ANTIVIRAL CASE #1
F2
Paril, Marie Jennifer F.
Quilicot, Sinclair Joseph U.
Objectives:
a. To identify the diagnosis of the patient
b. To identify the basis of the diagnosis
c. To determine at least 3 differential diagnoses
d. To discuss pharmacologic and non-pharmacologic
management to the patient
e. To discuss Congenital Varicella Syndrome
f. To differentiate Varicella Immunoglobin (VZIG) and Varicella
Zoster Vaccine (VZV)
g. To discuss the reactivation of such viral infection into adult life
h. To make a prescription of the antiviral agent indicated
5 Y/O
vesicular lesions with
maculopapular rashes
low to moderate
noted on the trunk and grade fever
extremities
HERPES ZOSTER
SCARLET FEVER
Pharmacological Management
Pharmacological Management
ACYCLOVIR VALACYCLOVIR
CLASS Antiviral Antiviral
Acyclic guanosine derivative L-valyl ester prodrug of acyclovir
INDICATIONS Herpes Simplex Virus Infection Herpes Simplex Virus Infection
Varicella-Zoster Virus Infection Varicella-Zoster Virus Infection
MOA: Antimetabolite prodrug Same with Acyclovir.
Pharmacodynamics Rapidly and almost completely
-Undergoes phosphorylation converted in man to aciclovir and
-converted to aciclovir valine, probably by the enzyme
monophosphate by virus-specific referred to as valaciclovir
thymidine kinase then further hydrolase.
converted to aciclovir triphosphate
by other cellular enzymes. Higher bioavailability with CSF
level 50% of serum value
-Aciclovir triphosphate inhibits DNA
synthesis and viral replication by
competing w/ deoxyguanosine
triphosphate for viral DNA
polymerase and being incorporated
into viral DNA.
Pharmacological Management
ACYCLOVIR VALACYCLOVIR
Pharmacokine Absorption: Poorly absorbed from the GI Absorption: Readily absorbed from the
tics: tract. Slight absorption after topical GI tract.
application to intact skin.
Bioavailability: Approx 54% (aciclovir).
Bioavailability: Approx 10-20% (oral). Time to peak plasma concentration: 1-2
hr.
Distribution: Widely distributed to body
tissues and fluids including CSF. Crosses the Distribution: Plasma protein binding:
placenta and distributed into breast milk. 13.5-17.9%.
Volume of distribution: 0.8 L/kg. Plasma
protein binding: 9-33%. Metabolism: Converted to aciclovir and
L-valine via first-pass intestinal or
Metabolism: Converted by viral enzymes to hepatic metabolism.
aciclovir monophosphate, and further
converted to diphosphate then triphosphate Excretion: Via urine (mainly as aciclovir
(active form) by cellular enzymes. and its metabolite 9-
carboxymethoxymethylguanine; <1% as
Excretion: Via urine (up to 14% as the unchanged drug).
inactive metabolite 9-
carboxymethoxymethylguanine). Plasma elimination half-life: 2.5-3.3 hr.
-Use of personal
protective
equipments such as
gloves/mask
-Proper isolation
Congenital Varicella Syndrome
Congenital Varicella Syndrome
• an extremely rare disorder in which affected
infants have distinctive abnormalities at birth
due to the mother's infection with chickenpox
(maternal varicella zoster) early during
pregnancy.