Exam 4 Flashcards

1
Q

Truvada

A
  • emtricitabine with TDF
  • taken once daily
  • recommended to prevent HIV among all people with sex or IVDU
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2
Q

Descovy

A
  • emtricitaabine with TAF
  • recommended to prevent HIV through sexual transmission (not receptive vaginal sex)
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3
Q

Apretude

A
  • Cabotegravir IM
  • first injection followed by a second injection 1 month after the first and q2 months after
  • prevent HIV among all people
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4
Q

What is PrEP

A

FDA approved med to prevent HIV in adults and adolescents weighing ≥77 lb

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5
Q

Substantial risk for HIV and ≤72 hours since exposure AND source is known to have HIV

A
  • nPEP vis recommended
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6
Q

Substantial risk for HIV and ≤72 hours since exposure AND source is unknown to have HIV

A

case-by-case determination

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7
Q

Substantial risk for HIV and ≥73 hours since exposure

A

nPEP not recommended

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8
Q

nPEP regimens

A
  • TDF/Emtricitabine once daily + raltegravir BID or dolutegravir daily
  • TDF/Emtricitabine + Darunavir/ritonavir daily
  • 28 days
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9
Q

HPV Vaccine

A
  • recommended for routine vaccination at age 11 or 12
  • does not treat existing HPV infections or diseases
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10
Q

Uncomplicated Gonorrhea

A
  • endocervix
  • asymptomatic or mildly symptomatic
  • disseminated infection may occur (in women mostly)
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11
Q

Gonorrhea in men

A
  • acute urethritis
  • purulent discharge and dysuria
  • spontaneous resolution after several weeks
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12
Q

Anorectal gonorrhea infection

A
  • most patients are asymptomatic
  • acute proctitus
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13
Q

pharyngeal gonorrhea infection

A
  • orogenital sexual exposure!
  • asymptomatic
  • screened less frequently
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14
Q

Gonorrhea in newborns

A
  • may be transmitted in utero, birth canal
  • opthalmia neonatorum
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15
Q

Treatment of Uncomplicated Gonoccoal Infections of Cervix/Urethra/Rectum

A
  • <150 kg ceftriaxone 500 mg IM x 1
  • > 150 kg ceftriaxone 1 gm IM x 1
  • if w/ chlamydia, give doxycycline 100 mg PO BID x 7 days (pregnant azithro 1 gm PO once)
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16
Q

Treatment of Uncomplicated Gonoccoal Infections of Cervix/Urethra/Rectum and Ceftriaxone is NOT availabile

A
  • gent 240 mg IM x 1 + azithro 2 g PO x 1
  • cefixime 800 mg PO x1
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17
Q

Expedited partner therapy

A
  • cefixime 800 mg PO x 1 + chlamydia treatment if not excluded
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18
Q

Primary Syphilis

A
  • painless lesion (chancre)
  • disappear spontaneously without treatment (3-6 weeks)
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19
Q

Secondary Syphilis

A
  • lesions anywhere on body including hands and soles of feet
  • malaise, fever, pharyngitis, headache, anorexia
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20
Q

Latent Syphilis

A
  • positive serologic tests but no other evidence of disease
  • early latent patient is potentially infectious
  • late latent, noninfectious except in pregnancy
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21
Q

Tertiary (Late) Syphilis

A
  • slowly progressing, inflammatory phase of the disease
  • can affect any organ in the body
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22
Q

Primary and Secondary Syphilis Treatment

A

Benzathine PenG 2.4 million units IM x 1 dose

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23
Q

Primary and Secondary Syphilis Treatment PCN Allergy

A
  • doxy 100 mg BID x 14 days
  • tetracycline 500 mg QID x 14 days
  • azithromycin 2 g x 1 dose (resistance)
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24
Q

