EXAM ONE Flashcards
Ticks are the ___common vector to transmit infectious disease in North America, and ___ most common globally.
MOST, 2nd
What are 3 Common Tick Borne Illnesses in the US?
- Lyme Disease
- Babesiosis
- Ehrlichiosis
Which disease is caused by the Lone Star Tick?
Ehrlichiosis
Tick-Induced Meat Allergy is also known as what?
Alpha-Gal Allergy
T/F: Southern Tick-Associated Rash Illness STARI is another name for Lyme disease that occurs in the southeastern and south central US.
False
Ticks have a ___ year lifecycle
2
T/F: A New Host is required during each lifestyle stage
True
Larva, Nymphs, and Adult Ticks feed on ___ for growth.
Blood
What species is known as HARD Ticks?
Ixodid
What species is known as SOFT Ticks?
Argasid
The most common ticks and the main vectors for Lyme disease are what?
Ixodid Species
What Tick species are known as rapid feeders and detach from their host 1 hour after feeding?
Argasid Species
In 2021, which Oklahoma County met CDC Criteria for Deer Tick Endemic with Lyme disease?
Cherokee
T/F: Ticks cause Lyme Disease
False
T/F: Ticks are a Vector for Spirochete Bacteria that causes Lyme disease.
True
List the 2 types of Deer Ticks
- Ixodes Scapularis
- Ixodes Pacificus
What is the bacteria that causes Lyme disease?
Spirochete Borrelia Burgdorferi
What are the symptoms of Lyme Disease?
- Bullseye Rash
- Flu-Like Syndrome
- Lymphadenopathy
List the 5 steps in How to Remove a Tick
- If possible, wear gloves to protect yourself from tick exposure
- Position the tweezers as close to the patient’s skin as possible and grasp the tick
- Pull Up. Do NOT twist tweezers
- Clean the bite area with disinfectant
- Dispose of tick by drowning it in alcohol, sealing it in a bag, wrapping tightly in tape, or flushing it down the toliet
T/F: You can use heat, nail polish, and Vaseline to remove a Tick.
False, AVOID all of these
Which first aid should be applied to the bite site after Tick Removal?
- Isopropyl Alcohol
- Water
- Soap
Define the S/S of Early Disseminated Classification of Lyme Disease
- Bullseye Rash
- Neurologic Symptoms: bell palsy, meningitis, radiuclopathy, encephalomyelitis
- Lyme Carditis
Define the S/S of Late Classification of Lyme Disease
- Arthritis
- Neurologic Symptoms: encephalomyelitis, encephalopathy, peripheral neuropathy
- Acrodermatitis Chronica Trophicans
Early Disseminated Classification in Lyme disease means what?
Localized Symptoms of Lyme Disease
Late Classification in Lyme disease means what?
Serious, taken root, progressive damage
Which patient is at greatest risk for developing Acrodermatitis Chronic Atrophicans?
Older European Female
Define Acrodermatitis Chronic Trophicans
Thinning out skin, red/blue hue, papery texture
T/F: All Ticks require referral to PCP
True
____ Care relies on OTC products and nonpharmacologic therapy
Preventive
List the 6 Non Pharmacological Prevention Methods
- Clothe as much skin as possible
- Avoid areas harboring ticks such as dense woods and brush
- Limit time spent outside especially at dawn and dusk
- Self inspect skin daily
- Keep pets pest free
- Apply inspect repellant
What are the 4 elements to consider with Insect Repellant?
- Ingredients
- Concentration
- Formulation
- Type and Length of Exposure
What agent is recommended as the drug of choice for prophylaxis of Lyme disease?
Doxycycline
What is the prophylaxis dosing of Doxycycline for Lyme disease?
200 mg PO for 1 DOSE
T/F: Recommend Topical Antibiotics Neosporin for Tick Bites.
False, wash the area with soap, water, and isopropyl alcohol
What 5 Criteria must be met for a patient to qualify for Doxycycline prophylaxis for Lyme disease?
- Tick identified as Ixodes Scapularis
- The tick was attached for >36 hours
- It has been <72 hours since the tick was removed
- Local rate of borrelia burfadorferi in ticks >20%
- The patient possess no contraindication to doxycycline
T/F: If one criteria for Doxycycline prophylaxis is not met, the patient does NOT qualify for therapy.
