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What are the recommended Chemoprophylaxis drugs when the influenza subtype is unknown? Zanamivir
Oseltamivir in combination with rimantadine
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What are the recommended Chemoprophylaxis drugs Influenza B?
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When influenza viruses are circulating in the community, antiviral chemoprophylaxis can be considered for _______ persons during the ______ weeks after vaccination before an immune response to inactivated vaccine develops.
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Antiviral chemoprophylaxis for influenza should be considered in high risk persons for whom the vaccine is___________, _______________ or ____________________.
Contraindicated, unavailable, or expected to have low effectiveness
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Antiviral chemoprophylaxis should be considered in high risk, unvaccinated individuals when influenza activity has been ______________________________________.
Documented in the community
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Antiviral chemoprophylaxis may be considered for_________________, __________________ and __________________, who are in close contact with high risk individuals during periods of influenza activity.
Unvaccinated adults, including healthcare workers and children ≥ 1 year
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Antiviral chemoprophylaxis should be initiated in ALL non-infected family members, when ______________________ and __________________________.
1 family member develops suspected or confirmed influenza and any other family member is at high risk for complications
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Antiviral chemoprophylaxis is recommended for ALL residents (vaccinated and unvaccinated) in institutions that are_____________________________________________________________.
Experiencing influenza outbreaks (≥ 2 residents with influenza-like symptoms within 72 hours)
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What Herpesviridae are associated with encephalitis or Meningitis?
HHV
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What Herpesviridae are associated with Mononucleosis?
EBV
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What are the Alphaherpesviruses?
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What are the Betaherpesviruses?
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What are the Gammaherpesviruses?
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HHV stands for:
Human herpes virus
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CMV stands for:
Cytomegalovirus
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EBV stands for:
Epstein-Barr virus
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HSV stands for:
Herpes simplex virus
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VZV stands for:
Varicella-zoster virus
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What are the common locations for HSV-1 to manifest?
- Mouth
- Skin
- Face
- Esophagus
- Brain
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What are the common locations for HSV-2 to manifest?
- Genitals
- Rectum
- Skin
- Hands
- Meninges
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HSV can be treated with what drugs?
- Acyclovir (Zovarix)
- Valacyclovir (Valtrex)
- Famcyclovir (Famvir)
- Penciclovir (Denavir)
- Foscarnet (Foscavir)
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Which drug has lower bioavailability at higher doses?
Acyclovir
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What is the oral bioavailability of Valacyclovir?
70%
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What is Acyclovir/Valacyclovir’s activity spectrum?
- Most against HSV-1 and half as active against HSV-2
- Some activity against CMV, VZV, and EBV
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What group would you dose adjust Acyclovir/Valacyclovir in?
Renal impairment
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What group is usually resistant to Acyclovir/Valacyclovir?
Immunocomprimised
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What are the SE for Acyclovir/Valacyclovir?
- Renal insufficiency (IV form = crystalline nephropathy)
- Phlebitis/Injection site reactions
- Neurotoxicity
- Thrombotic thrombocytopenia purpura ( At very high doses)
- N/V
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How can you reduce the risk of injection site reactions with Acyclovir/Valacyclovir?
Reduce the dose to < or = to 7 mg/mL (10 mg/mL in fluid restricted patients)
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What is the spectrum of activity for Famciclovir and Penciclovir?
HSV-1, HSV-2 and VZV
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What are the SE for Famciclovir and Penciclovir?
- HA/migraine
- Diarrhea
- Utricaria
- Hyperbilirubunemia
- Myelosuppression
- N/V
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When should you dose adjust Famciclovir/Penciclovir?
For renal insufficiency
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What is the activity spectrum fro Docosnol?
- HSV-1
- HSV-2
- CMV
- Influenza
- HHV-6
- RSV
- Not virucidal (stops virus from entering the cell)
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What is the expected benefit of Ducosonol?
Reduces the duration of symptoms attributed to cold sores and fever blisters
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How should Ducosonal be administered?
- 10% cream 5 times a day to lesions
- Beginning at start of symptoms
- Up to 10 days
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What are the dependent factors for treatment choice of Orolabial HSV in an immunocompetent host?
- Primary or secondary disease
- Severity of symptoms
- Site of infection
- Frequency of reoccurance
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What medications are indicated for primary orolabial HSV in an immunoCOMPETENT host and what are their doses?
- Acyclovir 400 mg PO TID x7-10 days OR 5 mg/kg IV Q8
- Famicilovir 500 mg PO TID x7 days
- Valacyclovir 1g PO BID x7 days
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How is Orolabial HSV reactivation disease usually treated?
No treatment for most immunocompetent hosts w/ minimal symptoms
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When should chronic suppressive therapy be used for Orolabial HSV reactivation disease?
- Frequent bothersome occurances
- Associated with systemic effects (Erythemia multiforme, Aseptic meningitis)
- ImmunoCOMPRIMISED host
- Patients without prodromal symptoms
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What drugs are available for Herpes labialis reactivation disease?
- Acyclovir
- Famciclovir
- Valacyclovir
- Penciclovir cream
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What is the dose for Acyclovir in the treatment of Herpes Labialis reactivation disease?
- Episodic:
- PO = 400 mg PO 5x/day x5 days
- Topical 5% cream = 5 times per day x4 days
- Chronic suppression:
- 400 mg PO bid
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What is the dose for Famciclovir in the treatment of Herpes Labialis reactivation disease?
- Episodic: 1500 mg PO x 1 dose
- Chronic suppression: 500 mg PO BID
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What is the dose for Valacyclovir in the treatment of Herpes Labialis reactivation disease?
- Episodic: 2 grams PO BID x 1 day
- Chronic Suppression: 500-1000 mg PO QD
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What is the dose for Penciclovir 1% cream in the treatment of Herpes Labialis reactivation disease?
Q2H during the day for 4 days
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Single-day dosing with either ____________ or _____________affords greater patient convenience and overall lower cost when compared with 5 days of acyclovir
famciclovir or valacyclovir
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Randomized trials of patients with sporadic recurrences of HSV-1 infection showed _____________therapy with creams or ointments are of modest benefit.
topical antiviral
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What age cut off determines whether you should or should not treat for VZV?
> or = to 13 should usually be treated (Also says >12)
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What are the S/S of Varicella?
- Vesicular rash
- Low grade fever
- Malaise
- Macropapules/Vesicles/Scabs
- Pain
- Pruritis
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