Early Latent Syphilis Treatment

A

Benzathine PenG 2.4 million units IM x 1 dose

if PCN allergy
- doxy 100 mg BID x 14 days
- tetracycline 500 mg QID x 14 days

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25
Late Latent Syphilis Treatment
Benzathine PenG 2.4 million units IM once weekly x 3 weeks if PCN allergy - doxy 100 mg BID x 28 days - tetracycline 500 mg QID x 28 days
26
Tertiary Syphilis Treatment
Benzathine PenG 2.4 million units IM once weekly x 3 weeks if PCN allergy - doxy 100 mg BID x 28 days - tetracycline 500 mg QID x 28 days
27
Neurosyphilis Treatment
- aqueous crystalline PenG 3-4 million units IV q4h x 10-14 days (or 18-24 million units/day as CI) - Procaine Pen 2.4 million units IM daily + probenecid 500 mg PO QID x 10-14 days if PCN allergy - ceftriaxone 2 g IM or IV daily x 10-14 days
28
HIV + and Primary/SEcondary syphillus
same as non HIV patient
29
HIV and early latent syphilis
Benzathine PenG 2.4 million units IM x 1 dose
30
HIV and late latent or unknown duration
Benzathine PenG 2.4 million units IM x once weekly x 3 weeks
31
HIV and neurosyphilis
- aqueous crystalline PenG 3-4 million units IV q4h x 10-14 days (or 18-24 million units/day as CI) - Procaine Pen 2.4 million units IM daily + probenecid 500 mg PO QID x 10-14 days if PCN allergy - ceftriaxone 2 g IM or IV daily x 10-14 days
32
Syphilis and Pregnancy
- penicillin is the only reliable agent to treat the fetus
33
Recommended treatment of chlamydia for adolescents and adults
doxycycline 100 mg PO BID x 7 days
34
Alternative treatment of chlamydia in adolescents and adults
- azithromycin 1 gm PO x 1 dose - levofloxacin 500 mg PO q24h x 7 days
35
Treatment of chlamydia in pregnancy
- azithromycin 500 mg PO x 1 dose - alternative is amox 500 mg PO TID x 7 days
36
Macrolide-susceptible mycoplasma gen
- doxy 100 mg PO bid x 7 days followed by azithromycin 1 g PO x 1 followed by 500 mg PO daily x 3 additional days
37
Macrolide-resistan mycoplasma gen
- doxy 100 mg PO BID x 7 days followed by moxi 400 mg PO daily x 7 days
38
Testing not available for mycoplasma gen
- doxy 100 mg PO BID x 7 days followed by moxi 400 mg PO daily x 7 days
39
First clinical episode of genital herpes
- acyclovir 400 mg PO TID or - famciclovir 250 mg PO TID or - valtrex 1 g PO BID - 7-10 days
40
Recurrent treatment of genital herpes
- acyclovir 800 mg PO BID x 5 days (or TID x 2 days) or - famciclovir 125 mg PO BID (or 1 g x1) or - valtrex 500 mg PO BID x 3 days (1 g po daily x 5 days)
41
Severe HSV disease
acyclovir 5-10 mg/kg/dose IV q8h for 2-7 days until clincial improvement
42
Suppressive treatment of HSV
- acyclovir 400 mg PO BID - famciclovir 250 mg po bid - valacyclovir 500 mg/1g PO daily
43
Pregnancy suppressive therpay for HSV
- acyclovir 400 mg PO TID - valacyclovir 500 mg PO BID start at 36 weeks
44
Trich treatment in women
metronidazole 500 mg PO BID x 7 days OR tinidazole 2 g po x 1 dose
45
Trich treatment in men
metronidazole 2g mg PO x 1 dose OR tinidazole 2 g po x 1 dose
46
Trich treatment in HIV
metronidazole 500 mg PO BID x 7 days
47
PID Standard Tratment
- ceftriaxone.1 g IV and - doxy 100 mg IV or PO BID and - metronidazole 500 mg IV or PO BID x 14 days
48
PID Alternative PN Treatment
- unasyn 3 g q6 and - doxy 100 mg IV/PO q12 14 days PCN allergy (clinda+gent)
49
PID IM/Oral treatment
- ceftriaxone 500 mg IM x 1 dose and doxy 100 mg BID and metronidazole 500 mg BID 14 days
50
Lab findings for endocarditis
- bacteremia is continuous and low grade (<100 CFU/mL blood) - draw at least 3 sets from different sites initially, then 2 sets q2-3 days
51
Major Criteria for Endocarditis
- microbio - imaging - surgicaal
52
Viridans Group Strep and S. gallolyticus native valve endocarditis treatment