True
DEET is the active ingredient found in bug sprays, however improper use/ingestion may lead to what AEs?
- Seizures
- Ataxia
- Hypotension
DEET Concentration _____% should be used for Tick Prevention
20-50
T/F: DEET Concentrations >50% suggests better efficacy.
False
T/F: DEET is safe to use in patients who are pregnant and lactating.
True
How often should you apply DEET?
q 4-8 hours
Why should you avoid DEET and Sunscreen combination products?
- Sunscreen needs to be applied q2 hrs
- DEET applied q 4-8 hrs
- Overapplication of DEET may lead to toxicities
What is first line therapy for PO treatment of Lyme disease?
- Doxycycline
- Amoxicillin
- Cefuroxime
What is the dosing of Doxycycline for Lyme disease?
- 100 mg BID
- 200 mg QD
What is the dosing of Amoxicillin for Lyme disease?
500 mg PO TID
What is the dosing of Cefuroxime for Lyme disease?
500 mg PO BID
If patients are unable to take first line PO medication for Lyme disease, what is the 2nd line PO option?
Azithromycin 500 mg PO QD
What is first line therapy IV treatment for Lyme disease and its dose?
Ceftriaxone 2 grams IV daily
What is 2nd line IV treatment options for Lyme disease and its dosing?
- Cefotaxime 2 grams IV TID
- Penicillin G 18-24 million units/day
When is IV treatment for Lyme disease indicated?
- Inpatient Lyme Carditis
- Parenchymal Neurologic Lyme Disease
- Lyme arthritis unresponsive to PO Abx
What are the precautions of Doxycycline?
- Patients <8 yrs
- Pregnant Patients
T/F: Hyclate Salt (Vibramycin) is more acidic than Monohydrate Salt (Monodox) which may cause more stomach upset
True
T/F: Monohydrate Doxycycline capsules work when gastric pH is high
False, may not work when gastric pH is high
What is the patient education for Doxycycline?
- Sit up right for 30 mins
- Separate from antacids/multivitamins for 2 hours
- Wear sunscreen
T/F: Amoxicillin has AEs of Diarrhea
True
T/F: Amoxicillin is not safe for patients who are pregnant or breastfeeding
False
T/F: Amoxicillin must be dose adjusted if comorbid renal impairment is present
True
What 3rd Generation Cephalosporins are used in the treatment of Lyme disease?
- Cefuroxime: first line PO
- Ceftriaxone: first line IV
- Cefotaxime: alternative IV
What is the main tolerability problem with 3rd Gen Cephalosporins in Lyme disease treatment?
C. diff associated diarrhea
Azithromycin Indications in Lyme disease are what?
- Patients unable to to take first line PO drugs for Lyme
- Only for skin reactions.
Azithromycin treatment for Lyme disease is used only for _________.
Erythema Mirgrans
What are the precautions of Azithromycin?
- Patients with pre-existing heart conditions
- Patients taking anti arrhythmic drugs
Penicillin G is used when in Lyme disease?
IV Options for patients unable to receive Ceftriaxone
Which Doxycycline formulation may be better in a patient taking Omeprazole?
Doxycycline Hyclate (Vibramycin)
T/F: Age less than 8 years is contraindicated to Doxycycline.
False
T/F: Pregnancy is a contraindication to Doxycycline.
False
Patients should be educated to sit upright for ____ minutes after taking Doxycycline.
30
Third generation cephalosporins increase the risk for C. diff diarrhea because of their increased activity against which microorganisms?
Gram Negative Rods
Which third generation cephalosporin does not require dose adjustments in the setting of renal impairment?
Ceftriaxone
When used to treat Lyme disease, Penicillin G is administered via which route?
IV
What is the duration of therapy for Doxycycline in the treatment of Erythema Migrans?
10 days
What is the duration of therapy for Amoxicillin or Cefuroxime in the treatment of Erythema Migrans?
14 days
What is the duration of therapy for Azithromycin in the treatment of Erythema Migrans?
7 days
What is duration of therapy for Carditis/Neurologic Lyme disease?
