Stds

Front 1

2 resources Amy used to compile her lecture on STD's

Back 1

Come on, you didn't really think I would ask that question did you? :) :)

Front 2

Syphilis: Causative agent?

Back 2

Treponema pallidum

Front 3

Syphilis: treat all partners within what time frame?

Back 3

the past 90 days

Front 4

Syphilis: Who in our class has it?

Back 4

just kidding, need to lighten the mood.

Front 5

Syphilis: Primary stage? (time frame, symptoms, resolution)

Back 5

10-90 days after exposure;
Painless chancre on genitals;
sponaneous resolution 2-6 weeks

Front 6

Syphilis: Primary stage treatment?

Back 6

PCN G IM x 1 dose
or if pcn-allergy:
Doxycycline or TCN x 14 days

Front 7

Syphilis: Secondary/Early Latent Stage--onset?

Back 7

occurs 4-10 weeks after inocculation

Front 8

Syphilis: Secondary/Early Latent Stage--s/sx?

Back 8

Painless, slightly raised skin lesions on palms, soles & trunk; Fever, h/a, anorexia, malaise, lymphadenopathy

Front 9

Syphilis: Secondary stage treatment?

Back 9

Same as primary treatment: PCN G or Doxycycline or TCN

Front 10

True or False: Latent phase individuals are non-infectious but can still pass it to the fetus.

Back 10

true

Front 11

Syphillis: Late Latent Stage--duration?

Back 11

typically over 1 year or no known duration

Front 12

Syphillis: Late Latent Stage--treatment?

Back 12

DOC: PCN G IM q week x 3wks
If PCN-allergic: Doxycycline or TCN PO x 4wks

Front 13

Syphillis: tertiary--affects what?

Back 13

various organs: CNS, CV, skin, skeleton

Front 14

Syphillis: tertiary--s/sx?

Back 14

typically no s/sx, neurosyphilis presents as stroke in younger pts

Front 15

Syphillis: tertiary--treatment?

Back 15

Same as Late Latent Stage
Neurosyphilis: PCN G IV q4hrs or CI x 10-14days; PCN-desensitization in PCN allergic pts

Front 16

Gonorrhea: Causative agent?

Back 16

Neisseria gonorrhea

Front 17

Gonorrhea: can cause what?

Back 17

PID, infertility & ectopic pregnancy

Front 18

Gonorrhea: affect to infants exposed in utero?

Back 18

gonococcal conjunctivitis leading to blindness

Front 19

Gonorrhea: prevalence?

Back 19

2/3 of gonorrhea cases in ages 16-24yrs

Front 20

Gonorrhea: s/sx in males vs. females

Back 20

males = Dysuria, urinary urgency, abnormal discharge

females= same above + abnormal vaginal bleeding

Front 21

Assume an infection of gonorrhea is accompanied by what other infection?

Back 21

Chlamidya

Front 22

Gonorrhea Treatment?

Back 22

Do pregnancy test

DOC: Ceftriaxone IM x 1 dose

Other options

FQ (Cipro, levofloxacin, ofloxacin) PO x 1 dose or
Cefixime PO x 1 dose

Front 23

Treatment of gonococcal infection of pharynx

Back 23

use ceftriaxone or ciprofloxacin & treat for Chlamydia

Front 24

Chlamydia: Causative agent?

Back 24

Chlamydia trachomatis

Front 25

Chlamydia can cause what disorders?

Back 25

PID, ectopic pregnancy, and infertility

Front 26

Chlamydia: Treatment?

Back 26

Doxycycline PO x 7days (Avoid in pregnancy) or
Azithromycin PO x 1 dose

Alternative agents
Erythromycin PO x 7days

Front 27

Chlamydia: abstain from sex for how long?

Back 27

>/= 1 week, so to treat all partners

Front 28

Pelvic Inflammatory Disease (PID): description?

Back 28

Ascending infxn of female genital tract involving fallopian tubes

Front 29

Pelvic Inflammatory Disease (PID): s/sx?

Back 29

Lower abdominal tenderness, cervical motion tenderness, fever (>101), abnormal vaginal or cervical discharge, increased C reactive protein, increased ESR, menorrhagia, dysuria

Front 30

Pelvic Inflammatory Disease (PID): causative agents?

Back 30

N. gonorrhea (50%), C. trachomatis, anaerobes, gram-negative pathogens, streptococci

Front 31

PID complications?

Back 31

Abscess in pelvic or fallopian tubes, tubal occlusion, fibrosis, ectopic pregnancy, infertility

Front 32

Pelvic Inflammatory Disease (PID): OUTPATIENT THERAPY?

