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Herpes Zoster Ophthalmicus

1)      What is Herpes Zoster ophthalmicus?
      Herpes zoster is a common infection caused by the human herpes virus, the same virus that causes varicella (i.e., chickenpox). It is a member of the same family (Herpes viridae) as herpes simplex virus, Epstein-Barr virus, and cytomegalovirus. Reactivation of the latent virus in neurosensory ganglia produces the characteristic manifestations of herpes zoster, commonly known as shingles. Normal aging, poor nutrition, and immunocompromised status correlate with outbreaks of herpes zoster, and certain factors such as physical or emotional stress and fatigue may precipitate an episode.

Herpes zoster ophthalmicus occurs when reactivation of the latent virus in the trigeminal ganglia involves the ophthalmic division of the nerve. The virus damages the eye and surrounding structures by secondary perineural and intraneural inflammation of sensory nerves. Herpes Zoster Ophthalmicus represents approximately 10 to 25 percent of all cases of herpes zoster. Although herpes zoster ophthalmicus most often produces a classic dermatomal rash, a minority of patients may have only ophthalmic findings, limited mainly to the cornea. Direct ocular involvement is not specifically correlated with age, gender, or severity of disease. Serious sequelae include chronic ocular inflammation, vision loss, and disabling pain.
2)      What are the drugs used in the management of herpes zoster ophthalmicus?
        Patients with herpes zoster ophthalmicus are treated with oral acyclovir (800 mg, five times daily) for 7 to 10 days. Studies report alleviation of pain with oral acyclovir during the initial stages of the disease, especially if the drug is taken within the first three days of symptoms, and it may have a favorable effect on postherpetic neuralgia. Additionally, acyclovir administered within 72 hours of onset has been found to speed resolution of skin lesions, reduce viral shedding, and decrease the incidence of dendritic and stromal keratitis as well as anterior uveitis.

Valacyclovir (Valtrex) has higher bioavailability and has been shown to be equally safe and effective for the treatment of herpes zoster at a dosage of 1,000 mg three times daily for seven or 14 days. Valacyclovir in a seven-day dosage regimen was recently shown to prevent ocular complications of herpes zoster ophthalmicus, including conjunctivitis, superficial and stromal keratitis, and pain. Famciclovir (Famvir), 500 mg orally three times a day for seven days, may also be used. Intravenous acyclovir is recommended in immunocompromised patients. Acute pain control is achieved by local care and oral analgesics. Topical anesthetics should never be prescribed because of their corneal toxicity.
3)       What are the non-pharmacological approaches in managing herpes zoster ophthalmicus?  
           -Consistent cleaning of affected eye
           -Eat a lot of fruits to boost the immune system
     4)   What are the classes of HIV drugs?
                   Nucleoside reverse transcriptase inhibitors (NRTIs)
                   Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
                   Protease inhibitors (PIs)
                   Integrase inhibitors (INSTIs)
                   Fusion inhibitors (FIs)
                  Chemokine receptor antagonists (CCR5 antagonists)
5)       How are HIV drugs combined?
           Antiretroviral therapy (ART) is the combination of several antiretroviral medicines used to slow the rate at which HIV makes copies of itself (multiplies) in the body. A combination of three or more antiretroviral medicines is more effective than using just one medicine (monotherapy) to treat HIV.
   The U.S. National Institutes of Health recommends using one of the following programs for people who begin treatment for HIV:

Dolutegravir + abacavir + lamivudine
Dolutegravir + tenofovir + emtricitabine
Elvitegravir + cobicistat + tenofovir + emtricitabine
Raltegravir + tenofovir + emtricitabine
Ritonavir-boosted darunavir + tenofovir + emtricitabine

This post first appeared on UNIVERSITY OF NIGERIA PAST QUESTIONS AND UNIVERSITY GIST, please read the originial post: here

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Herpes Zoster Ophthalmicus


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