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Pharmacy Practice VI > EXAM ONE > Flashcards

EXAM ONE Flashcards

1
Q

Ticks are the ___common vector to transmit infectious disease in North America, and ___ most common globally.

A

MOST, 2nd

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2
Q

What are 3 Common Tick Borne Illnesses in the US?

A
  1. Lyme Disease
  2. Babesiosis
  3. Ehrlichiosis
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3
Q

Which disease is caused by the Lone Star Tick?

A

Ehrlichiosis

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4
Q

Tick-Induced Meat Allergy is also known as what?

A

Alpha-Gal Allergy

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5
Q

T/F: Southern Tick-Associated Rash Illness STARI is another name for Lyme disease that occurs in the southeastern and south central US.

A

False

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6
Q

Ticks have a ___ year lifecycle

A

2

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7
Q

T/F: A New Host is required during each lifestyle stage

A

True

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8
Q

Larva, Nymphs, and Adult Ticks feed on ___ for growth.

A

Blood

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9
Q

What species is known as HARD Ticks?

A

Ixodid

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10
Q

What species is known as SOFT Ticks?

A

Argasid

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11
Q

The most common ticks and the main vectors for Lyme disease are what?

A

Ixodid Species

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12
Q

What Tick species are known as rapid feeders and detach from their host 1 hour after feeding?

A

Argasid Species

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13
Q

In 2021, which Oklahoma County met CDC Criteria for Deer Tick Endemic with Lyme disease?

A

Cherokee

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14
Q

T/F: Ticks cause Lyme Disease

A

False

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15
Q

T/F: Ticks are a Vector for Spirochete Bacteria that causes Lyme disease.

A

True

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16
Q

List the 2 types of Deer Ticks

A
  1. Ixodes Scapularis
  2. Ixodes Pacificus
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17
Q

What is the bacteria that causes Lyme disease?

A

Spirochete Borrelia Burgdorferi

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18
Q

What are the symptoms of Lyme Disease?

A
  1. Bullseye Rash
  2. Flu-Like Syndrome
  3. Lymphadenopathy
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19
Q

List the 5 steps in How to Remove a Tick

A
  1. If possible, wear gloves to protect yourself from tick exposure
  2. Position the tweezers as close to the patient’s skin as possible and grasp the tick
  3. Pull Up. Do NOT twist tweezers
  4. Clean the bite area with disinfectant
  5. Dispose of tick by drowning it in alcohol, sealing it in a bag, wrapping tightly in tape, or flushing it down the toliet
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20
Q

T/F: You can use heat, nail polish, and Vaseline to remove a Tick.

A

False, AVOID all of these

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21
Q

Which first aid should be applied to the bite site after Tick Removal?

A
  1. Isopropyl Alcohol
  2. Water
  3. Soap
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22
Q

Define the S/S of Early Disseminated Classification of Lyme Disease

A
  1. Bullseye Rash
  2. Neurologic Symptoms: bell palsy, meningitis, radiuclopathy, encephalomyelitis
  3. Lyme Carditis
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23
Q

Define the S/S of Late Classification of Lyme Disease

A
  1. Arthritis
  2. Neurologic Symptoms: encephalomyelitis, encephalopathy, peripheral neuropathy
  3. Acrodermatitis Chronica Trophicans
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24
Q

Early Disseminated Classification in Lyme disease means what?

A

Localized Symptoms of Lyme Disease

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25
Q

Late Classification in Lyme disease means what?

A

Serious, taken root, progressive damage

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25
Q

Which patient is at greatest risk for developing Acrodermatitis Chronic Atrophicans?

A

Older European Female

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26
Q

Define Acrodermatitis Chronic Trophicans

A

Thinning out skin, red/blue hue, papery texture

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27
Q

T/F: All Ticks require referral to PCP

A

True

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28
Q

____ Care relies on OTC products and nonpharmacologic therapy

A

Preventive

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29
Q

List the 6 Non Pharmacological Prevention Methods

A
  1. Clothe as much skin as possible
  2. Avoid areas harboring ticks such as dense woods and brush
  3. Limit time spent outside especially at dawn and dusk
  4. Self inspect skin daily
  5. Keep pets pest free
  6. Apply inspect repellant
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30
Q

What are the 4 elements to consider with Insect Repellant?

A
  1. Ingredients
  2. Concentration
  3. Formulation
  4. Type and Length of Exposure
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31
Q

What agent is recommended as the drug of choice for prophylaxis of Lyme disease?

A

Doxycycline

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32
Q

What is the prophylaxis dosing of Doxycycline for Lyme disease?