14-21 days
What is duration of therapy for Acrodermatitis chronic atrophicans Lyme disease?
21-28 days
What is duration of therapy for Arthritis Lyme disease?
28 days
T/F: Doxycycline is safe when used for 14 days in the treatment of Lyme disease for Pregnant Patients.
True
What are common symptoms seen in Recurrent Lyme disease?
- Fatigue
- Musculoskeletal Pain
- Neurocognitive Impairment
Are antibiotics recommended for Recurrent Lyme disease?
NO
T/F: Posttreatment Lyme disease syndrome will self-resolve over time and antibiotics are not recommended.
True
Doxycycline has been associated with which complications when used for inappropriate durations in pregnant patients?
- Birth Defects
- Premature Delivery
In terms of STIs, ____ patients are at greater risk for STI sequels including infertility, malignancy, and pain.
FEMALE
What are the components of the 5Ps Approach to Sexual History Collection?
- Past History
- Practices
- Pregnancy
- Partners
- Protection
What are the CDC’s 5 Public Health strategies for the prevention of STIs?
- Risk Assessment
- Vaccinate
- Symptomatic
- Patients
- Partners
What is recommended by the CDC to protect patients from STIs?
- Abstinence
- Mutual Monogamy
- Limit the Number of Sexual Partners
- Condoms
Condoms function as _____ to prevent STI Transmission and are classified as MEDICAL DEVICES by the FDA.
Barriers
T/F: Avoid recommending spermicide-containing condoms because of irritation and lack of efficacy.
True
Typical Use of Condoms is correlated with _____ leading to compromised efficacy and therefore, is a concern in terms of STIs.
Breakage
T/F: Spermicides are effective antibiotics for the prevention of sexually transmitted infections.
False
What are the 3 types of Male Condoms?
- Latex
- Natural Membrane
- Synthetic
Details about Latex Condoms
Cheap/Effective, cannot be used in patients with latex allergies
Details about Natural Membrane Condoms
DECREASED efficacy in protection against STIs due to porous nature
Details about Synthetic Condoms
Higher breakage rate, should be used 2nd line after Latex condoms
What is the hierarchy of Male Condoms?
Latex > Synthetic > Natural
T/F: Female condoms are equally efficacious as male condoms
True
For use of male condoms in STIs patients should be educated to trial different _____ before switching ____.
Brands; Types (latex vs synthetic)
What is the most common STI in the U.S.?
Human Papillomavirus HPV
Clinical HPV includes what 4 things?
- Common Worts or Anogenital Worts
- Respiratory Papillomatosis
- Cervical Cancer Precursors
- Cervical and Mucosal Cancers
HPV is what type of virus?
Double Stranded DNA virus that affects skin and mucosa
Common Worts caused by the virus, most of them are _____ .
Asymptomatic
T/F: Although some HPV warts develop in childhood often self-resolve, some will persist into adulthood.
True
T/F: Warts in adulthood are less persistent and insidious.
False, MORE persistent/insidious
T/F: Invasive cancers may develop as a result of HPV infection.
True
Cervarix HPV Vaccine covers what subtypes?
16 and 18
T/F: Cervarix covers genitoanal warts.
False
Gardasil HPV Vaccine covers what subtypes?
6,11,16,18
T/F: Gardasil covers genitoanal warts
True
T/F: Gardasil 9 is significantly better than the other vaccines.
False, no phase 4 clinical data cannot make that assumption
What is the Routine Vaccination age for the HPV Vaccine?
9-14 yrs
Ideally 11-12 yrs
What is the dosing schedule for Routine Vaccination of HPV?
Administer 2 doses 6-12 months apart
What is the Catch-Up Vaccination age for the HPV Vaccine?
- 15-26 years
- 9-14 years <5 months apart
What is the dosing schedule for Catch-Up Vaccination and Shared Clinical Decision of HPV?
Administer 3 doses at 0, 2 , and 6 months
T/F: Heterosexual Males Catch-Up Vaccination phase is from 15-26 years old.
False, 15-21 years old
Up to 26 yrs for MSM
What is the Shared Clinical Decision age for the HPV Vaccine?
27-45 years
Per the CDC/ACIP, the 9vHPV vaccine may be least effective in which age group?
27-45 years
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?
