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57 Cards in this Set
- Front
- Back
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HSV II
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sexually aquired
most havent been diagnosed with genital herpes |
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HSV I
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may not be sexually aquired
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HSV transmission
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incubation 2-12 days, viral shedding in absence of lesions, most infections transmitted when person is unaware of infection (asymptomatic)
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HSV primary infection
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infection in patient without pre-existing antibodies to HSV
fever, headache, malaise |
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Non primary HSV infection
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Aquisition of HSV I in a person with HSV II antibodies or vice versa
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Recurrent infection
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reactivation of genital HSV in which the HSV type recovered in lesion is the same as the antibodies present
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Prodrome
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symptoms prior to vesicle formation
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HSV: systemic antivirals
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can partially control signs and symptoms when used episodically or as suppressive therapy. do not eradicate latent virus
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HSV: topical therapy
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minimal benefit, discouraged
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efficacy of acyclovir, valacyclovir, famicyclovir
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all antivirals have similar efficacy
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advantage: Acyclovir
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cheapest antiviral tx
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advantage: Valacyclovir
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enhanced absorption after oral admin
longer t1/2 than acyclovir dis:$$ |
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advantage: Famicyclovir
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Longer t1/2 than acyclovir
high oral bioavaliability dis: $$ |
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MOA: Acyclovir
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inhibits replication of HSV
converted in cell by virally encoded thymidine kinase to monophosphate |
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Acyclovir counseling:
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not highly prot. bound
Food doesnt change absorption Excretion is renal ** may need to dose adjust |
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1st HSV episode tx:
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Acyclovir 400mg PO TID
Acyclovir 200mg PO 5x/d Famicyclovir 250mg PO TID Valacyclovir 1g PO BID all equally effective when used for 7-10 days tx extended if healing incomplete |
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HSV Episodic Tx: Acyclovir
(shortens duration of lesions) |
Acyclovir 400mg TID x 5d
Acyclovir 800mg BID x 5d Acyclovir 800mg TID x 2d |
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HSV Episodic Tx: Famciclovir
(shortens duration of lesions) |
Famciclovir 125mg BID x 5d
Famciclovir 1000mg BID x 1d |
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HSV Episodic Tx: Valacyclovir
(shortens duration of lesions) |
Valacyclovir 500mg BID x 3d
Valacyclovir 1000mg QD x 5d |
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Suppressive Tx:
(reduces freq of outbreak + decrease risk of trans. to partner) |
Acyclovir 400mg BID...(daily use)
Famciclovir 250mg BID Valacyclovir 500mg QD Valacyclovir 1g QD |
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AE of Antivirals
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. Similar to placebo
. IV may cause acute renal failure - precipitation of crystals in renal tubule . Neurologic toxicity - esp in pts w/ underlying renal failure |
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Antivirals counseling:
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Take with lots of water to avoid ppt of crystals
Tell pts to take in small doses w/ renal failure |
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Antiviral DIs
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. avoid use w/ other nephrotoxic drugs
. may inc. tenofovir conc. . may decrease phenytoin conc. -loss of seizure control . probenecid may increase AUC |
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HSV resistance
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Foscarnet 40mg/kg IV Q8H until resolution
inhibits viral DNA pol (thymidine kinase NOT required) |
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Causes of Acyclovir resistance:
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. reduced or absent thymidine kinase
. Altered DNA polymerase (also resistant to Vala, Fam, and Pen) |
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Risk to fetus in Pregnancy
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High risk: if genital herpes acquired near time of delivery
Low risk: if recurrent herpes or if infection acquired in 1st trimester |
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Herpetic lesions during delivery
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consider Cesarian
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Herpes tx during Preg:
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acyclovir administered to pregnant women.
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Syphilis transmission
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only when mucotaneous syphilitic lesions are present
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Syphilis Tx
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Penicillin G, dose depends on stage and symptoms:
-Bicillin LA |
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Which Penicillin G do we NOT use in tx of syphilis
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Bicillin CR
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When to tx Syphilis in Pregnacy
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DO NOT wait until after birth to treat, although early labor may be induced
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Missed dose of Pen G durring pregnancy
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repeat full course of medication
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Syphilis monitoring:
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Based on onset of illness
. Early: Follow up at 6 + 12 mo . Latent, or Unknown: 6, 12, 24 mo . Test all pts for HIV |
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Syphilis Partner management
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<90 days since exposure: tx presumptively
>90: still treat if no test results + follow up uncertain |
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Syphilis tx w/ penicillin allergy:
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* Doxycycline 100mg BID x 14d
Tetracycline 500mg QID x 14d (28d in latent syphilis) . maybe ceftriaxone 1g IM or IV QD x 8-10d |
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Chlamydia testing
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recommended in all women <25
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** Can you do culture sensitivity testing w/ nucleic acid amp tests?
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NO!!
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Azithromycin benefits
tx of chalmydia |
More $$ than erythromycin but LESS GI intolerance and can be dosed daily
Also, No CYP interactions! food may help, ok w/o too. |
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Metabolism of Doxycycline
tx of chalmydia |
not hepatically metabolized
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Doxycycline DIs
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dose separate with cation containing products
(quinapril contains magnesium) also: use backup method of birthcontrol |
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Doxycycline AE
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May increase photosensitivity
long term use: vitamin B deficiency |
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Levofloxacin DIs
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increased PT/INR- warfarin
Rare cases of QT prolongation |
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Chlamydia resistance:
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Currently- no strains display stable resistance to antibiotics!!
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Chlamydia monitoring
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advise all women w/ infection to be retested 3 months after treatment
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Chlamydia in pregnancy tx
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Amoxicillin 500mg TID 7d
Erythromycin 400mg QID 14d |
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Chlamydia in pregnancy: repeat testing
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Recommended: repeat testing 3 wks after tx if infection persists
BUT even dead organisms will show up (+) |
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Gonorrhea manifestation in men
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discharge and dysuria
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Dx Gonorrhea
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Gram (-) diplococci from male urethra
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Gonorrhea Tx
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Ceftriaxone 125mg IM x 1d
Cefixime 400mg PO x 1 + tx for chlamydia if infection cannot be ruled out |
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Ceftriaxone: advantage
tx of gonorrhea |
Longest half life of all cephalosporins
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Cephalosporins AE
tx of gonorrhea |
hyperthrombinemia
GI Seizures and CNS stim- most often w/ kidney dysfunction |
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Partner delivered tx for gonorrhea
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not a good option b/c many women don't know HIV + till preg
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when to tx genital warts (HPV)
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tx if: pain, functional impairment, cosmetic concern
(possibly reduces but doesn't eliminate HP infection or infectivity) No one best tx (most= painful) |
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Tx of genital warts:
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Imiquidmod 5%
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Imiquidmod AE
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weakens condoms+ other barrier methods
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Preventing HPV
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Guardasil: men + women, protects against cervical cancer + genital warts
(against many types HPV) Cevarix: women only |
