Treatment of Viral Infections: Flu, COVID, Herpes Flashcards
(24 cards)
Influenza: Sx/Antivirals
Sx:
-Fever, chills, fatigue, myalgia, non-prod cough, sore throat, ha
AV: (FLU BOPZ)
-Oseltamivir (neuraminidase inhibitors = ZOP)
-Zanamivir
-Peramivir
*Started within 48 hr of onset to be most effective
-Baloxavir (endonuclease inhibitor, post exposure ppx, single dose regimen, within 48 hr)
*Rimantadine/amantadine = resistance so not used anymore (amantadine used for Parkinson’s now)
Oseltamivir (Tamiflu): Dosing/W/AE/Storage
Dosing
-Wt based for peds
-TX (over 12 yr): 75 mg BID x 5d
-PPX (over 12 yr): 75 mg QD x 10d
-CrCl < 60: requires adj
Warning
-Neuropsychiatric events (conf, delir, hallu, unusal beh)
-SJS/TEN, ana
AE
-HA, NVD, abd pain
*Preferred in pregnancy over neuraminidases
*Store recon sis at RT for 10d or fridge for 17d
PORNOS 10-17 preg, renal, np, sjs/ten, storage
Zanamivir (Relenza): Dosing/W/AE
Dosing (ZANA is 7 BANC)
-TX (7+ yr): 10 mg (two 5 mg inhalations) BID x5d
Warning
-Neuropsychiatric events
-Bronchospasm (CI in asthma/COPD)* (stop if wheezing or breathing problems develop)
AE
-HA, throat pain, cough
Peramivir (Rapivab)
Dosing (PERA BLING is a SIN)
-600 mg IV as a single dose
-CrCl < 50: requires adj
Warning
-Neuropsychiatric events
-SJS/TEN, ana
-Renal impairment
AE
-HTN
-Insomnia
-Inc BG
-GI (diarrhea/constipation)
-Neutropenia
-Inc LFTs
Baloxavir (Xofluza): Dosing
Single dose (BAOX OF 10 ORCADs)
-≥ 80 kg: 80 mg PO x 1 dose
-20 to < 80 kg: 40 mg PO x 1 dose
-< 20 kg: 2 mg/kg PO x 1 dose
Avoid admin with dairy/AA/poly cations
Store in og blister packaging
Admin within 10 hr once reconstituted (store at RT)
COVID: Sx/Antivirals
Sx: (MR PRN is BTR bitter he got COVID)
-Fever, chills, SOB, myalgia, loss of taste/smell, sore throat
AV:
-Outpatient tx for severe COVID: Paxlovid (nirmatrelavir/ritonavir)
*50+ yr, not UTD on vaccines, IC
-Alt: IV remdesivir (Veklury) and oral molnupiravir (Lagevrio)
-Hospitalized pts: oxygen/MV, steroids, remdesivir, immuno (baricitinib, tocilizumab)
Herpes Viruses
HSV-1
-Oropharyngeal disease
HSV-2
-Genital disease
*both are capable of causing infections indistinguishable at both anatomical sites
Acyclovir/Valacyclovir/Famciclovir: W/AE
Warning (FAV FAN of HITLER)
-Caution in renal impairment, elderly, nephrotoxic drugs
-TTP (thrombotic thrombocytopenic purpura) in IC pts
-Hemolytic uremic syndrome (HUS) in IC pts
AE
-HA, NVD, rash, malaise
-Inc LFTs
-Neutropenia
-FAM only: anaphylaxis
Acyclovir (Zovirax): Specific Considerations
AE: Transient burning or stinging with topical
formulations (acyclovir)
Inc BUN/SCR with crystal nephropathy (IV form)
Acyclovir dose is based on IBW including in OBESE pts
Dec dose/extend int in renal impairment
Infuse acyclovir over at least 1 hour and maintain adequate hydration to reduce the risk of renal tubular damage
B SIRI
Acyclovir - Valacyclovir Conversion
5 mg/kg IV acyclovir = 1,000 mg PO valacyclovir
Topical Tx for Herpes Labialis
Docosanol (Abreva)
-Apply 5x daily at first sign of outbreak
Acyclovir (Zovirax)
-Apply 5x daily for 4d
Acyclovir (Sitavig)
-Apply 50 mg tablet as single dose to upper gum
Penciclovir (Denavir)
-Apply Q2 (when awake) for 4 d
DAPA after TOP lips
Acyclovir Dosing in Herpes Labialis and Genital Herpes
*Initial tx is always 7-10d
Oral Herpes
-Initial: 200 mg 5x daily or 400 mg TID
-Recurrence: 400 mg TID for 5-10d
-Chronic suppression: 400 mg BID
Genital Herpes