June 2023
HPV Vaccination is contraindicated in what patients?
Yeast Allergy
T/F: HPV Vaccine has vasovagal reactions and should monitor the patients for 15 minutes after administration.
True
T/F: You can administer HPV in pregnant and breastfeeding patients.
False, only admin in breastfeeding patients NOT pregnant patients
T/F: HPV = HSV
False
_____ drugs are NOT currently indicated for the general management of HPV.
Antiviral
Before using treatment, patients must do what for HPV common worts?
- Soak the affected skin in warm water for 5-10 mins
- Use emery board or sandpaper to desquamate upper layers of the wort
What is used in the treatment of HPV Common Warts?
Salicyclic Acid
What are the indications for the use of Salicyclic Acid?
- Uncomfortable warts
- Affect physical appearance
- Affect physical function
- Thought to increase cancer risk
What are the contraindications to the use of Salicylic Acid?
- Facial Warts
- Areas of Poor Circulation
- Areas of Ulceration or Poor Healing
- Neuropathies
What are the tolerability issues associated with Salicylic Acid?
- Wet wrinkly skin (maceration)
- Skin shedding (desquamation)
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.
True
What is the most important pearl about Salicylic Acid?
Adherence, at least once DAILY x 12 weeks
T/F: Internal Warts: anal/vaginal/cervical are treated with pharmacotherapy.
False, they are not and need to be referred to provider
What 3 Agents are used for the treatment of Anogenital Warts?
- Imiquimod
- Podofilox
- Sinecatechins
Efficacy of Imiquimod
10-70%
Efficacy of Podofilox
40-80%
Efficacy of Sinecatechins
~60%
Contraindications to the use of Imiquimod
- Pregnancy
- Autoimmune Disorders
Contraindications to the use of Podofilox
- Pregnancy
Contraindications to the use of Sinecatechins
- HIV
- Immunocompromised
- Genital Herpes
- Pregnancy
AEs of Imiquimod
- Hypopigmentation
- Myalgia
AEs of Podofilox
- Inflammation
- Skin Erosion
AEs of Sinecatechins
- Ulceration
- Induration
- Vesicular Rash
What are the Uncommon AEs of Sinecatechins that are concerning?
- Lymphadenitis
- Vulvovaginitis
- Balanitis
How do you apply Imiquimod?
- Wash off cream 6-10 hours after application
- 3.75% appleid QD
- 5% applied 3x per week
How do you apply Podofilox?
- Applied as a cycle 3 days on and 4 days off
- Repeat up to 4 weeks
- Use no more than 0.5 mL/day
How do you apply Sinecatechins?
- Apply TID
- Do not wash off after use
T/F: Imiquimod may weaken condoms and diaphragms.
True
T/F: Podofilox can be used >10 cm2
False, Do not use in >10 cm2
A patient with which condition should avoid Salicylic Acid?
Fibromyalgia
Which product for genital warts must be washed off within 12 hours after application?
Imiquimod
Which product for genital warts must be applied as an on-off cycle?
Podofilox
Which product for genital warts has the greatest risk to cause skin discoloration?
Imiquimod
Which product for genital warts has the greatest risk of causing muscle pain?
Imiquimod
Sinecatechins should be avoided in patients living with HIV because:
It was not studied in patients living with HIV
Which product for genital warts should be applied every 8 hours?
Sinecatechins
When used appropriately, which product for genital warts possess the highest clearance rate?
Podofilox
Which anti-wart drug should be avoided in patients with an ASA allergy?
Compound W aka Salicylic Acid
Which product for genital warts may cause inflammation of the glans?
Sinecatechins
T/F: PrEP is for ALL sexually active adolescents and adults
True
T/F: Nonadherence is ok in with PrEP it will still be effective
False, ADHERENCE is ESSENTIAL, or there will not be a high enough blood concentration leading to HIV infection
T/F: Ineffective PrEP (non adherence) = new HIV infection
True
It takes ____ weeks for drug PrEP to accumulate in tissue.
3
It takes ___ days for drug PrEP to accumulate in the rectum.
7
It takes ___ days for drug PrEP to accumulate in the blood/vagina.
20
What are the 5 High Risk Behaviors that would qualify a patient for PrEP Treatment?