A

200 mg PO for 1 DOSE

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33
Q

T/F: Recommend Topical Antibiotics Neosporin for Tick Bites.

A

False, wash the area with soap, water, and isopropyl alcohol

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34
Q

What 5 Criteria must be met for a patient to qualify for Doxycycline prophylaxis for Lyme disease?

A
  1. Tick identified as Ixodes Scapularis
  2. The tick was attached for >36 hours
  3. It has been <72 hours since the tick was removed
  4. Local rate of borrelia burfadorferi in ticks >20%
  5. The patient possess no contraindication to doxycycline
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35
Q

T/F: If one criteria for Doxycycline prophylaxis is not met, the patient does NOT qualify for therapy.

A

True

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36
Q

DEET is the active ingredient found in bug sprays, however improper use/ingestion may lead to what AEs?

A
  1. Seizures
  2. Ataxia
  3. Hypotension
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37
Q

DEET Concentration _____% should be used for Tick Prevention

A

20-50

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38
Q

T/F: DEET Concentrations >50% suggests better efficacy.

A

False

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39
Q

T/F: DEET is safe to use in patients who are pregnant and lactating.

A

True

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40
Q

How often should you apply DEET?

A

q 4-8 hours

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41
Q

Why should you avoid DEET and Sunscreen combination products?

A
  1. Sunscreen needs to be applied q2 hrs
  2. DEET applied q 4-8 hrs
  3. Overapplication of DEET may lead to toxicities
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42
Q

What is first line therapy for PO treatment of Lyme disease?

A
  1. Doxycycline
  2. Amoxicillin
  3. Cefuroxime
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43
Q

What is the dosing of Doxycycline for Lyme disease?

A
  1. 100 mg BID
  2. 200 mg QD
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44
Q

What is the dosing of Amoxicillin for Lyme disease?

A

500 mg PO TID

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45
Q

What is the dosing of Cefuroxime for Lyme disease?

A

500 mg PO BID

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46
Q

If patients are unable to take first line PO medication for Lyme disease, what is the 2nd line PO option?

A

Azithromycin 500 mg PO QD

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47
Q

What is first line therapy IV treatment for Lyme disease and its dose?

A

Ceftriaxone 2 grams IV daily

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48
Q

What is 2nd line IV treatment options for Lyme disease and its dosing?

A
  1. Cefotaxime 2 grams IV TID
  2. Penicillin G 18-24 million units/day
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49
Q

When is IV treatment for Lyme disease indicated?

A
  1. Inpatient Lyme Carditis
  2. Parenchymal Neurologic Lyme Disease
  3. Lyme arthritis unresponsive to PO Abx
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50
Q

What are the precautions of Doxycycline?

A
  1. Patients <8 yrs
  2. Pregnant Patients
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51
Q

T/F: Hyclate Salt (Vibramycin) is more acidic than Monohydrate Salt (Monodox) which may cause more stomach upset

A

True

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52
Q

T/F: Monohydrate Doxycycline capsules work when gastric pH is high

A

False, may not work when gastric pH is high

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53
Q

What is the patient education for Doxycycline?

A
  1. Sit up right for 30 mins
  2. Separate from antacids/multivitamins for 2 hours
  3. Wear sunscreen
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54
Q

T/F: Amoxicillin has AEs of Diarrhea

A

True

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55
Q

T/F: Amoxicillin is not safe for patients who are pregnant or breastfeeding

A

False

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56
Q

T/F: Amoxicillin must be dose adjusted if comorbid renal impairment is present

A

True

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57
Q

What 3rd Generation Cephalosporins are used in the treatment of Lyme disease?

A
  1. Cefuroxime: first line PO
  2. Ceftriaxone: first line IV
  3. Cefotaxime: alternative IV
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58
Q

What is the main tolerability problem with 3rd Gen Cephalosporins in Lyme disease treatment?

A

C. diff associated diarrhea

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59
Q

Azithromycin Indications in Lyme disease are what?

A
  1. Patients unable to to take first line PO drugs for Lyme
  2. Only for skin reactions.
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60
Q

Azithromycin treatment for Lyme disease is used only for _________.

A

Erythema Mirgrans

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61
Q

What are the precautions of Azithromycin?

A
  1. Patients with pre-existing heart conditions
  2. Patients taking anti arrhythmic drugs
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62
Q

Penicillin G is used when in Lyme disease?

A

IV Options for patients unable to receive Ceftriaxone

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63
Q

Which Doxycycline formulation may be better in a patient taking Omeprazole?

A

Doxycycline Hyclate (Vibramycin)

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64
Q

T/F: Age less than 8 years is contraindicated to Doxycycline.