Back 32

FQ (Ofloxacin or levofloxacin) PO x 14 days, with or without metronidazole PO x 14 days

Front 33

Pelvic Inflammatory Disease (PID): ALTERNATIVE OUTPATIENT THERAPY

Back 33

Ceftriaxone IM x 1 dose OR cefoxitin IM x 1 dose AND doxycycline PO x 14 days AND probenecid (given for gout) PO x 1 dose with or without metronidazole (used for anaerobes) PO x 14 days

Front 34

Pelvic Inflammatory Disease (PID): INPATIENT THERAPY?

Back 34

Cefotetan OR cefoxitin IV (d/c 24 hrs after improvement) AND doxycycline IV/PO (14 DAYS)

Metronidazole or clindamycin can be added for anaerobic coverage

Front 35

Pelvic Inflammatory Disease (PID): ALTERNATIVE INPATIENT THERAPY

Back 35

Clindamycin IV (14 days) AND gentamicin IV/IM (d/c 24 hrs after improvement) AND doxycycline IV/PO (14 days)

Front 36

Herpes: causative agents?

Back 36

HSV-1 (assoc. w/oropharyngeal dz, also some genital transmission); HSV-2 (predominant assoc. w/genital herpes)

Front 37

Herpes: s/sx?

Back 37

Genital burning, vesicle formation, ulcer formation; fever blisters (HSV-1), kertatoconjunctivitis (HSV-1 infxn of eye)

Front 38

Herpes: stages

Back 38

Primary infxn then latent virus

Front 39

Herpes: initial treatment?

Back 39

Acyclovir PO tid or 5x/day x 7-10

Famciclovir PO tid x 7-10days

Valacyclovir PO bid x 7-10days

Front 40

Herpes: recurrent treatment?

Back 40

If tx started w/in 1 day of lesion onset, can see benefit:

Acyclovir PO bid-tid x 2-5 days (dose-dep.)
Famciclovir PO bid x 1day
Valacyclovir PO qday x 5 days

Front 41

Herpes encephalitis: Causative agent?

Back 41

HSV-1 spreading thru neural routes during primary or recurrent infxn

Front 42

T or F: Herpes encephalitis is highly mortal if untreated

Back 42

True

Front 43

Herpes encephalitis: s/sx?

Back 43

H/A, fever, speech disorders, behavioral changes, focal seizures, abnormal CSF (elevated protein, lymphocytosis)

Front 44

Hertpes encephalitis: treatment?

Back 44

Acyclovir IV x 2-7days then PO antiviral x 10days total tx

Front 45

Doxycycline MOA?

Back 45

Inhibits protein synthesis for broad spectrum of gram+ & gram- bacteria

Front 46

Doxycycline ADE?

Back 46

Photosensitivity, GI upset (take with food), inc. BUN

Front 47

Doxycycline-drug interactions?

Back 47

Accutane (intracranial HTN), digoxin (inc. dig levels)

Front 48

Metronidazole: MOA?

Back 48

Microbicidal action

Front 49

Metronidazole: ADE?

Back 49

Abdominal discomfort, loss of appetite, metallic taste, N/V, h/a, vaginal discharge, disulfiram-like rxn=severe vomiting

Front 50

Metronidazole: drug interactions?

Back 50

EtOH!! Ergot, warfarin (inc. INR), amiodarone (QT prolongation)

Front 51

metronidazole-pregnancy

Back 51

C/I’d during 1st trimester

Front 52

Probenecid

Back 52

Antihyperuricemic; Atbx-therapy adjunct

Front 53

Probenecid: MOA

Back 53

Competitive inhibitor of weak acid secretion (PCN, cephalosporins) so then leads to Inc. blood conc. of PCN & cephalosporins & prolongs duration of action

Front 54

Probenecid: ADE?

Back 54

Rash, N/V, loss of appetite, h/a, blood dyscrasias

Front 55

Probenecid: drug interactions?

Back 55

MTX,=(Methatrexate toxicity)

Front 56

acyclovir: MOA

Back 56

Competitively inhibits viral DNA polymerase; Active against HSV-1, HSV-2 & varicella-zoster virus

Front 57

acyclovir: ADE

Back 57

N/V/D, agitation, confusion, dizziness, hallucinations, somnolence, inc. BUN/SCr (IV infusion-related)

Front 58

acyclovir: drug interactions

Back 58

Varicella vaccine (dec. vaccine effectiveness)

Front 59

Famciclovir: MOA

Back 59

Inhibits viral DNA replication; Active against HSV-1, HSV-2, VZV, Epstein-Barr virus

Front 60

Famciclovir: ADE

Back 60

N/V/D, h/a, dysmenorrhea

Front 61

Famciclovir: drug intxns?

Back 61

none

Front 62

Valacyclovir: MOA

Back 62

Prodrug converted to acyclovir; Same MOA; Active against HSV-1, HSV-2, VZV

Front 63

Valacyclovir: ADE

Back 63

Rash, abdominal pain, N/V, h/a, fatigue, Thrombocytopenia (TTP)

Front 64

Valacyclovir: drug interactions

Back 64

Mycophenolate

Front 65

HIV: s/sx?