- Unprotected sex with multiple partners
- Sex with patient living with HIV
- Commercial sex workers
- IV drug use within the last 6 months
- Recent STI within the last 6 months
What is Risk Compensation in terms of HIV/PrEP?
Increase in risk behaviors due to the perception that the patient is protected from HIV
T/F: PrEP ONLY works against HIV not any other STIs
True
What are the ingredients in Truvada?
Tenofovir Disoproxil Fumarate/Emtricitabine
What risk behaviors of HIV can use Truvada?
ALL 5 risk behaviors
When is Truvada contraindicated?
CrCl <60
What are the AEs of Truvada?
- AKI
- Bone Pain
- Osteopenia
Risk for AEs is increased in Truvada with concomitant _____ or _____ use.
HCV treatment or NSAIDs
When is Truvada On Demand indicated?
Only indicated for MSM
How is Truvada on Demand taken?
2-1-1 Rule
-2 tabs before sex
-1 tab 24 hrs after sex
-1 tab 48hrs after sex
What are two toxicities associated with Truvada?
- Renal Toxicity
- Osteopenia
Which nonprescription analgesics should be avoided in a patient taking Truvada for PrEP because of the additive risk for acute kidney injury?
- Ecotrin
- Motrin
- Aleve
What are the active ingredients of Descovy?
Tenofovir Alafenamide/Emtricitabine
When can Descovy be used?
- MSM
- Transgender Women who have sex with men
When is Descovy contraindicated?
CrCl <30
T/F: Descovy is unsafe in breastfeeding women but unknown in pregnant women.
True
What are the AEs with Descovy?
- N/V/D
- HA
- Weight Loss
What is the uncommon concerning AE of Descovy?
Hypercholesterolemia
Based on PK data, which PrEP regimen was theorized to be more effective as PrEP for men who have sex with men?
Truvada: dispositing in the mucosal tissue
Descovy: CD4 cells
Both are equally effective
Descovy may increase what?
Serum triglycerides
Compared to Truvada, Descovy is safe to use when CrCl is what?
30-60
Vocaria is what?
Cabotegravir Oral
Apretude is what?
Cabotegravir IM Shot
When is Cabotegravir indicated?
- Difficulty taking oral PrEP
- Request injection instead
- Patients with severe CKD
T/F: Apretude is seen as 2nd line therapy for those that qualify.
True
What are the AEs of Apretude?
- Injection Site Rxns
- N/V/D
- Abdominal Pain
Only the _____ of Cabotegravir is approved for PrEP
ER IM Injection
The oral tablet of Cabotegravir may be considered for __ month of optional induction therapy
1
What is the CrCl cutoff with Apretude?
> 15
T/F: Apretude is more effective than Truvada for MSM
True
Why Apretude 2nd Line Therapy?
Concern of integrate inhibitor resistance if PrEP fails
T/F: Apretude is an IM injection into the deltoid.
False, into gluteal
T/F: Before starting Apretude for PrEP, patients must take Vocabria for a 4 week lead in.
False
Apretude for PrEP may be a good choice in patients with:
Chronic Kidney Disease
What should be monitored quarterly with PrEP?
- HIV PCR
- Bacterial STI
- Adherence
- DDIs
- Pregnancy Test
What should be monitored semi-annually with PrEP?
Renal Function
What should be monitored Annually with PrEP?
If on Descovy, lipid panel
T/F: MPox is an endemic in central/western Africana aand not considered an STI
True
MPox is what type of virus
Orthopoxivirus
Transmission of MPox from animal to animal occurs via what?
Fluids, lesions, bites, or ingestion
Transmission of MPox from human to human occurs via what?
Biologic fluids (semen) and lesions
What are the forms of Human Transmission via Direct Contact?
- Skin to Skin during intercourse
- Sexual transmission through exchange of body fluids
What are the forms of Human Transmission via Indirect Contact?
Contact with contaminated materials like clothing or bedding
Once infected, the Incubation Period is ____ weeks
2
MPox is most similar to ____.
Smallpox
MPox incubation typically takes 14-21 days, and how is that seen?
