24/9/21 Flashcards
How long does it take to achieve maximum protection when taking daily PrEP for men? How long for women?
Men - 7 days
Women - 20 days
What are the 5 Steps in prescribing Prep?
- Behavioural Suitability
- Clinical Suitability
- Other Testing
- Prescribing PrEP
- Ongoing Monitoring
What is involved in Step 2 of prescribing PrEP -> Clinical Suitability? (3 points)
HIV Status + ?recent exposure
Renal Function
Nephrotoxic Medication
If HIV negative but recent exposure, what are the next steps?
Refer to/Consult with PEP prescriber -> consider PrEP following completion of PrEP
What is involved in Step 3? (Other Testing)
STI Testing + Heptatits B + C Testing
- STI testing - as per STI guidelines
- Hepatitis B testing - HBsAg, Anti-HBs, Anti-HBc → vaccinate if not immune. If HBsAg is positive → refer to HBV specialist
- Hepatitis C testing → anti-HCV, followed by HCV RNA if anti-HCV positive. If HCV RNA positive → treat Hepatitis C
What are the 2 options when prescribing PrEP (Step 4)?
Who is suitable for either option?
- Daily Continuous PrEP → 1 pill daily of tenofovir/emtricitabine → start 7 days before HIV risk
- suitable for anyone with ongoing risk of HIV exposure
- On-Demand PrEP (2-1-1 method) → tenofovir/emtricitabine → 2 pills 2/24 before sex, 1 pill 24/24 later, 1 pill 48/24 after first dose
- suitable only in cis-male who have sex with men whose HIV risk if from anal sex not from IVDU
What are the 9 points involved in ongoing monitoring following commencement of PrEP (Step 5)?
HIV Testing Side Effects Hep A Hep B Hep C STI Screening Renal Function (eGFR) Urine Protein Creatinine Ratio Pregnancy Test
What testing takes place at baseline when starting PrEP?
HIV Testing Hep A Hep B Hep C STI Screening Renal Function (eGFR) Urine Protein Creatinine Ratio Pregnancy Test
What testing takes place at 1 month following commencement of PrEP?
HIV Testing
Side Effects
Pregnancy Test
What testing takes place at 3 months following commencement of PrEP?
HIV Testing Side Effects STI Screening Renal Function (eGFR) Urine Protein Creatinine Ratio Pregnancy Test
What testing takes place every 3 months after the commencement of PrEP?
HIV Testing
Side Effects
STI Screening
Pregnancy Test
What additional testing needs to take place following commencement of PrEP?
eGFR + urine protein creatinine ratio -> every 6 months or sooner as per CKD guidelines
Hep C -> 12 monthly but more frequent if ongoing risk -> e.g MSM with anal trauma or IVDU
Hep B -> If required Hep B immunisation -> check immune response 1 month after last vaccination
Short Term and Long Term side effects of PrEP (2 each please)
Short Term - headache + nausea
Long-Term - Renal Toxicity + Lowered Bone Density
In Lewy Body Dementia, what are the three associated features along with the memory loss?
- Any 2 of: fluctuating confusion, visual hallucinations, spontaneous motor Parkinsonism and sleep behaviour disorder
In frontotemporal dementia, what are two of the earliest manifestations of this disease?
- personality change and altered behaviour can be the earliest manifestations of this condition
Lab Findings for Cholestatic Picture of deranged LFTs.
Common Causes of Cholestatic Picture (give me 3)
- Laboratory Findings → ALP >200 + ALP > 3xALT
- Common Causes:
- Biliary Obstruction
- Pregnancy
- Drugs → erythromycin, oestrogen
- Infiltration → Malignancy
Lab Findings for Hepatocelluliar Damage Picture for deranged LFTs.
Common Causes of Hepatocelluliar Damage Picture. (give me 3)
- Laboratory Findings → ALT >200 + ALT > 3xALP
- Common Causes
- Infection → Hepatitis B, C, A, EBV, CMV
- Alcohol → AST often >2xALT
- Fatty Liver
- Drugs → paracetamol
- Metal Overload
- Hypoxia
- Autoimmune
Risk Factors for Pancreatic Cancer (4 points). How many fold is the increase in risk with these risk factors?
- ≥2 affected first degree relatives
- Lynch Syndrome OR BRCA2 Gene Carrier + ≥1 affected first degree relative
- Hereditary pancreatitis with PRSS1 mutation
- Peutz-Jehger Syndrome
5 times the risk of the general population
3 indications for referral to specialist in the context of pancreatic cancer.
- Unexplained weight loss + any of: back pain, abdo pain, nausea/vomiting, diarrhoea or constipation, new onset diabetes → CT Abdo → Pancreatic Mass → specialist referral
- Jaundice + Age ≥ 40yo → specialist referral
- Risk Factors -> specialist referral