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Questions and Answers
Which of the following viral pathogens is most commonly associated with respiratory tract infections?
What symptom is typically NOT associated with a viral respiratory tract infection?
Which antiviral medication can be used for the prevention of oral herpes simplex?
Which patient population requires specific symptomatic management considerations when treating RSV?
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Which of the following is a characteristic of supportive care for viral respiratory infections?
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What is a common monitoring requirement for patients on Nirmatrelvir/ritonavir (Paxlovid)?
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Which class of drugs is typically used to treat Hepatitis B?
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Which of the following is NOT a common adverse effect of Benzoatate?
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Which option indicates when antiviral treatment is NOT appropriate for viral respiratory infections?
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Which medication is indicated for the treatment of oral herpes simplex?
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What is the primary viral cause of respiratory tract infections in infants that may require hospitalization?
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Which symptoms are typically associated with rhinovirus infections?
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How is adenovirus primarily transmitted?
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What characteristic cough is associated with parainfluenza virus infection in children?
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What is a potential complication of respiratory syncytial virus (RSV) infections in infants?
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Which of the following viruses belongs to the Paramyxoviridae family?
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What type of virus is primarily responsible for the common cold?
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Which of the following is NOT a typical sign or symptom of respiratory tract infections?
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What type of treatment is primarily recommended for viral respiratory tract infections?
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Which of the following age groups is most affected by parainfluenza infection?
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Which antiviral medication acts as a neuraminidase inhibitor?
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Which virus is NOT typically associated with a yearly vaccination due to high genetic variation?
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What medication is indicated for children older than two weeks with influenza infection?
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Which of the following statements about Respiratory Syncytial Virus (RSV) management is correct?
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Which of the following is NOT a characteristic of COVID-19?
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What is the primary mechanism of action for Oseltamivir?
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Among the following viruses, which is managable through supportive care primarily?
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The most common subtypes of influenza in the US are:
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Which virus is associated with a vaccination not typically included for respiratory tract viral infections?
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Which aspect of influenza vaccination strategy is essential due to its genetic properties?
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Study Notes
Respiratory Tract Infections Viral Pathogens
- Parainfluenza - Paramyxoviridae family, enveloped RNA virus
- Primarily affects children 4-10 years old
- Causes infection of the larynx, trachea, and sometimes the bronchi
- Symptoms include a “barking” cough, stridor, and usually a non-toxic appearing child
- Management is symptomatic
- Rhinovirus - Most common cause of the common cold and an asthma trigger
- Mostly cause URTIs (Upper Respiratory Tract Infections)
- Symptoms include nasal dryness/irritation, sore throat, headache, cough, facial/ear pressure
- Treatment is symptomatic
- Adenovirus - Double Stranded DNA Viruses, many serotypes
- Most common in children
- Transmitted via respiratory secretions, contact with contaminated objects, airborne, and waterborne
- Symptoms include common cold, fever, pharyngitis, conjunctivitis, otitis media, cough, exudative tonsillitis, GI symptoms
- Management is symptomatic
- Respiratory Syncytial Virus (RSV) - Single stranded RNA virus
- Most common cause of respiratory hospitalization in infants
- Seasonality: Starts in the fall and peaks in winter
- Symptoms: Usually presents as URTI symptoms but can cause pneumonia and bronchiolitis
- Management: Supportive care, glucocorticoids, bronchodilators, Ribavirin (nucleoside analog), IVIG, and monoclonal antibodies (Palivizumab, Nirsevimab)
- Influenza - A & B are the most common subtypes seen in the US
- Symptoms: Fever, nonproductive cough, myalgia, malaise, sore throat, nausea, nasal congestion, and headache.
- High genetic variability due to antigenic drift and antigenic shift, requiring yearly vaccination.
- Management: Oseltamivir (Tamiflu)
- COVID-19 (SARS-CoV-2) - Coronavirus; enveloped positive sense single stranded RNA
- Previously similar to the common cold, now has developed the ability to infect the lower respiratory tract and cause serious pulmonary symptoms (SARS, MERS, COVID-19)
- Like Influenza, high genetic variability requires yearly vaccination
Supportive Care for Viral RTIs
- Rest
- Hydration
- Over-the-counter pain relievers (acetaminophen, ibuprofen)
- Antihistamines for allergy-related symptoms
Cough Management Options
- Benzonatate
- Mechanism of action: local anesthetic effect on the stretch receptors of the respiratory tract
- Dextromethorphan
- Mechanism of action: acts on the cough center in the brainstem, suppressing the cough reflex
- Guaifenesin
- Mechanism of action: thins and loosens mucus in the respiratory tract, making it easier to cough up
Viral Vaccination
- Available vaccinations include
- COVID-19
- Influenza
- RSV
- Varicella (Chickenpox)
- Shingles
- Monkeypox
- Hib (Haemophilus influenzae type b)
- Hepatitis A & B
- HPV (Human Papilloma Virus)
Oseltamivir (Tamiflu)
- Medication Class: Antiviral Agent; Neuraminidase Inhibitor.
- Mechanism of action: blocks the activity of the neuraminidase enzyme on the surface of the virus, which prevents viral budding, replication, and infectivity.