A

False

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65
Q

T/F: Pregnancy is a contraindication to Doxycycline.

A

False

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66
Q

Patients should be educated to sit upright for ____ minutes after taking Doxycycline.

A

30

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67
Q

Third generation cephalosporins increase the risk for C. diff diarrhea because of their increased activity against which microorganisms?

A

Gram Negative Rods

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68
Q

Which third generation cephalosporin does not require dose adjustments in the setting of renal impairment?

A

Ceftriaxone

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69
Q

When used to treat Lyme disease, Penicillin G is administered via which route?

A

IV

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70
Q

What is the duration of therapy for Doxycycline in the treatment of Erythema Migrans?

A

10 days

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71
Q

What is the duration of therapy for Amoxicillin or Cefuroxime in the treatment of Erythema Migrans?

A

14 days

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72
Q

What is the duration of therapy for Azithromycin in the treatment of Erythema Migrans?

A

7 days

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73
Q

What is duration of therapy for Carditis/Neurologic Lyme disease?

A

14-21 days

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74
Q

What is duration of therapy for Acrodermatitis chronic atrophicans Lyme disease?

A

21-28 days

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75
Q

What is duration of therapy for Arthritis Lyme disease?

A

28 days

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76
Q

T/F: Doxycycline is safe when used for 14 days in the treatment of Lyme disease for Pregnant Patients.

A

True

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77
Q

What are common symptoms seen in Recurrent Lyme disease?

A
  1. Fatigue
  2. Musculoskeletal Pain
  3. Neurocognitive Impairment
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78
Q

Are antibiotics recommended for Recurrent Lyme disease?

A

NO

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79
Q

T/F: Posttreatment Lyme disease syndrome will self-resolve over time and antibiotics are not recommended.

A

True

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80
Q

Doxycycline has been associated with which complications when used for inappropriate durations in pregnant patients?

A
  1. Birth Defects
  2. Premature Delivery
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81
Q

In terms of STIs, ____ patients are at greater risk for STI sequels including infertility, malignancy, and pain.

A

FEMALE

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82
Q

What are the components of the 5Ps Approach to Sexual History Collection?

A
  1. Past History
  2. Practices
  3. Pregnancy
  4. Partners
  5. Protection
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83
Q

What are the CDC’s 5 Public Health strategies for the prevention of STIs?

A
  1. Risk Assessment
  2. Vaccinate
  3. Symptomatic
  4. Patients
  5. Partners
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84
Q

What is recommended by the CDC to protect patients from STIs?

A
  1. Abstinence
  2. Mutual Monogamy
  3. Limit the Number of Sexual Partners
  4. Condoms
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85
Q

Condoms function as _____ to prevent STI Transmission and are classified as MEDICAL DEVICES by the FDA.

A

Barriers

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86
Q

T/F: Avoid recommending spermicide-containing condoms because of irritation and lack of efficacy.

A

True

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87
Q

Typical Use of Condoms is correlated with _____ leading to compromised efficacy and therefore, is a concern in terms of STIs.

A

Breakage

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88
Q

T/F: Spermicides are effective antibiotics for the prevention of sexually transmitted infections.

A

False

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89
Q

What are the 3 types of Male Condoms?

A
  1. Latex
  2. Natural Membrane
  3. Synthetic
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90
Q

Details about Latex Condoms

A

Cheap/Effective, cannot be used in patients with latex allergies

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91
Q

Details about Natural Membrane Condoms

A

DECREASED efficacy in protection against STIs due to porous nature

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92
Q

Details about Synthetic Condoms

A

Higher breakage rate, should be used 2nd line after Latex condoms

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93
Q

What is the hierarchy of Male Condoms?

A

Latex > Synthetic > Natural

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94
Q

T/F: Female condoms are equally efficacious as male condoms

A

True

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95
Q

For use of male condoms in STIs patients should be educated to trial different _____ before switching ____.

A

Brands; Types (latex vs synthetic)

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96
Q

What is the most common STI in the U.S.?

A

Human Papillomavirus HPV

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97
Q

Clinical HPV includes what 4 things?

A
  1. Common Worts or Anogenital Worts
  2. Respiratory Papillomatosis
  3. Cervical Cancer Precursors
  4. Cervical and Mucosal Cancers
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98
Q

HPV is what type of virus?

A

Double Stranded DNA virus that affects skin and mucosa

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99
Q

Common Worts caused by the virus, most of them are _____ .

A

Asymptomatic

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100
Q

T/F: Although some HPV warts develop in childhood often self-resolve, some will persist into adulthood.