Asymptomatic 1-14 days
Symptoms 14-21 days
Full Blown Disease >21 days
Define characteristics of Prodromal Phase
- HA, fever, fatigue, muscle pain
- Swollen Lymph Nodes are a hallmark
- Nonspecific Infection
Define characteristics of Eruptive Phase
- Rash develops within 1-4 days of prodrome
- Macule - Papule - Vesicle - Pustule - Scab
Define Macule
Small red dots, NOT raised
Define Papule
RAISED dots, filled with fluid
Define Vesicle
Clear FLUID
Define Pustule
PUS FILLED
Define Scab
Popped pustule, oxidized
The common terms for vesicle is ____.
Blister
What types of Eruptive Phase cutaneous manifestations last 1-2 days?
- Macules
- Papules
- Vesivles
What types of Eruptive Phase cutaneous manifestations last 5-7 days?
Pustules
What types of Eruptive Phase cutaneous manifestations last 7-14 days?
Scabs
T/F: No matter early of late stage, the cutaneous manifestations show up quickly and disappear quickly.
False, late phase lesions last longer and take longer to get rid of 14-21 days
What is used to confirm the diagnosis of MPox?
PCR to detect MPox DNA
T/F: Most patients will respond to supportive care OTC analgesics
True
What is used for supportive care of Pain in MPox?
- NSAIDS- systemic
- APAP- systemic
- Local Topical Corticosteroids/Anesthetics
- Opioids- refractory
T/F: You can use local topical corticosteroids/anesthetics on genital tissues and large surfaces.
False, avoid both
T/F: Opioid use for refractory pain is appropriate in patients in the late stage with scabs/lesions.
True
What is used for supportive care of Proctitis in MPox?
- Stool Softener
- Gabapentin
What is used for supportive care of Pruritus in MPox?
- Oral antihistamines
- Calamine lotion
- Petroleum Jelly
- Colloid Oatmeal
What is used for supportive care of Oral Lesions in MPox?
- Saltwater Rinse
- Chlorhexidine
- Local Anesthetics
T/F: Metamucil can be recommended for MPox proctitis.
False
T/F: Tramadol may be considered for severe MPox pain.
True
Which anesthetic is safe to use for oral lesions?
Benzocaine
T/F: Tecovirimat is FDA approved for MPox.
False, FDA approved for smallpox but not Mpox
What is the contraindication for the use of Tecovirimat?
CrCl <30 for IV FORM ONLY
Dosing of Tecovirimat
Weight based 14 day treatment
Tecovirimat should be avoided with concomitant use of ______ or ______.
- Repaglinide
- Midazolam
T/F: Tecovirimat strongly induces CYP3A4 and inhibits CYP2C9/2C19.
False, weakly
Concomitant use of Repaglinide and Tecovirimat leads to what?
More hypoglycemia
Concomitant use of Midazolam and Tecovirimat leads to what?
Reduced anti-anxiety
What is the AE that is seen in PO and IV formulations of Tecovirimat?
HA
How should Tecovirimat be taken?
Take with a full glass of water 30 minutes after a 600 calorie meal
T/F: MPox vaccine is FDA approved for smallpox and Mpox via subQ injection.
True
T/F: MPox vaccine is FDA approved for MPox Intradermal injection.
False, expanded use authorization
What is the MPox Vaccine dosing for SQ route?
0.5 mL x 2 doses 4 weeks apart
What is the MPox Vaccine dosing for Intradermal route?
0.1 mL x 2 doses 4 weeks apart
MPox Vaccine will have local injection site reactions that will persist for ___ weeks.
3
T/F: Proven concern from myocarditis and pericarditis if MPox Vaccine administered within 12 weeks of mRNA COVID-19 vaccine.
False, unproven
T/F: Tecovirimat is nephrotoxic
False
T/F: MPox vaccine may be administered IM
False
T/F: MPox vaccine is more effective when given intradermally than subcutaneously.
False
Young adult males should avoid receiving which vaccine within 4 weeks of the Mpox vaccine?
Covid-19
T/F: MPox vaccine is contraindicated in patients living with AIDS.
