PCL 2- Management and treatment of shingles

Management and treatment

Treatment

Antiviral agent

-aimed at inhibiting the replication of VZV

-nucleoside analogues acyclovir,famciclovir and valacyclovir , show efficacy in treating VZV infections.

-Acyclovir is a guanosine analog that is selectively phosphorylated by VZV thymidine kinases (it is a poor substrate for cellular thymidine kinase) and thus is concentrated in infected cells. Cellular enzymes then convert acyclovir monophosphate to acyclovir triphosphate, which interferes with viral DNA synthesis by inhibiting viral DNA polymerase.

-Two prodrugs, valacyclovir and famiclovir , are better and more reliably absorbed than acyclovir after oral administration

-greater bioavailablity, resulting in higher blood levels and a less frequent dosing schedule

-Valacyclovir is a valine ester of acyclovir that is converted enzymatically to acyclovir after absorption

-Famciclovir is a prodrug of penciclovir , a nucleoside analog similar to acyclovir in mechanism of action and antiviral activity against VZV and HSV. Famciclovir is converted enzymatically to penciclovir after absorption

-oral acyclovir (800 mg five times a day for 7 days), famciclovir (500 mg q 8 hours for 7 days), and valaciclovir (1 gm three times a day for 7 days)

-can decrease the duration of skin rash and pain, including the pain of PHN. These medications must be started early (up to about 24-72 hours after rash development) in the disease to have any benefit

-immunocompromised patients with herpes zoster showed that intravenous acyclovir (500 mg/m² every 8 hours for 7 days) halted progression of the disease

For pain

-Patients with mild pain maybe managed with acetaminophen or nonsteroidal agents

-Patients with moderate to severe pain usually require treatment with an opioid analgesic (e.g., oxycodone).

-Anti-Inflammatory Therapy

-The anti-inflammatory effects of corticosteroids have been postulated to reduce herpes zoster symptoms but there remains controversy over their use

-However, clinical trials have shown reductions in acute pain and one randomized controlled trial showed benefits in improvement in time to uninterrupted sleep, return to routine activities, and cessation of analgesic medications among patients with no relative contraindications to corticosteroids

-Therefore, corticosteroids maybe useful in reducing moderate to severe acute pain unrelieved by antiviral agents and analgesics.

-they should be used only under the supervision of a health-care practitioner since in some patients, corticosteroids may make the infection worse

Non pharmacological treatment

-Patients should be instructed to keep the rash clean and dry to decrease the chances of developing bacterial superinfection.

-Topical antibiotics should be discouraged.

- Cool compresses, calamine lotion, cornstarch, or baking soda may help to reduce local symptoms and speed the drying of the vesicles.

-When the vesicles have crusted over, a bland ointment or olive oil may help separate the adherent crusts.

-Occlusive ointments and topical steroids should be avoided.

- Reassurance and education directly address concerns about contagiousness, for example, who is at risk for contracting VZV, zoster pain management, and potential disability.

-Social support

-mental and physical activity

-adequate nutrition, and a caring attitude are important interventions for coping with a herpes zoster attack.