A

True

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101
Q

T/F: Warts in adulthood are less persistent and insidious.

A

False, MORE persistent/insidious

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102
Q

T/F: Invasive cancers may develop as a result of HPV infection.

A

True

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103
Q

Cervarix HPV Vaccine covers what subtypes?

A

16 and 18

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104
Q

T/F: Cervarix covers genitoanal warts.

A

False

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105
Q

Gardasil HPV Vaccine covers what subtypes?

A

6,11,16,18

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106
Q

T/F: Gardasil covers genitoanal warts

A

True

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107
Q

T/F: Gardasil 9 is significantly better than the other vaccines.

A

False, no phase 4 clinical data cannot make that assumption

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108
Q

What is the Routine Vaccination age for the HPV Vaccine?

A

9-14 yrs
Ideally 11-12 yrs

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109
Q

What is the dosing schedule for Routine Vaccination of HPV?

A

Administer 2 doses 6-12 months apart

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110
Q

What is the Catch-Up Vaccination age for the HPV Vaccine?

A
  1. 15-26 years
  2. 9-14 years <5 months apart
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111
Q

What is the dosing schedule for Catch-Up Vaccination and Shared Clinical Decision of HPV?

A

Administer 3 doses at 0, 2 , and 6 months

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112
Q

T/F: Heterosexual Males Catch-Up Vaccination phase is from 15-26 years old.

A

False, 15-21 years old
Up to 26 yrs for MSM

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113
Q

What is the Shared Clinical Decision age for the HPV Vaccine?

A

27-45 years

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114
Q

Per the CDC/ACIP, the 9vHPV vaccine may be least effective in which age group?

A

27-45 years

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115
Q

An 18 year old patient received dose #1 of the HPV vaccine January 2023 and dose #2 in February 2023. When should the patient receive dose #3?

A

June 2023

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116
Q

HPV Vaccination is contraindicated in what patients?

A

Yeast Allergy

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117
Q

T/F: HPV Vaccine has vasovagal reactions and should monitor the patients for 15 minutes after administration.

A

True

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118
Q

T/F: You can administer HPV in pregnant and breastfeeding patients.

A

False, only admin in breastfeeding patients NOT pregnant patients

119
Q

T/F: HPV = HSV

A

False

120
Q

_____ drugs are NOT currently indicated for the general management of HPV.

A

Antiviral

121
Q

Before using treatment, patients must do what for HPV common worts?

A
  1. Soak the affected skin in warm water for 5-10 mins
  2. Use emery board or sandpaper to desquamate upper layers of the wort
122
Q

What is used in the treatment of HPV Common Warts?

A

Salicyclic Acid

123
Q

What are the indications for the use of Salicyclic Acid?

A
  1. Uncomfortable warts
  2. Affect physical appearance
  3. Affect physical function
  4. Thought to increase cancer risk
124
Q

What are the contraindications to the use of Salicylic Acid?

A
  1. Facial Warts
  2. Areas of Poor Circulation
  3. Areas of Ulceration or Poor Healing
  4. Neuropathies
125
Q

What are the tolerability issues associated with Salicylic Acid?

A
  1. Wet wrinkly skin (maceration)
  2. Skin shedding (desquamation)
126
Q

T/F: It is recommended to start with 10-26% concentrations of Salicylic Acid, higher concentrations in naive patients can lead to increased side effects.

A

True

127
Q

What is the most important pearl about Salicylic Acid?

A

Adherence, at least once DAILY x 12 weeks

128
Q

T/F: Internal Warts: anal/vaginal/cervical are treated with pharmacotherapy.

A

False, they are not and need to be referred to provider

129
Q

What 3 Agents are used for the treatment of Anogenital Warts?

A
  1. Imiquimod
  2. Podofilox
  3. Sinecatechins
130
Q

Efficacy of Imiquimod

A

10-70%

131
Q

Efficacy of Podofilox

A

40-80%

132
Q

Efficacy of Sinecatechins

A

~60%

133
Q

Contraindications to the use of Imiquimod

A
  1. Pregnancy
  2. Autoimmune Disorders
134
Q

Contraindications to the use of Podofilox

A
  1. Pregnancy
135
Q

Contraindications to the use of Sinecatechins

A
  1. HIV
  2. Immunocompromised
  3. Genital Herpes
  4. Pregnancy
136
Q

AEs of Imiquimod

A
  1. Hypopigmentation
  2. Myalgia
137
Q

AEs of Podofilox

A
  1. Inflammation
  2. Skin Erosion
138
Q

AEs of Sinecatechins

A
  1. Ulceration
  2. Induration
  3. Vesicular Rash
139
Q

What are the Uncommon AEs of Sinecatechins that are concerning?