-Initial: 400 mg TID or 200 mg 5x daily
-Recurrence: 400 mg TID x 5d or 800 mg BID x 5d or 800 mg TID x 2d
-Chronic suppression: 400 mg BID
Valacyclovir Dosing in Herpes Labialis and Genital Herpes
Oral Herpes
-Initial: 1 g BID
-Recurrence: 2 g BID for 1d
-Chronic suppression: 500 mg or 1 g QD
Genital Herpes
-Initial: 1 g BID
-Recurrence: 500 mg BID x 3d or 1 g QD x 5d
-Chronic suppression: 500 mg or 1 g QD
Famciclovir Dosing in Herpes Labialis and Genital Herpes
Oral Herpes
-Initial: 250 mg TID or 500 mg BID
-Recurrence: 1.5 g x 1 dose
-Chronic suppression: none
Genital Herpes
-Initial: 250 mg TID
-Recurrence: 125 mg BID x5d or 500 mg x1 then 250 mg BID x 2d or 1 g BID x 1d
-Chronic suppression: 250 mg BID
Invasive HSV Infections
HSV is most common cause of viral encephalitis
-Tx: IV Acyclovir 10 mg/kg/dose Q8 x14-21d
Esophagitis and pneumonitis (more common in IC)
-Tx: IV Acyclovir 5 mg/kg/dose Q8
Herpes Zoster (Shingles) Tx
Start tx within 72 hr of rash
Pain: Lidoderm, pregabalin/gabapentin, NSAIDs, opioids
Famiciclovir: 500 mg TID for 7d
Acyclovir: 500 mg 5x daily for 7-10d
Valacyclovir: 1 g TID for 7d
Shingles Vaccine
Shingrix
Recommended in
-50+ yrs old
-19+ yrs old who are immunosuppressed
If vaccinated with Zostavax previously = should be re-vac with Shingrix
CMV: OW
Very common in IC
Causes retinitis, colitis, esophagitis
Tx
-Ganciclovir and valganciclovir are DOC
-Foscarnet and cidofovir are reserved for refractory cases
-Maribavir (Livtencity) is an option for post-transplant CMV disease refractory
CMV: PPX
Letermovir (Prevymis) in pts receiving a kidney transplant
-if donor is CMV-positive + recipient CMV-negative or in bone marrow transplant
-if recipient CMV-positive
Ganciclovir and valganciclovir are used for ppx of CMV in SOT recipients at high risk
-donor is CMV-positive + recipient is CMV-negative
Ganciclovir/Valganciclovir: BBW/AE
BBW (G-gan-valg CRASH my FETUS)
-Myelosuppression
-Carcinogenic
-Fetal tox/impaired fertility
AE
-NVD, anorexia, fever, increase Scr
-Retinal detachment (in CMV retinitis)
-Seizures (rare)
Notes
-Females: contraception during and for 30d after (males should use a barrier contraceptive for 90d after)
-Hazardous agents
*VAL only: refrigerate oral recon soln (discard after 49d)
Cidofovir: BBW/CI
CMV retinitis tx in HIV pts only
BBW (CID the HUNTER of CPS)
-Nephrotoxicity, neutropenia, carcinogenic and teratogenic
CI
-Scr over 1.5, CrCl < 55
-Urine protein 100+ (2+ proteinuria)
-Sulfa allergy
-Use with or within 7d of nephrotoxic agents
-Direct intraocular injustamente
Notes
-Hazardous agent
-Hydration before each dose and probenecid before/after each dose (dec renal tox)
Foscarnet (Foscovir): BBW/AE
BBW (FOS is HERS)
-Renal impairment (prehydration rec)
-Seizures due to elec imbalances
AE
-Elec abnormalities (dec K, Ca, Mg, phos)
-Inc Scr/BUN
-OTP
Do not exceed max inf rate
Letermovir (Prevymis): CI/AE
CMV PPX (kid txp/bmt)
CI
-Admin with pimozid or ergot alkaloids
-Admin with pitavastatin and simvastatin (if also on cyclosporine)
IV vehicle (hydroxypropyl betadex) can accumulate if CrCl < 50 mL/min
EBV: OW
Mononucleosis or “mono” = kissing disease
-Spread through bodily fluids (saliva)
No drug treatment or vaccine exists
-Sx resolve in 2-4 weeks
Note
-Amoxicillin/ampicillin tx in a child with EBV can cause a non-pruritic (non-itchy) rash (looks similar to allergic rxn)
-It is not and should not be included as an “allergy” in the medical record
