PANCE Blueprint Pulmonary (12%)

Influenza (ReelDx)

REEL-DX-ENHANCED-PAID-MEMBERS-ONLY

Patient will present with →  sudden onset of fever, chills, malaise, sore throat, headache coryza and myalgia (especially in the back and legs)

Two types: Influenza A and B - mainly during winter season

  • Patients will present with fever, headache, myalgia and malaise.
  • With rare exceptions, all persons older than age 6 months should be vaccinated against influenza yearly.
  • Complications from influenza are most common in the very young, very old, and those with preexisting comorbidities.

Diagnosis is usually clinical, rapid antigen test can be performed in clinic

Can treat with medications if symptoms are less than 48 hours in duration

  • Zanamivir and Oseltamivir both treat influenza A and B (think Dr. “OZ” treats the flu)
    • Oseltamivir (Tamiflu) 75 mg PO two times per day for 5 days
  • Amantadine and Rimantadine treat only influenza A
  • The use of salicylates should be avoided, particularly in children below 18 years of age, because of association with Reye's syndrome. Remember Bismuth contains salicylates, should be avoided, and could be a cause of Reye's syndrome.

Responsible use of antivirals: 

  • Antiviral treatment depends on current resistance patterns each year; check www.cdc.gov/flu or local health department for current patterns. Antivirals are most effective if administered within 1st 48 hours in those with laboratory-confirmed (or highly suspected based on clinical findings) influenza illness.

  • Antivirals within 48 hours of symptom onset recommended if at risk of complications (ie. Diabetes, CHD, COPD, Asthma, etc.)

  • Antivirals recommended if hospitalized

  • Antivirals may be considered for persons not at increased risk of complications from influenza whose onset of symptoms is within the past 48 hours and who wish to shorten the duration of illness and further reduce their relatively low risk of complications.

  • Symptomatic treatment is preferred for those patients without risk factors and without signs of lower respiratory tract infection

Question 1
A 62 year-old female is admitted to a nursing home during an outbreak of influenza. In review of her records, you note that she did not receive the flu vaccine this year. Which of the following is the most appropriate drug of choice for influenza prophylaxis in this patient?
A
Ciprofloxacin (Cipro)
Hint:
Ciprofloxacin is indicated for postexposure prophylaxis of anthrax.
B
Zanamivir (Relenza)
C
Clarithromycin (Biaxin)
Hint:
Clarithromycin is indicated for prophylaxis against disseminated Mycobacterium avium complex.
D
Alpha-2b interferon (Avonex)
Hint:
Alpha-2b interferon is indicated for treatment of several disorders, such as chronic hepatitis B & C, but has no role in prophylactic treatment of any condition.
Question 1 Explanation: 
Either zanamivir or oseltamivir are indicated for prophylactic use against influenza A or B.
Question 2
Which of the following is the most appropriate therapeutic agent for acute influenza?
A
azithromycin (Zithromax)
Hint:
See D for explanation.
B
acyclovir (Zovirax)
Hint:
See D for explanation.
C
tetracycline (Sumycin)
Hint:
See D for explanation.
D
zanamivir (Relenza)
Question 2 Explanation: 
Zanamivir is an anti-viral agent that is active against the influenza virus. Relenza (zanamivir) is approved for treatment of acute uncomplicated illness due to influenza A and B in patients 7 years of age and older.
Question 3
An 85 year-old nursing home resident presents with abrupt onset of cough, sore throat, headache, myalgias, and malaise. On examination the patient's temperature is 102 degrees F; the rest of the exam is unremarkable. Nasal smear is positive for Influenza B. Which of the following is the treatment of choice in this patient?
A
Amantadine (Symmetrel)
Hint:
Amantadine is only used to treat influenza A.
B
Oseltamivir (Tamiflu)
C
Acyclovir (Zovirax)
Hint:
Acyclovir is used to treat viral infections due to certain herpes viruses.
D
Nevirapine (Viramune)
Hint:
Nevirapine is used to treat infection due to HIV.
Question 3 Explanation: 
Oseltamivir is used to treat both influenza A and B.
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