A
  1. Lymphadenitis
  2. Vulvovaginitis
  3. Balanitis
140
Q

How do you apply Imiquimod?

A
  1. Wash off cream 6-10 hours after application
  2. 3.75% appleid QD
  3. 5% applied 3x per week
141
Q

How do you apply Podofilox?

A
  1. Applied as a cycle 3 days on and 4 days off
  2. Repeat up to 4 weeks
  3. Use no more than 0.5 mL/day
142
Q

How do you apply Sinecatechins?

A
  1. Apply TID
  2. Do not wash off after use
143
Q

T/F: Imiquimod may weaken condoms and diaphragms.

A

True

144
Q

T/F: Podofilox can be used >10 cm2

A

False, Do not use in >10 cm2

145
Q

A patient with which condition should avoid Salicylic Acid?

A

Fibromyalgia

146
Q

Which product for genital warts must be washed off within 12 hours after application?

A

Imiquimod

147
Q

Which product for genital warts must be applied as an on-off cycle?

A

Podofilox

148
Q

Which product for genital warts has the greatest risk to cause skin discoloration?

A

Imiquimod

149
Q

Which product for genital warts has the greatest risk of causing muscle pain?

A

Imiquimod

150
Q

Sinecatechins should be avoided in patients living with HIV because:

A

It was not studied in patients living with HIV

151
Q

Which product for genital warts should be applied every 8 hours?

A

Sinecatechins

152
Q

When used appropriately, which product for genital warts possess the highest clearance rate?

A

Podofilox

153
Q

Which anti-wart drug should be avoided in patients with an ASA allergy?

A

Compound W aka Salicylic Acid

154
Q

Which product for genital warts may cause inflammation of the glans?

A

Sinecatechins

155
Q

T/F: PrEP is for ALL sexually active adolescents and adults

A

True

156
Q

T/F: Nonadherence is ok in with PrEP it will still be effective

A

False, ADHERENCE is ESSENTIAL, or there will not be a high enough blood concentration leading to HIV infection

157
Q

T/F: Ineffective PrEP (non adherence) = new HIV infection

A

True

158
Q

It takes ____ weeks for drug PrEP to accumulate in tissue.

A

3

159
Q

It takes ___ days for drug PrEP to accumulate in the rectum.

A

7

160
Q

It takes ___ days for drug PrEP to accumulate in the blood/vagina.

A

20

161
Q

What are the 5 High Risk Behaviors that would qualify a patient for PrEP Treatment?

A
  1. Unprotected sex with multiple partners
  2. Sex with patient living with HIV
  3. Commercial sex workers
  4. IV drug use within the last 6 months
  5. Recent STI within the last 6 months
162
Q

What is Risk Compensation in terms of HIV/PrEP?

A

Increase in risk behaviors due to the perception that the patient is protected from HIV

163
Q

T/F: PrEP ONLY works against HIV not any other STIs

A

True

164
Q

What are the ingredients in Truvada?

A

Tenofovir Disoproxil Fumarate/Emtricitabine

165
Q

What risk behaviors of HIV can use Truvada?

A

ALL 5 risk behaviors

166
Q

When is Truvada contraindicated?

A

CrCl <60

167
Q

What are the AEs of Truvada?

A
  1. AKI
  2. Bone Pain
  3. Osteopenia
168
Q

Risk for AEs is increased in Truvada with concomitant _____ or _____ use.

A

HCV treatment or NSAIDs

169
Q

When is Truvada On Demand indicated?

A

Only indicated for MSM

170
Q

How is Truvada on Demand taken?

A

2-1-1 Rule
-2 tabs before sex
-1 tab 24 hrs after sex
-1 tab 48hrs after sex

171
Q

What are two toxicities associated with Truvada?

A
  1. Renal Toxicity
  2. Osteopenia
172
Q

Which nonprescription analgesics should be avoided in a patient taking Truvada for PrEP because of the additive risk for acute kidney injury?

A
  1. Ecotrin
  2. Motrin
  3. Aleve
173
Q

What are the active ingredients of Descovy?

A

Tenofovir Alafenamide/Emtricitabine

174
Q

When can Descovy be used?

A
  1. MSM
  2. Transgender Women who have sex with men
175
Q

When is Descovy contraindicated?

A

CrCl <30

176
Q

T/F: Descovy is unsafe in breastfeeding women but unknown in pregnant women.

A

True

177
Q

What are the AEs with Descovy?

A
  1. N/V/D
  2. HA
  3. Weight Loss
178
Q

What is the uncommon concerning AE of Descovy?

