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IOS 11 Exam 2
Treatment of Herpes Virus Infections
| Question | Answer |
|---|---|
| Acyclovir MOA | 1st step is monophosphorylation by intracellular VIRAL Thymidine kinase and second phosphorylation br cellular GMP inhibits DNA polymerase to cause chain termination |
| Acyclovir PK | Poor absorption, good CNS penetration and RENAL excretion |
| Acyclovir side effects | Increased with hig dose IV or renal dysfunction-rash, burning, NAUSEA?V?DCNS-tremor, vertigo, HA, confusion, crystaluria, ATN |
| Valacyclovir MOA | Ester prodrug 1st converted to L-valine and acyclovir is then phosphorylated by thymidine kinase, and second phosphorylation by GMP to inhibit DNA polymerase. |
| Valacyclovir PK | 50-60% bioav, peak serum concentrations increased 3-5 fold,decreased GI SE |
| Valcyclovir side effects | Cutaneous:Rash, burning GI: Less than acyclovir, CNS:tremor,vertigo, HA,confusion, renal-crystaluria, ATN |
| Famciclovir MOA | Diacetyl prodrug of penciclovir, guanine nucleoside analog simular to acyclovir. |
| Famciclovir PK | Poor absor, good CNS, renal excretion |
| Famcuclovir side effects | Cutaneous:Rash, buring, GI-less than acyclovir, CNS-tremor, HA, confusion, Reanl:crystaluria, ATN |
| Idoxuridine MOA | Iosinated thymidine nucleoside analog. Inctracellular conversion to idoxuridine triphosphate, inhibits DNA polymerase, 10 times less potent than acyclovir (ocular) |
| Idoxuridine Side effects | Topical-irritation,hypersensitivity reactions |
| Trifluridine (Viroptic) | Fluroinated pyrimidine -Triphosphorylated intracellularly, inhibits DNA polymerase, (viral thymidine kinase is not necessary) |
| Trifluridine Side effects | May cause mild stinging when applied, or hypersensitivity |
| Vidarabine (Vira-A) MOA | Adenodine nucleoside analod- triphosphorylated to inhibit DNA polymerase, rapid deamination to hypoxanthine after IV infusion, renal excretion |
| Vidarabine (Vira-A) Side effects | Topical-Stinging, lacrimation Oral-GI-N?V,D, Bone marrow suppression, Electrolyte -SIADH |
| HSV-2 | Urogenital or neonatal |
| HSV-1 | Non-genital |
| Herpes Keratitis is | Leading cause of corneal blindness in the us |
| Herpes Keratitis symptoms | Eye pain, blurred vision, conjunctititis, corneal lesions |
| Idoxuridine MOA | Iosinated thymidine nucleoside analog. Inctracellular conversion to idoxuridine triphosphate, inhibits DNA polymerase, 10 times less potent than acyclovir (ocular) |
| Idoxuridine Side effects | Topical-irritation,hypersensitivity reactions |
| Trifluridine (Viroptic) | Fluroinated pyrimidine -Triphosphorylated intracellularly, inhibits DNA polymerase, (viral thymidine kinase is not necessary) |
| Trifluridine Side effects | May cause mild stinging when applied, or hypersensitivity |
| Vidarabine (Vira-A) MOA | Adenodine nucleoside analod- triphosphorylated to inhibit DNA polymerase, rapid deamination to hypoxanthine after IV infusion, renal excretion |
| Vidarabine (Vira-A) Side effects | Topical-Stinging, lacrimation Oral-GI-N?V,D, Bone marrow suppression, Electrolyte -SIADH |
| HSV-2 | Urogenital or neonatal |
| HSV-1 | Non-genital |
| Herpes Keratitis treatment | Idoxuridine or Vidarabine,trifluridine (Avoid-topical steroids) |
| Orofacial and mucocutaneous Herpes Infections | Normally asymptomatic-incubation 2-12 days -Gingivostomatitis,pharyngitis,esophagitis cased by HSV1 |
| Orofacial and Mucocutaneous Herpes s/s | Fever, sore throat, dysphagia, cervical adenopathy, inability to eat |
| Treatment of Orofactial and mucocutaneous herpes | Acyclovir 200mg PO 5 times/day x 7 or Immunocompromised 400mg PO 5 times a day x 10 days , 5mg/kg IV q8 hrs x 10 days or Penciclovir cream for cold sores or Docosanol (OTC-Abreva) |
| Chronic suppressio of recurrent genital herpes | acyclovir 400mg PO BID most cost effective when >6 recurrence/year reassessment of therapy in 1 year |
| Acyclovir resistance | Most occurs via viral thymidine kinase also can have naturally occurrin resistance of HSV and other herpes viruses (<1%) |
| Neonatal herpes characteristics | Onset 5-17 days after exposure presents with fluid filled lesions, CNS infections and 70% have progressive systemic disease |
| High mortality rates with | Neonatal herpes-65% and 90% of survivors have CNS disfunction |
| Neonatal Herpes Treatment | Acyclovir 10mg/kg IV q8hrs x 10 days or vidarabine 15mg/kg IV BID x 10 daysreduces mortality |
| Herpes encephalitis- Caused by HSV 2 in neonates and HSV 1 in adults | Very rare infection- mortality 60-80% if untreated |
| S/S of Herpes encephalitis | acute fever, HA, mental status changes, seizures, coma, diagnosis is exclusion and lumbar puncture |
| Treatment of Herpes Encephalitis | acyclovir or vidarabine |
| Primary Varicell infection | Supportive care, systemic antihistamines, and if immunocompromised Acyclovir 5mg/kg IV q8hrs x 10 days or Vidarabine 15mg/kg QD BID x 5 days if less severe 400mg PO 5 times/day x 10 days |
| Herpes Zoster-shingles treatment | Acyclovir superior to Vidarabine in preventing dissemination Competent 800mg PO 5 /day x 7 days if compromised 10mg/kg IV q8hr x 7 or vidaradine 15mg/kg BID x 5 days |
| Post herpetic neuralgia treatment | Carbamazepine, TCA, Lamatrogine, felbamate |
| Varicella Zoster Vaccine | Prevention of Shingles in those >60. It is a live vaccine that is attenuated casuing induction of antibodies to cause cell-mediated response against the Varicella Zoster Virus |
| Contraindications to Varicella Zoster virus | Anaphylactiv reactio to gelatin or neomycin, immunocompromised, untreated TB, pregnancy, or w/in 3 months of planning |
Created by:
liza001
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