Back 65

Rare when first infected; Flu-like illness ~1-2mths post-exposure (N/V/D, fever, splenomegaly, hepatomegaly, h/a, muscle pain, sore throat, thrush, rash on abdomen or extremities), then disappear in 1-4wks; May remain asymptomatic x8-10yrs then complications & signs of infxn develop (fever, sweats, weight loss, herpes infxn, lack of energy, PID not responding to tx, persistent skin rashes, shingles, short-term memory loss)

Front 66

HIV: Anti-retroviral therapy (ART)

Back 66

1. AIDS-defining illness (PCP, MAC, etc.)

OR

2. CD4 T-cell count <350 cells/mm3
3. Should always be initiated in:
-Pregnancy women
-HIV-associated nephropathy
-Co-infection with Hepatitis -B-regardless of the CD4 count

Front 67

HIV: treatment?

Back 67

Most regimens combine
2 NRTI’s (non-reverse transcriptase inhibitors)

AND

NNRTI (non-nucleoside reverse transcriptase inhibitor) OR ritonavir-boosted PI (protease inhibitor)
-Efavirenz preferred agent
-Nevirapine is alternative

Front 68

HIV: 2nd alternative treatment

Back 68

Triple NRTI regimen

Front 69

NNRTI’s

Back 69

Delavirdine, efavirenz, nevirapine-best tolerated, etravine

Front 70

NNRTI's MOA:

Back 70

Prevents copying of viral RNA to DNA

Front 71

NNRTI's ADE?

Back 71

Rash; Headache;
CNS ADR’s (insomnia, impaired concentration,nightmares)-efavirenz;
Inc. LFT’s (efavirenz, nevirapine-best tolerated )

Front 72

NRTI’s

Back 72

Emtricitabine, abacavir, lamivudine (has least toxicity), didanosine, zidovudine

Front 73

NRTI’s: MOA

Back 73

Prevents copying of viral RNA to DNA

Front 74

NRTI’s: ADE

Back 74

Lactic acidosis; Nausea, diarrhea;
Peripheral neuropathy (didanosine, stavudine);
Inc. LFT’s (stavudine);
Pancreatitis (didanosine)

Front 75

PI's list

Back 75

Atazanavir, darunavir, fosamprenavir, lopinavir, ritonavir, saquinavir

Front 76

PI's : MOA

Back 76

Inhibits HIV proteases

Front 77

PI's: ADE

Back 77

GI symptoms (N/V/D)
Inc. LFT’s
Lipid abnormalities
Insulin resistance

Front 78

Entry Inhibitors: Enfuvirtide (Fuzeon)
ADE?

Back 78

Hypersensitivity rxns, injection site rxns, pneumonia

Front 79

Entry Inhibitors: Enfuvirtide (Fuzeon)
Drug intxns?

Back 79

None identified yet

Front 80

Entry Inhibitors: Enfuvirtide (Fuzeon) indication?

Back 80

Indicated for treatment-experienced HIV

Front 81

Entry Inhibitors: Maraviroc (Selzentry)
indications?

Back 81

Indicated for treatment-experienced HIV AND infected solely with R5 strains of virus

Front 82

Entry Inhibitors: Maraviroc (Selzentry)
ADE

Back 82

Abdominal pain, cough, dizziness, musculoskeletal s/sx, rash, fever, URTI’s, hepatotoxicity, orthostatic hypotension

Front 83

Integrase Inhibitors: Raltegravir (Isentress)
MOA?

Back 83

Inhibits transfer of viral DNA to host cell DNA

Front 84

Integrase Inhibitors: Raltegravir (Isentress)
Indications?

Back 84

Indicated for treatment-experienced HIV

Front 85

Integrase Inhibitors: Raltegravir (Isentress)
ADE?

Back 85

Nausea, h/a, diarrhea, fever, CPK elevation

Front 86

When to adjust HIV therapy?

Back 86

1. Virologic failure
--Not achieving RNA<400copies/mL by 24 wks or <50copies/mL by 48wks
--Repeated detection of virus (RNA >400copies/mL) after initial suppression to undetectable
2. Immunologic failure
--Failure to inc. 25-50cells/mm3 above baseline CD4 count during 1st 12mths of tx
--Decrease to below baseline CD4 count on tx
3. Clinical progression of disease

Front 87

Always assess what before adjusting HIV therapy?

Back 87

NONCOMPLIANCE

Front 88

HIV therapy resistance procedures?

Back 88

Perform resistance testing if patient is on failing regimen or w/in 4wks of stopping regimen
If suspect single drug resistance, consider changing the one drug, adding boosting drug (i.e. ritonavir-it increases the concentration of the protease inhibitors), or changing entire regimen
If suspect multi-drug resistance, consider changing drug classes or agents, adding new drugs