A

Hypercholesterolemia

179
Q

Based on PK data, which PrEP regimen was theorized to be more effective as PrEP for men who have sex with men?

A

Truvada: dispositing in the mucosal tissue
Descovy: CD4 cells
Both are equally effective

180
Q

Descovy may increase what?

A

Serum triglycerides

181
Q

Compared to Truvada, Descovy is safe to use when CrCl is what?

A

30-60

182
Q

Vocaria is what?

A

Cabotegravir Oral

183
Q

Apretude is what?

A

Cabotegravir IM Shot

184
Q

When is Cabotegravir indicated?

A
  1. Difficulty taking oral PrEP
  2. Request injection instead
  3. Patients with severe CKD
185
Q

T/F: Apretude is seen as 2nd line therapy for those that qualify.

A

True

186
Q

What are the AEs of Apretude?

A
  1. Injection Site Rxns
  2. N/V/D
  3. Abdominal Pain
187
Q

Only the _____ of Cabotegravir is approved for PrEP

A

ER IM Injection

188
Q

The oral tablet of Cabotegravir may be considered for __ month of optional induction therapy

A

1

189
Q

What is the CrCl cutoff with Apretude?

A

> 15

190
Q

T/F: Apretude is more effective than Truvada for MSM

A

True

191
Q

Why Apretude 2nd Line Therapy?

A

Concern of integrate inhibitor resistance if PrEP fails

192
Q

T/F: Apretude is an IM injection into the deltoid.

A

False, into gluteal

193
Q

T/F: Before starting Apretude for PrEP, patients must take Vocabria for a 4 week lead in.

A

False

194
Q

Apretude for PrEP may be a good choice in patients with:

A

Chronic Kidney Disease

195
Q

What should be monitored quarterly with PrEP?

A
  1. HIV PCR
  2. Bacterial STI
  3. Adherence
  4. DDIs
  5. Pregnancy Test
196
Q

What should be monitored semi-annually with PrEP?

A

Renal Function

197
Q

What should be monitored Annually with PrEP?

A

If on Descovy, lipid panel

198
Q

T/F: MPox is an endemic in central/western Africana aand not considered an STI

A

True

199
Q

MPox is what type of virus

A

Orthopoxivirus

200
Q

Transmission of MPox from animal to animal occurs via what?

A

Fluids, lesions, bites, or ingestion

201
Q

Transmission of MPox from human to human occurs via what?

A

Biologic fluids (semen) and lesions

202
Q

What are the forms of Human Transmission via Direct Contact?

A
  1. Skin to Skin during intercourse
  2. Sexual transmission through exchange of body fluids
203
Q

What are the forms of Human Transmission via Indirect Contact?

A

Contact with contaminated materials like clothing or bedding

204
Q

Once infected, the Incubation Period is ____ weeks

A

2

205
Q

MPox is most similar to ____.

A

Smallpox

206
Q

MPox incubation typically takes 14-21 days, and how is that seen?

A

Asymptomatic 1-14 days
Symptoms 14-21 days
Full Blown Disease >21 days

207
Q

Define characteristics of Prodromal Phase

A
  1. HA, fever, fatigue, muscle pain
  2. Swollen Lymph Nodes are a hallmark
  3. Nonspecific Infection
208
Q

Define characteristics of Eruptive Phase

A
  1. Rash develops within 1-4 days of prodrome
  2. Macule - Papule - Vesicle - Pustule - Scab
209
Q

Define Macule

A

Small red dots, NOT raised

210
Q

Define Papule

A

RAISED dots, filled with fluid

211
Q

Define Vesicle

A

Clear FLUID

212
Q

Define Pustule

A

PUS FILLED

213
Q

Define Scab

A

Popped pustule, oxidized

214
Q

The common terms for vesicle is ____.

A

Blister

215
Q

What types of Eruptive Phase cutaneous manifestations last 1-2 days?

A
  1. Macules
  2. Papules
  3. Vesivles
216
Q

What types of Eruptive Phase cutaneous manifestations last 5-7 days?

A

Pustules

217
Q

What types of Eruptive Phase cutaneous manifestations last 7-14 days?

A

Scabs

218
Q

T/F: No matter early of late stage, the cutaneous manifestations show up quickly and disappear quickly.

A

False, late phase lesions last longer and take longer to get rid of 14-21 days

219
Q

What is used to confirm the diagnosis of MPox?

A

PCR to detect MPox DNA

220
Q

T/F: Most patients will respond to supportive care OTC analgesics

A

True

221
Q

What is used for supportive care of Pain in MPox?

