Therapeutics 2 Exam 3

Front 1

Most frequently reported bacterial STD in the U.S. - 3 million new cases each yr

Back 1

Chlamydia Trachomatis (Nongonococcal Urethritis)

Sx: Dysuria / increase urinary frequency, discharge

Front 2

Non culture test for chlamydia that is the most rapid (30 min result) and cost effective with good sensitivity and specificity

Back 2

DNA hydridization probe

Front 3

Recommended treatment for Chlamydia

Back 3

Azithromycin 1 g po ONCE or doxycycline 100 mg po BID for 7 days

Alternatives: Erythromycin Base 500 mg QID, EES 800 mg QID, Ofloxacin 300 mg BID, Levofloxacin 500 mg QD

Front 4

Which drugs are contraindicated for pregnant women when treating Chlamydia?

Back 4

Doxycycline, Fluoroquinolones, Erythromycin Estolate
Recommended for Pregant women: Azith 1 g po ONCE or amox 500 po TID for 7 days

Front 5

Most common site of infection for Gonorrhea is

Back 5

Cervix

Front 6

Gonorhea symptoms for both genders are

Back 6

Dysuria, urethral & anal purulent discharges, pharyngitis

Front 7

Treatment for uncomplicated Gonococcal infection (cervix, urethra, rectum)

Back 7

Ceftriaxone 125 mg IM or cefixime 400 mg po PLUS treat for Chlamydia if not ruled out

Front 8

Gonorrhea Treatment in Pregnancy

Back 8

Ceftriaxone (Rocephin) 125 mg IM once

Alternative: 2 g spectinomycin IM once
Plus
Treat for Chlamydia w/
Azith or Amox
NO FLUOROQUINOLONES or TCN

Front 9

Stage of Syphilis that has an ulcer or chancre at infection site and is highly infectious

Back 9

1 (Primary)

Front 10

Stage of Syphilis that shows signs of rash, mucocutaneous lesions, enlarger lymph nodes

Back 10

2 (Secondary)

Front 11

Stage of Syphilis that has a positive serologic test, asymptomatic and NONINFECTIOUS STAGE.

Back 11

Latent (3rd Stage)
Early Latent - up to 1 yr after exposure
Late Latent - > 1 yr after exposure

Front 12

Stage of Syphilis that can lead to irreversible cardiac, neurologic, opthalmic, & auditory complications
Noncontagious but highly destructive

Gummatous Lesion, neurosyphilis

Back 12

Tertiary (last stage) - 1/3 cases progress to tertiary (morbidity, mortality)

Front 13

Localized Symptoms of the secondary syphilis stage

Back 13

skin lesions, rash, patchy alopecia, condyloma lata (skin lesion), and mucous patches

Front 14

Systemic Symptoms of the secondary syphilis stage

Back 14

Malaise, anorexia, headache, sore throat, and arthralgia

Front 15

Treatment of Primary, Secondary, Early Latent Syphilis Stages

Back 15

Benzathine Penicillin G (Bicillin LA) - 2.4 million units IM once

If Penicillin Allergy = Doxycycline, TCN, Ceftriaxone, Azithromycin 2 g once

Front 16

Treatment of Tertiary and Late Latent Syphilis

Back 16

Benzathine Penicillin G, 2.4 million units IM at 1 week intervals x 3 doses

Penicillin Allergy: Doxycycline 100 mg BID x 28 days
Tetracycline 500 mg QID x 28 days

Ceftriaxone and Azith not for tertiary or late latent stage

Front 17

Neurosyphilis Treatment

Back 17

Aqueous Crystalline Penicillin G

Alternative = Procaine Penicillin

Penicillin Allergy = Ceftriaxone 2 g

Front 18

Syphilis Treatment in Pregnancy

Back 18

Penicillin regimen based on stage an additinal IM dose of benzathine PCN

if allergic to benzathine PCN then desensitize

Front 19

ADR of syphillis treatment is

Back 19

Jarisch-Herxheimer - fever, chills, headache, myalgia, exacerbation of lesions, malaise due to endotoxins released from bacteria and the body can't get rid of them fast enough