- Indications: Influenza infection in patients >2 weeks old
- Adverse Effects: Nausea, vomiting, diarrhea, headache, abdominal pain, dizziness
- Contraindications: Hypersensitivity to oseltamivir, severe renal impairment
- Interactions: May increase the risk of bleeding with warfarin, may decrease effectiveness of theophylline
- Monitoring: Closely monitor for adverse effects, renal function, and blood glucose levels
- Patient Education: Take as directed, complete the full course, drink plenty of fluids, avoid contact with others while contagious
Nirmatrelvir/ritonavir (Paxlovid)
- Medication Class: Protease Inhibitor
- Mechanism of action: inhibits the activity of the SARS-CoV-2 3CL protease, an enzyme essential for viral replication. Ritonavir is included to extend the half-life of Nirmatrelvir
- Indications: Mild to moderate COVID-19 in adults and adolescents ≥12 years old with risk factors for severe illness
- Adverse Effects: Bitter taste, diarrhea, muscle aches, elevated blood pressure, and liver enzyme elevations.
- Contraindications: Hypersensitivity to nirmatrelvir or ritonavir, conditions related to drug interactions
- Interactions: Numerous potential interactions with other drugs, including CYP3A4 substrates and inhibitors
- Monitoring: Blood pressure, liver function, and drug interactions should be monitored.
- Patient Education: Take as directed with a full glass of water, take with food, avoid grapefruit and grapefruit juice, complete full course, and inform doctor of all current medications.
Benzonatate
- Medication Class: Antitussive (cough suppressant)
- Mechanism of action: Local anesthetic effect on the stretch receptors of the respiratory tract, suppressing the cough reflex
- Indications: Relief of cough in adults and children ≥10 years old
- Adverse Effects: Dizziness, drowsiness, nausea, constipation, GI upset.
- Contraindications: Hypersensitivity to benzonatate
- Interactions: No significant known interactions
- Monitoring: Monitor for adverse effects, especially in patients with a history of seizures or respiratory depression
- Patient Education: Take as directed, swallow whole, do not chew or break the capsules, avoid alcohol, especially during initial use
Dextromethorphan
- Medication Class: Antitussive (cough suppressant)
- Mechanism of action: Acts on the cough center in the brainstem, suppressing the cough reflex
- Indications: Relief of cough in adults and children ≥6 years old
- Adverse Effects: Dizziness, drowsiness, nausea, constipation, headache, and confusion.
- Contraindications: Hypersensitivity to dextromethorphan, severe liver disease, and patients taking MAOIs
- Interactions: Significant interactions with MAOIs (monoamine oxidase inhibitors), opioids, and other CNS depressants.
- Monitoring: Monitor for adverse effects, especially in patients with a history of seizures or respiratory depression
- Patient Education: Take as directed, avoid alcohol, especially during initial use.
Guaifenesin
- Medication Class: Expectorant (mucus thinner)
- Mechanism of action: Thins and loosens mucus in the respiratory tract, making it easier to cough up.
- Indications: To make phlegm easier to cough up
- Adverse Effects: Nausea, vomiting, diarrhea, stomach upset, and rash.
- Contraindications: Hypersensitivity to guaifenesin.
- Interactions: No significant known interactions
- Monitoring: Monitor for adverse effects, especially in patients with a history of GI disorders.
- Patient Education: Take as directed, drink plenty of fluids, and be aware that it may take a few days to see results.
Acyclovir
- Medication Class: Antiviral Agent; Nucleoside Analog
- Mechanism of action: inhibits the activity of viral DNA polymerase. It is incorporated into viral DNA, causing chain termination and preventing further viral replication.
- Indications: Treatment and prevention of herpes simplex virus (HSV) infections, including genital herpes, oral herpes, and herpes encephalitis.
- Adverse Effects: Nausea, vomiting, diarrhea, headache, dizziness, and rash.
- Contraindications: Hypersensitivity to acyclovir.
- Interactions: Can interact with other nephrotoxic drugs, such as aminoglycosides, and can increase the risk of nephrotoxicity.
- Monitoring: Renal function should be monitored, especially in patients with renal impairment.
- Patient Education: Important to take as directed, complete the full course, and inform healthcare providers of all current medications, including OTC medications and supplements.
Valacyclovir
- Medication Class: Antiviral Agent; Nucleoside Analog
- Mechanism of action: converted to acyclovir in the body, inhibits viral DNA polymerase.
- Indications: Treatment of HSV infections and prevention of HSV outbreaks.
- Adverse Effects: Nausea, vomiting, diarrhea, headache, dizziness, and rash, similar to acyclovir
- Contraindications: Hypersensitivity to acyclovir or valacyclovir.
- Interactions: Similar interactions with acyclovir, can interact with other nephrotoxic drugs, such as aminoglycosides, and can increase the risk of nephrotoxicity.
- Monitoring: Monitor for adverse effects and renal function.
- Patient Education: Similar to acyclovir, important to take as directed, complete the full course, and inform healthcare providers of all current medications.
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Description
This quiz covers various viral pathogens responsible for respiratory tract infections, focusing on their characteristics, symptoms, and management. Key viruses discussed include Parainfluenza, Rhinovirus, and Adenovirus, with a particular emphasis on their impact on children's health. Test your knowledge on the symptoms and treatments associated with these common viruses.