A
  1. NSAIDS- systemic
  2. APAP- systemic
  3. Local Topical Corticosteroids/Anesthetics
  4. Opioids- refractory
222
Q

T/F: You can use local topical corticosteroids/anesthetics on genital tissues and large surfaces.

A

False, avoid both

223
Q

T/F: Opioid use for refractory pain is appropriate in patients in the late stage with scabs/lesions.

A

True

224
Q

What is used for supportive care of Proctitis in MPox?

A
  1. Stool Softener
  2. Gabapentin
225
Q

What is used for supportive care of Pruritus in MPox?

A
  1. Oral antihistamines
  2. Calamine lotion
  3. Petroleum Jelly
  4. Colloid Oatmeal
226
Q

What is used for supportive care of Oral Lesions in MPox?

A
  1. Saltwater Rinse
  2. Chlorhexidine
  3. Local Anesthetics
227
Q

T/F: Metamucil can be recommended for MPox proctitis.

A

False

228
Q

T/F: Tramadol may be considered for severe MPox pain.

A

True

229
Q

Which anesthetic is safe to use for oral lesions?

A

Benzocaine

230
Q

T/F: Tecovirimat is FDA approved for MPox.

A

False, FDA approved for smallpox but not Mpox

231
Q

What is the contraindication for the use of Tecovirimat?

A

CrCl <30 for IV FORM ONLY

232
Q

Dosing of Tecovirimat

A

Weight based 14 day treatment

233
Q

Tecovirimat should be avoided with concomitant use of ______ or ______.

A
  1. Repaglinide
  2. Midazolam
234
Q

T/F: Tecovirimat strongly induces CYP3A4 and inhibits CYP2C9/2C19.

A

False, weakly

235
Q

Concomitant use of Repaglinide and Tecovirimat leads to what?

A

More hypoglycemia

236
Q

Concomitant use of Midazolam and Tecovirimat leads to what?

A

Reduced anti-anxiety

237
Q

What is the AE that is seen in PO and IV formulations of Tecovirimat?

A

HA

238
Q

How should Tecovirimat be taken?

A

Take with a full glass of water 30 minutes after a 600 calorie meal

239
Q

T/F: MPox vaccine is FDA approved for smallpox and Mpox via subQ injection.

A

True

240
Q

T/F: MPox vaccine is FDA approved for MPox Intradermal injection.

A

False, expanded use authorization

241
Q

What is the MPox Vaccine dosing for SQ route?

A

0.5 mL x 2 doses 4 weeks apart

242
Q

What is the MPox Vaccine dosing for Intradermal route?

A

0.1 mL x 2 doses 4 weeks apart

243
Q

MPox Vaccine will have local injection site reactions that will persist for ___ weeks.

A

3

244
Q

T/F: Proven concern from myocarditis and pericarditis if MPox Vaccine administered within 12 weeks of mRNA COVID-19 vaccine.

A

False, unproven

245
Q

T/F: Tecovirimat is nephrotoxic

A

False

246
Q

T/F: MPox vaccine may be administered IM

A

False

247
Q

T/F: MPox vaccine is more effective when given intradermally than subcutaneously.

A

False

248
Q

Young adult males should avoid receiving which vaccine within 4 weeks of the Mpox vaccine?

A

Covid-19

249
Q

T/F: MPox vaccine is contraindicated in patients living with AIDS.

A

False

250
Q

Pre-Exposure Vaccination Criteria MPox

A
  1. Gay, bisexual, MSM, transgender, nonbinary or gender diverse with>1 partner or new diagnosis of STIs
  2. Persons having sex: commercially, MPox transmission is high
  3. Clinical/healthcare workers caring for patients with MPox
251
Q

Post Exposure Vaccination Criteria MPox

A

Within 4 days post exposure
1. Contact of someone with Mpox
2. Sexual partner within last 2 weeks
3. Areas where MPox is circulating and person has multiple partners
4. Healthcare personnel with moderate to high risk exposure

252
Q

T/F: Influenza is an RNA Virus

A

True

253
Q

Define Flu A

A

Most common, may cause seasonal or pandemic flu

254
Q

Define Flu B

A

Second most common, seasonal outbreaks only

255
Q

Define Hemagglutinin

A

Helps the flu virus bind to host receptors and enter host cells

256
Q

Define Neuraminidase

A

Once the host cells are infected they start to create new flu virus, neuraminidase is the enzyme that helps to release new flu virus from the infected host cells

257
Q

What is the main target for antiviral flu medications?

A

Neuraminidase

258
Q

What is the main target for flu vaccinations?

A

Hemagglutinin

259
Q

Flu incubates for ___ days and a patient is infectious for about ___ days.