Front 20

Normal Vaginal Flora (lactobacillus sp) are replace by: Gardnerella vaginalis and/or mycoplasma hominis

Back 20

Bacterial Vaginosis

Front 21

Thin, whitish or grayish vaginal discharge
Fishy odor
vulvar itching and irritation
Elevated vaginal pH> 4.5
+ whiff test (KOH prep)

Back 21

Bacterial Vaginosis

Front 22

Bacterial Vaginosis recommended regimen is

Back 22

Metronidazole tablets, intravaginal gel, clindamycin cream 5 g intravaginally

Alternative: clindamycin 300 mg po BID x7
Clindamycin ovules 100 g intravaginally qhs x3

Front 23

Bacterial Vaginosis Treatment in Pregnancy

Back 23

Metronidazole 250 mg tid or 500 mg bid x 7 days or Clindamycin 300 mg BID x 7 days (Intravag Cream only to be used the 2nd half of pregnancy)

Metronidazole Gel to sustain cure

Front 24

Transmitted through sexual contact, direct exposure with contaminated surfaces (wet towels, toilet seats), mother to newborn during passage through birth canal

Provides an increase risk for acquiring HIV

Back 24

Trichomoniasis (Trichomonas vaginalis) - flagellated motile protozoan

Front 25

Malodorous yellow-green frothy/foamy vaginal discharge, Dysuria, dyspareunia (painful sex), vulvar irritation and pruritus
Clinical Findings: Strawberry spots surface erosions on the cervix, alkaline pH
Men = asymptomatic

Back 25

Trichomoniasis

Front 26

Treatment for Trichomonas

Back 26

Metronidazole 2 g po single dose, tinidazole 2 g po in a single dose, NO ETOH!
Alternative: Metronidazole 500 mg BID x7

Pregnancy: Metronidazole 2 g po x1 dose, no breastfeeding

Front 27

Trichomoniasis Treatment Failure

Back 27

Retreat with metro 500 BID x7 or tinidazole 2 g x1 dose
if repeated failure - metro/tinidazole 2 g po qd x5

Front 28

What is the 5 Stage Cycle of HSV Pathogenesis

Back 28

1. Primary mucocutaneous infection
2. Infection of ganglia
3. Establishment of latency
4. Reactivation (induced by immune responses, menstruation, stress, excessive friction, or surgical trauma)
5. Recurrent infection

PIERR

Front 29

For resistant strains of HSV use

Back 29

Foscarnet 40 mg/kg IV q8 x14-21days or topical cidofovir gel 1% daily x 5 days

Front 30

For pregnant women use ____ and if allergic then

Back 30

Acyclovir, if allergic then desensitize

Front 31

To prevent transmission from infected partner to non-infected partner use

Back 31

Valacyclovir 500 mg daily

Front 32

Soft, pink or red "cauliflower-like" swellings, may be external, on the cervix, vagina, urethra, perianal, or oral cavity, painful and/or pruritic

Back 32

Human Papillomavirus (HPV) types 6, 11 cause visible warts

Front 33

HPV Treatment

Back 33

goal is to remove visible warts
Patient Applied:
Podofilox 0.5% solution or gel and Imiquimod 5% cream

Provider Applied:
Cryotherapy (freeze and remove) or
Podophyllin Resin 10-25%
Trichloroacetic or Bichloroacetic acid 80-90% or surgical removal

Laser Surgery and intralesional interferon

Front 34

HPV Treatment in Pregnancy do not use

Back 34

Imiquimod, podofilox, podophyllin

recommend wart removal

Front 35

Oral Temperature > 101 F (>38.3 C)
Abnormal Cervical or vaginal mucopurulent Discharge
Elevated ESR and C-reactive protein

Back 35

Pelvic Inflammatory Disease (PID)

Front 36

PID Hospital Treatment

Back 36

A: Cefotetan 2 g or Cefoxitin 2 g
PLUS Doxycyline 100 mg
continue for 14 days once
improves
B: Clindamycin 900 mg IV PLUS
Gentamicin IV or IM
once patient improves start on
doxy or clindamycin po

Front 37

PID Outpatient

Back 37

A: Ofloxacin 400 mg or levofloxacin 500 with or without metronidazole 500 x 14 days