- pen G or ceftriaxone 4 weeks - pen g + gent 2 weeks (not for patients with cardiac abscessess) - ceftriaxone + gent 2 weeks - vanc 4 weeks only for patients who cannot tolarate beta lactams
53
Viridans Group Strep and S. gallolyticus pen resistant native valve endocarditis treatment
- pen g (4 weeks) + gent (2 weeks) - ceftriaxone (4 weeks) + gent (2 weeks - vancomycin 4 weeks
54
Viridans Group Strep and S. gallolyticus prothestic valve endocarditis treatment
- pen g w or w/o gent - ceftriaxone w or w/o gent - vancomycin - amp is reasonable alternative - gent is 2 weeks, others are 6 weeks
55
Viridans Group Strep and S. gallolyticus prosthetic valve pen resistant endocarditis treatment
- pen g + gent - ceftriaxone + gent - vancomycin - amp is reasonable alternative - 6 weeks
56
staphylococci native valve endocarditis MSSA
- nafcillin or oxacillin x 6 weeks - cefazolin for pcn allergy x 6 weesks - if uncomplicated, then 2 weeks
57
staphylococci native valve endocarditis MRSA
- vanc or dapto x 6 weeks
58
What is daptomycin FDA approved for in endocarditis?
- right sided endocarditis 6 mg/kg/day - 14-28 days uncomplicated - 28-42 days complicated
59
staphylococci prosthetic valve endocarditis oxacillin susceptible
- nafcillin/oxacillin (6 weeks) + - rifampin (6 weeks) + - gent (2 weeks)
60
staphylococci prosthetic valve endocarditis oxacillin resistant
- vanc (6 weeks) + - rifampin (6 weeks) + - gent (2 weeks)
61
Enterococi endocarditis pen and gent susceptible
- amp + gent - pen + gent - aamp + ceftriaxone for pts with clcl <50 mL/min
62
Enterococi endocarditis pen susceptible and gent resistanat
- amp + ceftriaxone
63
Enterococi endocarditis pen and gent resistant and streptomycin susceptible
- amp + streptomycin - pen + streptomycin
64
Enterococi endocarditis unable to tolerate beta lactam
- vanc + gent
65
Enterococi endocarditis resistant to beta lactams or pcn
vanc+gent
66
Enterococi endocarditis pen, aminoglycoside, vanc resistant
daptomycin or linezolid
67
HACEK Endocarditis
- ceftriaxone - unasyn - cipro
68
culture negative native valve endo
- vanc + cefepime (acute) - unasyn + vanc (subacute)
69
culture negative prosthetic valve endo eaarly
- vanc + - gent + - rifampin + - cefepime
70
culture negative prosthetic valve endo laate
vanc + ceftriaxone
71
SBP Empiric Treatment
- ceftriaxone - cefepime - zosyn - meropenem
72
SBP risk for MRSA
add vanc/dapto/linezolid
73
Treatment duration for SBP
- 5-7 days for patient with cirrhosis and ascites - 14-21 days for patients undergoing CAPB
74
Enterococci coverage for secondary peritonitis
- high seveirty IAI - history of recent cephalosporin use - immunocompromised - biliary source of infection - history of valvular heart disease - prosthetic intravascular material
75
CA Mild-Moderate SP
- ceftriaxone + metro - cefazolin + metro - cefoxitin - ertapenem - tigecycline
76
CA Severe and HA SP
- zosyn - meropenem - cefepime
77
Oral therapy for SP
- augement q8 - cefpodoxime + metro - cephalexin + metro - cefadroxil + metro - cipro + metro - levo + metor - TMP/SMX DS + metro
78
Treatment duration for SP
4-7 days after source control
79
Treatment of MRSA SAB
- vancomycin 15-20 mg/kg IV q8-12h - daptomycin 6-10 mg/kg IV q24h (right sided endo)
80
Treatment of MSSA bactermia
- nafcillin 2g IV q4h - oxacillin 2g IV q4h - cefazolin 2g IV q8h *inocculum effect?*
81
Duration of uncomplicated SAB
- 14 days from first negative blood culture
82
Duration of complicated SAB
- 4 weeks IV
83
duration of complicated SAB with metastataic infection
6-8 weeks IV
84
Streptococci bacteremia
- penicillin for group strep - ceftriaxone or penicillin for strep pneumo - 14 days
85
enterococci bacteremia
- e faecalis is amp (vanc/dapto if allergy) - e faecium vanc (VRE use dapto/linezolid) - 7 days
86