A

2 and 7

260
Q

S/S of Influenza

A
  1. Myalgia
  2. HA
  3. Nonproductive cough
  4. Sore Throat
  5. Fever that develops quickly
261
Q

When would laboratory confirmation of influenza is recommended when?

A
  1. Low prevalence of flu
  2. High risk for transmission among patients such as nursing homes
262
Q

T/F: RDT = POC

A

False, RDT is a subtype of POC

263
Q

T?F: RDT POC Flu Tests are Clinical Laboratory Improvement Amendment CLIA Waived Tests

A

True

264
Q

T/F: Pharmacists do not need to follow the manufacture instructions verbatim on POC Flu Tests?

A

False, you must follow it precisely

265
Q

T/F: POC Flu Tests look for influenza antigens not viral DNA/RNA.

A

True

266
Q

What is the most important step of the PPCP that applies to Influenza?

A

Follow Up

267
Q

When should you follow up with a patient for influenza?

A

1-2 days after POC, if they are worsening refer them to PCP

268
Q

If the patient received LAIV <7 days, RDT POC for flu may be ____ ____.

A

Falsely positive

269
Q

What 3 population types are not candidates for POC Flu testing?

A
  1. Vulnerable Populations
  2. Lung Disease
  3. Signs of Critical Illness
270
Q

What are 3 forms of Nonpharmacologic Therapy are used in influenza?

A
  1. Rest
  2. Drink plenty of fluids
  3. Palliate symptoms with cough drops, warm tea, or warm soup
271
Q

T/F: A patient with rhinorrhea, watery eyes, and palate itching presents to the pharmacy, they should be tested for flu.

A

False

272
Q

Which flu vaccine may cause a false positive on RDT POC flu test?

A

FluMist

273
Q

Healthy adults with >48 hours of symptoms need what type of flu treatment?

A

No Rx therapy

274
Q

Healthy adults with <48 hours of symptoms need what type of flu treatment?

A

Consider Rx therapy

275
Q

Hospitalized, severe symptoms, and high risk need what type of flu treatment?

A

Recommend Rx therapy

276
Q

Is HTN alone a high risk complication in influenza that would deem necessary treatment?

A

No

277
Q

T/F: Do not use adamantes for the prevention or treatment of influenza.

A

True

278
Q

What are the 3 Neuraminidase Inhibitors and their ROA?

A
  1. Oseltamivir: capsule or suspension
  2. Zanamivir: inhalation
  3. Peramivir: IV
279
Q

What is the MOA of Neuraminidase Inhibitors?

A

Prevent the neuraminidase enzyme from releasing virions from infected host cells

280
Q

What is the dosing of Adults >13 yrs for Oseltamivir?

A

75 mg PO BID

281
Q

What is the dosing of Oseltamivir for CrCl 31-60?

A

30 mg PO BID

282
Q

What is the dosing of Oseltamivir for CrCl 11-30?

A

30 mg PO QD

283
Q

What is the dosing of Oseltamivir for CrCl <10?

A

Not recommended

284
Q

How should you take Tamiflu?

A

With food

285
Q

T/F: Stop oseltmaivir if the patient develops a rash.

A

True

286
Q

What is the drug of choice for influenza in pregnant patients?

A

Tamiflu

287
Q

When is Zanamivir Contraindicated?

A

Milk protein Allergy

288
Q

When should Zanamivir be avoided?

A
  1. Asthma
  2. COPD
289
Q

When is Zanamivir recommended?

A

Only in adults who have failed Oseltamivir

290
Q

When is Peramivir recommended?

A

Patients unable to take oral medications

291
Q

What is the MOA of Baloxavir/Xofluza?

A

Disrupts RNA trasncription to prevent flu virus replication

292
Q

What is the FDA approved use of Xofluza?

A

> 12 yrs presenting with symptoms WITHIN 48 hours and HIGH RISK for developing serious symptoms

293
Q

What is the dose of Xofluza for weight <80 kg?

A

40 mg one time dose

294
Q

What is the dose of Xofluza for weight >80 kg?

A

80 mg one time dose

295
Q

Prophylaxis of Influenza pre-exposure can be considered if what?

A
  1. High risk during 14 days after vaccination
  2. High risk if not vaccinated and close contact with flu
  3. High risk and contraindicated to vaccination
296
Q

Prophylaxis of Influenza post-exposure can be considered if what?

A

<48 hrs following flu exposure:
1. Within 14 days following flu vaccine
2. Immunosuppressed
3. Contraindicated to flu vaccine

Pharmacy Practice VI (1 decks)

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