B: Ceftriaxone 250 mg IM or cefoxitin 2 g IM once and Probenecid 1 g once
PLUS doxycycline with or without metronidazole 500

Treat partners for C. Trachomatis and N gonorrhoeae

Front 38

Prevention method that protects against cervical gonorrhea and chlamydia but not against HIV, increases the risk for candidasis

Back 38

Vaginal Sponge

Front 39

Protects against cervical gonorrhea, chlamydia, and trichomoniasis, increased risk for bacterial UTI in women, no protection against HIV

Back 39

Diaphragm

Front 40

Alone, is not recommended for STD & HIV prevention, can induce genital lesions and increase the risk for HIV transmission, not effective against cervical gonorrhea, chlamydia, HIV infections, increased risk of bacterial UTI

Back 40

Vaginal Spermicide

Front 41

Lower Urinary Tract

Back 41

Bladder (cystitis)
Urethra (urethritis)
Prostate Gland (Prostatitis)
Epididymitis

Front 42

Upper Urinary Tract

Back 42

Kidneys (pyelonephritis)
Ureters

Front 43

Things that could be present in urine that indicate a UTI

Back 43

Protein, Nitrite, Leukocyte esterase, RBS, WBC >10/mm3, Bacteria, alkaline pH (normal = 4.5-8.5), appearance is cloudy

Front 44

Symptomatic Female has a urine culture finding of

Back 44

>/= 10'2 CFU coliforms/mL or >/= 10'5 non coliforms/mL

Front 45

Symptomatic Male has a urine culture finding of

Back 45

>/= 10'3 CFU bacteria/mL

Front 46

Asymptomatic individual has a urine culture finding of

Back 46

>/= 10'5 CFU bacteria/mL x 2 specimens

Front 47

Catheterized Individual has a urine culture finding of

Back 47

>/= 10'2 CFU bacteria/mL

very cautious

Front 48

Clinical Presentation of Major Depressive Disorder

Back 48

SIGECAPS - Sleep, interests, guilt, energy, concentration, appetite - or +, psychomotor (retardation), suicidal thoughts and ideations

Front 49

MOA of TCA's

Back 49

Inhibition of presynaptic reuptake of NE and 5-HT, changes in receptor sensitivity

Front 50

MOA of Monoamine Oxidase Inhibitors

Back 50

Inhibition of MAO (irreversible) and reduces the breakdown of NE, 5-HT, and DA (MAO is responsible for the break down of these 3)

Front 51

MAO-B is the type of MAO primarily in the

Back 51

CNS (B for Brain)

Front 52

MAO-A is the type of MAO primarily in the

Back 52

GI Tract

Front 53

Wait __ weeks when discontinue antidepressant to start MAO-I except with ___ have to wait __ weeks before start MAO-I

Back 53

2 weeks, with fluoxetine (prozac) wait 4 weeks long half life!!!

Front 54

If u combine which drugs/foods with MAO-I's you will go into hypertensive crisis

Back 54

Tyramine containing foods (aged cheese, meats, yeast, red wines) and direct sympathomimetics (cocaine, OTC decongestants)
BP is 180/120 - decrease mean arterial pressure slow! no more than 20% per hour.

Front 55

MOA of Selective Serotonin Reuptake Inhibitors (SSRIs)

Back 55

Specifically inhibits reuptake of serotonin

Front 56

Only antidepressant medication don't have to taper off slowly

Back 56

Prozac - fluoxetine

Front 57

sexual dysfunction of not being able to get an erection is due to

Back 57

The Parasympathetic Nervous System (Point) which is because of the depression

Front 58

sexual dysfunction of not being able to ejaculate is due to

Back 58

the Sympathetic Nervous System (Shoot), usually a problem with the antidepressant (SSRI's)

Front 59

This SSRI has the least drug interactions and is great for an elderly person take 10 to 12 medications and causes more diarrhea than others but is ok for an elderly person more prone to constipation

Back 59

Zoloft (Sertraline)
initial = 25 to 50
range = 50 to 200 mg/day

Front 60

This SSRI has a lot of drug interactions and is more SEDATING than others

Back 60

Paxil (Paroxetine) - much more interactions and sedation than prozac
initial = 5 to 20 mg and range = 20 to 60 mg

