Pulmonary Viral Syndromes Fall 2024 Augsburg PA Program PDF

Pharmacotherapy I: Pulmonary Viral Syndromes & Antivirals Augsburg PA Program, 2024 Miranda LaCroix, MSPAS, PA-C  Learning Objectives 1. Describe the most common viral pathogens associated with respiratory tract infections. 2. Outline the typical presentation of a pa...

Pharmacotherapy I: Pulmonary Viral Syndromes & Antivirals Augsburg PA Program, 2024 Miranda LaCroix, MSPAS, PA-C  Learning Objectives 1. Describe the most common viral pathogens associated with respiratory tract infections. 2. Outline the typical presentation of a patient presenting with a viral respiratory tract infection. 3. Identify the viral pathogens that can be prevented through vaccination and the viral pathogens that can be treated with specific antiviral therapy. 4. Outline therapies provided and suggested to patients considered to be “supportive care.” 5. Briefly summarize the pathophysiology of viral pulmonary infection, highlighting increased sputum production and cough. 6. Differentiate when antivirals are appropriate to be prescribed for treating viral respiratory infections and they are not. 7. List symptomatic management options for the treatment of cough. 8. List the symptomatic management options for pediatric patients presenting with Respiratory Syncytial virus (RSV) 9. Write a prescription for the prevention of oral herpes simplex with either acyclovir or valacyclovir. 10. Write a prescription for the treatment of oral herpes simplex with either acyclovir or valacyclovir. 11. Identify the drug classes used to treat Hepatitis B and Hepatitis C. 12. For the following representative medications, know the medication class, mechanism of action, indications, adverse effects, contraindications, interactions (common), monitoring (if needed), and patient education. a. Oseltamivir b. Nirmatrelvir/ritonavir (Paxlovid) c. Benzonatate d. Dextromethorphan e. Guaifenesin f. Acyclovir g. Valacyclovir Respiratory Tract Infections Respiratory Tract Viral Infections Respiratory Tract Infection Viruses Respiratory Tract Parainfluenza Infection RSV Influenza Pathophysiology COVID Vaccinations Antiviral Therapy & Supportive Cares Virus enters respiratory tract Inflammatory response (cytokines) can induce cough and airway sensitization Increased mucous production to aid in movement of foreign invasion Inflammation decreases airway clearance and traps mucous  Viral RTI Presentation Signs & Symptoms Cough Sneezing Rhinorrhea Sore Throat Headache Malaise Fever Respiratory Tract Viral Infections Respiratory Tract Infection Viruses Respiratory Tract Parainfluenza Infection RSV Influenza Pathophysiology COVID Vaccinations Antiviral Therapy & Supportive Cares  Parainfluenza AKA Croup Paramyxoviridae family, enveloped RNA virus Infection of larynx, trachea (sometime bronchi) Affects young children (4-10 years) “Barking” cough (seal-like), Stridor Child usually non-toxic appearing Symptomatic management Adenovirus Double Stranded DNA Viruses, many serotypes MC in children Vector: respiratory secretions, contact with contaminated object, airborne, waterborne Common cold; fever, pharyngitis, conjunctivitis, otitis media, cough, exudative tonsilitis, GI symptoms Symptomatic management  Rhinovirus MCC of common cold, asthma trigger Mostly cause URTIs Nasal dryness/irritation, sore throat, headache, cough, facial/ear pressure Symptomatic treatment Respiratory Syncytial Virus Single stranded RNA virus MCC of respiratory hospitalization of infants Starts in fall and peaks in winter URTI symptoms, can cause PNA, bronchiolitis Vaccination available (for pregnant women or infants and elderly)! Respiratory Syncytial Virus in Children Symptomatic Management Supportive Glucocorticoids Bronchodilators Ribavirin (nucleoside analog) IVIG Monoclonal antibodies (Раlivizսmab, Nirsevimab)  Influenza A & B are most common subtypes seen in the US Fever, nonproductive cough, myalgia, malaise, sore throat, nausea, nasal congestion, and headache. High genetic diversity during replication through antigenic drift and antigenic shift → yearly vaccination Management: Oseltamivir (tamiflu)  COVID-19 (SARS-CoV-2) Coronavirus; enveloped positive sense single stranded RNA Previously similar to common cold, now has developed ability to infect the lower respiratory tract and cause pulmonary symptoms (SARS, MERS, COVID-19) Like Influenza, ability to have high genetic variation → yearly vaccination Respiratory Tract Viral Infections Respiratory Tract Infection Viruses Respiratory Tract Parainfluenza Infection RSV Influenza Pathophysiology COVID Vaccinations Antiviral Therapy & Supportive Cares  Viral Vaccination Vaccinations are available for the Hib (Haemophilus influenzae type b) following viruses: Hepatitis A & B COVID-19 HPV (Human Papilloma Virus) Influenza RSV Varicella (Chickenpox) Shingles Monkeypox Respiratory Tract Viral Infections Respiratory Tract Infection Viruses Respiratory Tract Parainfluenza Infection RSV Influenza Pathophysiology COVID Vaccinations Antiviral Therapy & Supportive Cares  Oseltamivir (Tamiflu) Medication Class: Antiviral Agent; Neuraminidase Inhibitor Mechanism of Action: inhibiting the activity of the viral neuraminidase enzyme found on the surface of the virus, which prevents budding from the host cell, viral replication, and infectivity. Indications: Influenza infection (>2 weeks old,