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In this lesson, we'll cover the mechanisms of action, spectrums, side effects, indications and contraindications of neuraminidase inhibitors, amantadine, and rimantadine.",{"id":215,"name":216},1,"Course previews",[218,229,234,239,246],{"type":219,"data":220},"video",{"readDurationInSeconds":221,"video":222},350,{"platform":223,"name":224,"url":225,"size":226},"YouTube","Administering anti influenza medications","https:\u002F\u002Fwww.youtube.com\u002Fwatch?v=42zy68brUvc",{"width":227,"height":228},200,113,{"type":230,"data":231},"free_text",{"readDurationInSeconds":232,"text":233},9.866666666666667,"\u003Cp>In this short video, Dr John Fisher–infectious disease specialist–will teach you the \u003Cem>nuts and bolts\u003C\u002Fem> of anti-influenza medications. You'll learn about the indications, contraindications, and best practices regarding these medications with a focus on neuraminidase inhibitors, amantadine, and rimantadine.\u003C\u002Fp>",{"type":230,"data":235},{"readDurationInSeconds":236,"title":237,"text":238},14.666666666666668,"Join our Antimicrobial Stewardship Essentials course today!","\u003Cp>Each day, patients die of bacterial infections for which no active agents are available. This course will familiarize you with the wide variety of antimicrobial agents available, as well as their mechanisms of action, spectrum of activity, and toxicity profiles, so you can be more selective in choosing an agent when one is required and do your part to delay antimicrobial resistance.\u003C\u002Fp>",{"type":240,"data":241},"cta",{"readDurationInSeconds":242,"text":243,"buttonText":244,"buttonUrl":245},3.466666666666667,"Become a great clinician with our video courses and workshops","Start learning for free","https:\u002F\u002Fwww.medmastery.com\u002Fuser\u002Fregister",{"type":230,"data":247},{"readDurationInSeconds":248,"title":249,"text":250},137.6,"Video Transcript","\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-a612090e-7fff-e988-3b04-f6b80be13646\">[00:00:00] \u003C\u002Fb>During influenza epidemics, attack rates and unvaccinated populations are estimated to be 10% to 20%. The CDC reported that the burden of illness during the 2017-2018 season had an estimated 48.8 million people getting sick with influenza, 22.7 million people going to a health care provider,\u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-a612090e-7fff-e988-3b04-f6b80be13646\">[00:00:30] \u003C\u002Fb>959,000 hospitalizations, and 79,400 deaths from influenza in the United States alone. There are several classes of drugs that target influenza through different mechanisms. Let's start by looking at the neuraminidase inhibitors. After infecting and replicating in bronchial epithelial cells, influenza virus requires an enzyme called neuraminidase\u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-a612090e-7fff-e988-3b04-f6b80be13646\">[00:01:00] \u003C\u002Fb>in order to allow it to freely leave the cell and infect nearby cells. As their name suggests, neuraminidase inhibitors inhibit this enzyme effectively, trapping the virus within the infected cell, and preventing spread to neighboring cells. Common neuraminidase inhibitors include zanamivir which is inhaled, oseltamivir which is orally active, and peramivir which is typically\u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-a612090e-7fff-e988-3b04-f6b80be13646\">[00:01:30] \u003C\u002Fb>administered IV. The neuraminidase inhibitors are reasonably effective for preventing influenza among household contacts or in nursing home settings during an outbreak. However, the data show that they are not particularly effective for treating influenza especially if given after infection has been present for more than 48 hours and they are expensive. Oral administration of oseltamivir\u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-a612090e-7fff-e988-3b04-f6b80be13646\">[00:02:00] \u003C\u002Fb>is associated with nausea, epigastric distress or emesis in 10% to 15% of adults. Other side effects are uncommon. Because inhaled zanamivir can cause bronchospasm, they should not be used in persons with serious underlying respiratory disease, for example, COPD. For completeness, amantadine and rimantadine should be discussed even though many current\u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-a612090e-7fff-e988-3b04-f6b80be13646\">[00:02:30] \u003C\u002Fb>strains of influenza virus have developed resistance to these agents. The ion channel protein M2 on influenza viruses allows acids in respiratory epithelial cells to enter the virus. This triggers the virus to release genetic instructions and \"replicate.\" Amantadine and rimantadine sterically interfere with the function of the M2 protein channel,\u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-a612090e-7fff-e988-3b04-f6b80be13646\">[00:03:00]\u003C\u002Fb> thus, preventing viral replication. Once reasonably effective for prophylaxis but minimally effective for treatment, since the 2004-2005 outbreak of H3N1 influenza, there has been fairly widespread resistance to these agents. Moreover, the CNS side effects made them not ideal for prevention in nursing home settings. So these drugs are generally reserved for seriously ill patients\u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-a612090e-7fff-e988-3b04-f6b80be13646\">[00:03:30] \u003C\u002Fb>with a hope that they may be of some help in eliminating the virus. Amantadine and rimantadine are commonly associated with CNS toxicity which may be mild, such as nervousness, anxiety, difficulty concentrating, lightheadedness are rarely serious, including confusion, delirium, or hallucinations. Influenza generally differs clinically from a typical respiratory infection due to other viruses\u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-a612090e-7fff-e988-3b04-f6b80be13646\">[00:04:00]\u003C\u002Fb> in that it is much more aggressive and patients have to go to bed often with fever and chills, bad muscle aches, headache, and joint aches. Since the drugs are expensive, and the symptoms begin abruptly, rapid influenza testing and treatment would be reasonable for patients who present within the first 48 hours after disease onset. If the illness has been present for more than 48 hours, the literature suggests\u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-a612090e-7fff-e988-3b04-f6b80be13646\">[00:04:30]\u003C\u002Fb> that the drugs are unlikely to be as effective. This does not mean that they are not at all effective. Indeed, there is evidence of decreased mortality in patients hospitalized with proven influenza if treated with neuraminidase inhibitors. This is the reason that the current guidelines recommend that persons of any age who are hospitalized with influenza regardless of illness duration prior to hospitalization be treated. 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Learn when injectable cholesterol medication helps and how PCSK9 inhibitors work.",{"alt":342,"title":290,"size":343,"location":344},"Two PCSK9 inhibitor autoinjector pens—an injectable cholesterol medication—shown on a light blue background.",{"width":319,"height":319},{"bucket":295,"key":345},"\u002F2026-05\u002FC121(3)_magazine image.png",{"id":347,"title":348,"relativeURL":349,"image":350,"professionLong":351,"profession":352,"weight":271},1563,"Franz Wiesbauer, MD MPH","\u002Fteachers\u002Ffranz-wiesbauer-md-mph","https:\u002F\u002Fmedmastery-backend-prod-kjbeds.s3.eu-west-1.amazonaws.com\u002Fmedia\u002Fimages\u002F9c43cef0-41ee-4005-9e4a-d8711c816401","Franz is the founder and CEO of Medmastery. He is an internist with a specialization in cardiology and a master’s in public health from Johns Hopkins University.",{"name":353},"Internist","\u002Fmagazine\u002Fpcsk9-injectable-cholesterol-medication",279,"5m",{"created":358,"updated":359,"published":360},1779483663,1779495630,1779495631,{"seo":362,"og":364},{"title":363,"description":213},"Administering anti-influenza medications | Medmastery",{"title":363,"description":213,"image":365},{"alt":290,"title":290,"size":366,"location":369},{"width":367,"height":368},691,496,{"bucket":295,"key":370},"\u002Fmigrated-images\u002Fmagazine-060819.png",{"id":372,"created":373,"updated":374,"published":373},316,1564969402,1655189586]