Front 61

No major significant drug interactions and is not as activating as prozac or zoloft but not as sedating as paxil

Back 61

Celexa (Citalopram) initial = 10 to 20 mg and range = 20 to 60 mg

Front 62

The SSRI that causes headache and hypotension and interacts with warfarin and benzo's (CYP3A4), mainly indicated for anxiety

Back 62

Luvox (Fluvoxamine) initial 50 mg range = 50 to 300

Front 63

MOA of Serotonin & Norepinephrine Reuptake Inhibitor Effexor (Venlafaxine)

Back 63

5-HT > NE >> DA reuptake inhibitor (little DA but mainly 5-HT and NE)
increase dose = decrease 5-HT and more NE activity
similar to TCA's but less adverse events

Front 64

SNRI that is more NE based less CYP2D6 interactions,

Back 64

Pristiq (Desvenlafaxine) - More NE based 50 mg inital, no added benefit of going above 50 mg

Front 65

SNRI with a very short half life, need to taper off!! NO DA activity, also used for fibromyalgia

Back 65

Cymbalta (Duloxetine) initial is 20 mg BID, range = 40 to 60
CYP1A2 and CYP2D6
serotonin = weight gain and sexual dysfunction!!

Front 66

MOA of the aminoketone, wellbutrin (bupropion)

Back 66

Weak DA and NE reuptake inhibitor
NO Serotonin activity = no weight gain! less sexual side effects!!

Front 67

If go above 450 mg, seizure risk is increased!!! SE include mild hand tremor, constipation, nausea
Contraindicated in seizure disorder, eating disorder

Back 67

Wellbutrin (Bupropion) initial dose = 150 mg/d and range = 150 to 450 mg/d

Front 68

Tetracyclic Antidepressant MOA

Back 68

Mirtazapine (Remeron) - Alpha2 receptor antagonist; post synaptic block of 5-HT2 and 5-HT3 receptors

Front 69

Less Nausea and vomiting than other antidepressants, causes sexual dysfunction, minimal drug interactions

@ low doses = a lot of sedation and weight gain

increase dose = less weight gain and less sedation

Back 69

Mirtazapine (Remeron) - initial = 15 mg
range = 15 - 45 mg

Front 70

Triazolopridine Antidepressant MOA

Back 70

Nefazodone (Serzone) 5-HT >> NE reuptake inhibitor, 5-HT2 antagoinst

Trazodone (Desyrel) - weak 5-HT reuptake inhibitor, 5-HT2 Antagonist

Front 71

This antidepressant is rarely used because hepatotoxicity and causes a potent CYP3A4 interaction with benzo's

Back 71

Nefazodone (Serzone)

Front 72

This antidepressant is very seadating at low doses, adverse event is priapism

Back 72

Trazodone (Desyrel) - sleep = 50 to 200 mg, up to 600 mg/d

Front 73

Among the SSRI's this drug has least weight gain

Back 73

Fluoxetine (Prozac)

Front 74

SSRI's most activating

Back 74

Sertraline and Fluoxetine

Front 75

SSRI most sedating

Back 75

Paxil (paroxetine)

Front 76

SSRI's with most drug interactions

Back 76

Prozac and Paxil

Front 77

If depressed patient has insomnia?

Back 77

Mirtazapine, Paxil

Front 78

Depressed patient taking ritonavir, phenytoin, carbamazepine which antidepressant would be best?

Back 78

Celexa, Zoloft

Front 79

If a depressed patient failed 2 SSRI's what would you try?

