Long-term Care Pharmacy News: A Primer on Influenza

The influenza (flu) virus is a relatively common but potentially life-threatening respiratory illness that affects millions of people every year in the United States and around the world. The effects of the flu are particularly profound among the senior population, making it important for long-term care providers, including LTC pharmacy services, to stay up to date on the condition. It is often characterized by symptoms including fever, cough, sore throat, muscle aches, vomiting, diarrhea, and chills. The flu is highly contagious and can be spread by water droplets and fluids that are released when infected individuals sneeze, cough, or talk. Furthermore, touching contaminated surfaces, followed by touching one’s own mouth, eyes, or nose, can also lead to transmission of the flu.   It is important to note that the flu is not the same as the cold. While they may share some similar symptoms, colds usually go away after several days while the flu may persist for weeks and can lead to more serious complications such as pneumonia. Also, the flu can present with symptoms such as vomiting, diarrhea, and muscle aches that are not typically seen with the cold. [Tweet “While they may share some similar symptoms, colds usually go away after several days while the flu may persist for weeks.”]

Long-term Care Pharmacy Update: Understanding the Basics of Influenza in Seniors

While the flu affects all ages and populations, it can cause serious problems in high-risk population groups, including the elderly and those with chronic medical conditions such as asthma, diabetes, or heart disease.
This is particularly important, especially in Skilled Nursing Facilities, where residents tend to be elderly and have comorbid chronic diseases. To combat the flu, there are several recommended steps that both employees and residents should take.
The best way of treating the flu is to prevent it in the first place. Indicated residents and employees, including post-acute care pharmacy providers, should receive the annual flu vaccination when available.  
Furthermore, sanitary practices should be employed, including properly washing hands with soap after contact with residents, covering one’s mouth when coughing/sneezing, and providing adequate access to hand sanitizers. Also, quarantining infected residents can reduce the risk of flu transmission to others within the SNF.  

Long-term Care Pharmacy Update: What to Do if a Flu Outbreak Occurs

In the event of an outbreak (>2 infected residents), active surveillance must be conducted for at least one week from the last influenza case. All potentially ill residents should be tested via throat swab or other methods for confirmation of influenza.

Also, it is important to note that some immunocompromised or post-surgery residents may not show typical signs of flu such as fever—and it is important to monitor for other signs such as changes to cognitive function.

Furthermore, Standard and Droplet precautions must be implemented, including quarantining the sick resident and requiring all employees to wear a facemask prior to entering the resident’s room, in order to reduce the risk of flu transmission.

Long-term Care Pharmacy Update: Surveying the Antiviral Options

Immediate antiviral therapy should be initiated within 24 hours of detecting flu symptoms, especially if the resident has a fever. It is important to keep in mind that although these medications will not cure the flu, they will reduce the duration and severity of the resident’s flu symptoms, resolving symptoms in as short as three days.

Options include oral oseltamivir (Tamiflu®) or zamamivir (Relenza®) inhalation, which both are usually given twice daily for five to 10 days. Although commonly prescribed, oseltamivir dosing must be adjusted for residents with renal insufficiency.

For residents who cannot tolerate oral therapy or have renal failure, IV options include peramivir (Rapivab®), which is given as a single dose.
In addition to the resident receiving the medications, all residents within the same wing/hall of the infected resident should also receive antiviral prophylactic therapy, regardless of whether they are showing flu-like symptoms or not. This prophylactic therapy should continue for seven days following the last positive flu diagnosis in that wing/hall.

These medications tend to have minor side effects, which may include headache or nausea. However, for residents with asthma, COPD, or other respiratory disorders, zamamivir may exacerbate these conditions and should be used with caution.

Through both preventive and reactive measures, we can work together to reduce the risk of flu outbreaks and reduce severity of these outbreaks if they occur.

Long-term care pharmacy encompasses more than just oral medications—immunizations are also important. Our Grane Rx team stays informed about the latest related to health conditions and passes that knowledge to your team. Call (866) 824-MEDS (6337) to find out how your SNF could benefit.

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