevention: Covid 19
vaccination -Moderna -pfozer wash hand often - avoid touching your eyes, nose, and mouth avoid close contact with sick individuals or stay home
55
analogs
purine adenosine n-hydroxycytidine
56
analog: purines
acyclovir famciclovir valacyclovir
57
analog: adenosine
remdesivir
58
analog: n-hydroxycytidine
molnupiravir
59
Inhibitors
neuraminidase endonuclease activity protease
60
Inhibitors: neuraminidase
oseltamivir zanamivir peramivir
61
Inhibitors: endonuclease activity
baloxavir
62
Inhibitors: protease
nirmatrelvir
63
purine analog acyclovir
synthesize purine nucleoside analog with inhibitory action against HSV and VZV stops replication by competitive inhibition of DNA polymerase
64
Acyclovir tidbits
low bioavailability extensive renal elinination high concentration= nephrotoxicity, due to -rapid infusion -dehydration -renal insufficiency -increase dose SE: neurologic toxicity mechanism unknown (reversible)
65
Other purine analogs
valacyclovir -ester of acyclovir - well absorbed 3-5 x better FAmciclovir -metablolized to penciclovir ( active)
66
Adenosine analog: remdesiver
prodrug metabolized to nucleoside monophosphate intermediate inhibitor of SAR-CoV-2 RNA polymerase essential for vial replication
67
adenosine alnalog tidbits
dosing -inpatient: IV x 5 days -outpatient: IV x 3 days monitor -Liver function test ( d/c if elevate alt ) -heat rate -infusion rate
68
n-hydroxcytidine analog: mulnupiravir
prodrug metabolized into n-hydroxytidine phhosphylated to form active triphosphate - incorporated in SARS-CoV-2 RNA
69
neuraminidase inhibitors
block the function of viral neuraminidase -preventing its reproduction by budding from the host cell influenza a and b
70
neuraminidase tidbits
toxic effects are minimal and difficult to distinguish from influenza - Nausea, vomiting, diarrhea, HA caution with potential for confusion in dosing oral suspension
71
endonuclease activity inhibitor: baloxavir
inhibits replication of virus by interfering with cap snatching -hijack the host mRNA transcription process -5'methylated caps of the cellular mRNA are cleaved by the viral endonuclease and used to prime transcription of viral mRNA by viral RNA polymerase
72
endonuclease activity inhibitor: baloxavir TIDBITS
AE: -N/D -HA -bronchitis -nasopharyngitis avoid coadministration of multivalent cation as it can interfere with absorption
73
protease inhibitor: nirmatrelvir
-combined with ritinavir (paxlovid) -is a peptidomimeti inhibitor of the SAR-CoV-2 main protease
74
protease inhibitor: nirmatrelvir tidbits
AE: -diarrhea -taste sense altered recommended for high risk pts -DM, BMI> 25, lung disease, immunocompromised, cancer, . 65 etc

ID (27 decks)

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