Back 79

SNRI, bupropion

Front 80

Obese or afraid of gaining weight from antidepressant then try

Back 80

Prozac or Bupropion

Front 81

It usually take __ weeks to see benefits from most antidepressants

Back 81

4 weeks, 1st couple of weeks see alot more SE usually last 2 weeks

Front 82

First line for antidepressants

Back 82

SSRI's

Front 83

Drugs for Generalized Anxiety Disorder

Back 83

SSRIs - list line
Venalafaxine
TCAs
Benzo's
Buspirone
Hydroxyzine (Vistaril)
ALL ARE SCHEDULED NOT PRN!!
START AT LOWER DOSES MAY PUSH UPPER LIMITS - takes longer to treat 10 to 14 weeks

Front 84

3 benzodiazepines that you can use in liver damage or with a lot of other medications

Back 84

LOT - lorazepam, oxazepam, temazepam (by pass liver enzymes)

Front 85

MOA of Buspirone (Buspar)

Back 85

5-HT1A partial agonist, increases DA transmission
Only works for mild symptoms, 4 to 6 weeks before it works, LONG ONSET, need to push higher dose 60mg/day

If failed benzos then buspar won't work, NEVER PRN!!

Front 86

Drugs used for Social Anxiety

Back 86

Same as GAD except no TCA's, no hydroxyzine
SSRIs, Venlafaxine, Benzos, buspirone
beta blockers, gabapentin, MAOI's

Cognitive Behavioral Therapy is most effective nonpharmacologic Therapy

Front 87

Can use Benzos as PRN for this type of Anxiety

Back 87

Social Anxiety

Front 88

This type of med is used for social anxiety but contraindicated in CHF, bradycardia, bronchospasms

Back 88

Propranolol 10 to 20 mg 1 or 2 hours before social event to decrease peripheral manifestations such as palpitations, sweating, tachycardia

Front 89

Last line for Social Anxiety

Back 89

MAOIs - phenelzine
overdose = death
tyramine restrictions

Front 90

Drugs for Panic Disorder

Back 90

SSRIs - scheduled, paxil more sedating
TCAs - not well tolerated may see imipramine
MAOIs - last line
Benzos - PRN or scheduled use as bridge waiting for SSRI to work, if can't predict event then use scheduled

Front 91

These drugs have shown to be INEFFECTIVE in controlled trials for panic disorder

Back 91

Buspar, Propranolol, Clonidine

Wellbutrin is too activating - only hits NE and DA not serotonin

Front 92

Drugs for OCD

Back 92

SSRIs - 1st line push higher doses
TCAs - SE's

Combo SSRI
+ mood stabilizer if aggressive
+ antipsychotic if have delusions
+ benzo if anxiety
+ CBT if anxiety

Front 93

Anticonvulsants "mood stabilizers" if patient is being

Back 93

Aggressive - Valproic Acid, Carbamazepine, lithium, topamax

Front 94

Drugs for PTSD

Back 94

SSRIs - sertraline, fluoxetine
TCAs
MAOIs - 3rd line drug interactions, diet Anticonvulsants - if aggressive
Antipsychotics - if hallucinations

Front 95

This drug has been shown to be useless and ineffective in PTSD

Back 95

Benzodiazepines

Front 96

If patient abuses alcohol use these benzos for anxiety/panic attack

Back 96

LOTe - lorazepam, oxazepam, temazepam

Front 97

Use these antidepressants for suicidal risk

Back 97

SSRI's, SNRI's

Front 98

Anxiety is due to which neurotransmitter

Back 98

Serotonin

Front 99

This Second Generation Antisphychotic is the worst for movement disorders (EPS) and increase risk of stroke

Back 99

Risperidone

Front 100

These Second Generation Antisphychotic has the most weight gain

Back 100

Clozapine, Olanzepine (Zyprexa)

Front 101

These 2 SGA have the least weight gain associated with them

Back 101

Ziprasidone (geodon), Aripiprazole (abilify)

Front 102

This SGA has increased akathsia (feeling of inner restlessness)

Back 102

Aripiprazole (abilify) - give in am with food

Front 103

This SGA has sedation and cataracts associated with it

Back 103

Quetiapine (seroquel) - give HS, monitor for cataracts if over 40

Front 104

This SGA has an adverse effect of hyperprolactinemia, galactorrhea, gynecomastia, and dose dependent movement disorders

Back 104

Risperidone

Front 105

This SGA has a QTc prolongation associated with higher doses and akathisia in lower doses

Back 105

Ziprasidone - get baseline ECG

Front 106

Target Lithium Plasma levels are ___ and when do you obtain levels

Back 106

0.8 to 1.2 mEq/L, obtain before 1st morning dose of Lithium and least 8 to 12 hours after evening dose