False
Pre-Exposure Vaccination Criteria MPox
- Gay, bisexual, MSM, transgender, nonbinary or gender diverse with>1 partner or new diagnosis of STIs
- Persons having sex: commercially, MPox transmission is high
- Clinical/healthcare workers caring for patients with MPox
Post Exposure Vaccination Criteria MPox
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
T/F: Influenza is an RNA Virus
True
Define Flu A
Most common, may cause seasonal or pandemic flu
Define Flu B
Second most common, seasonal outbreaks only
Define Hemagglutinin
Helps the flu virus bind to host receptors and enter host cells
Define Neuraminidase
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
What is the main target for antiviral flu medications?
Neuraminidase
What is the main target for flu vaccinations?
Hemagglutinin
Flu incubates for ___ days and a patient is infectious for about ___ days.
2 and 7
S/S of Influenza
- Myalgia
- HA
- Nonproductive cough
- Sore Throat
- Fever that develops quickly
When would laboratory confirmation of influenza is recommended when?
- Low prevalence of flu
- High risk for transmission among patients such as nursing homes
T/F: RDT = POC
False, RDT is a subtype of POC
T?F: RDT POC Flu Tests are Clinical Laboratory Improvement Amendment CLIA Waived Tests
True
T/F: Pharmacists do not need to follow the manufacture instructions verbatim on POC Flu Tests?
False, you must follow it precisely
T/F: POC Flu Tests look for influenza antigens not viral DNA/RNA.
True
What is the most important step of the PPCP that applies to Influenza?
Follow Up
When should you follow up with a patient for influenza?
1-2 days after POC, if they are worsening refer them to PCP
If the patient received LAIV <7 days, RDT POC for flu may be ____ ____.
Falsely positive
What 3 population types are not candidates for POC Flu testing?
- Vulnerable Populations
- Lung Disease
- Signs of Critical Illness
What are 3 forms of Nonpharmacologic Therapy are used in influenza?
- Rest
- Drink plenty of fluids
- Palliate symptoms with cough drops, warm tea, or warm soup
T/F: A patient with rhinorrhea, watery eyes, and palate itching presents to the pharmacy, they should be tested for flu.
False
Which flu vaccine may cause a false positive on RDT POC flu test?
FluMist
Healthy adults with >48 hours of symptoms need what type of flu treatment?
No Rx therapy
Healthy adults with <48 hours of symptoms need what type of flu treatment?
Consider Rx therapy
Hospitalized, severe symptoms, and high risk need what type of flu treatment?
Recommend Rx therapy
Is HTN alone a high risk complication in influenza that would deem necessary treatment?
No
T/F: Do not use adamantes for the prevention or treatment of influenza.
True
What are the 3 Neuraminidase Inhibitors and their ROA?
- Oseltamivir: capsule or suspension
- Zanamivir: inhalation
- Peramivir: IV
What is the MOA of Neuraminidase Inhibitors?
Prevent the neuraminidase enzyme from releasing virions from infected host cells
What is the dosing of Adults >13 yrs for Oseltamivir?
75 mg PO BID
What is the dosing of Oseltamivir for CrCl 31-60?
30 mg PO BID
What is the dosing of Oseltamivir for CrCl 11-30?
30 mg PO QD
What is the dosing of Oseltamivir for CrCl <10?
Not recommended
How should you take Tamiflu?
With food
T/F: Stop oseltmaivir if the patient develops a rash.
True
What is the drug of choice for influenza in pregnant patients?
Tamiflu
When is Zanamivir Contraindicated?
Milk protein Allergy
When should Zanamivir be avoided?
- Asthma
- COPD
When is Zanamivir recommended?
Only in adults who have failed Oseltamivir
When is Peramivir recommended?
Patients unable to take oral medications
What is the MOA of Baloxavir/Xofluza?
Disrupts RNA trasncription to prevent flu virus replication
What is the FDA approved use of Xofluza?
> 12 yrs presenting with symptoms WITHIN 48 hours and HIGH RISK for developing serious symptoms
What is the dose of Xofluza for weight <80 kg?
40 mg one time dose
What is the dose of Xofluza for weight >80 kg?
80 mg one time dose
Prophylaxis of Influenza pre-exposure can be considered if what?
- High risk during 14 days after vaccination
- High risk if not vaccinated and close contact with flu
- High risk and contraindicated to vaccination
Prophylaxis of Influenza post-exposure can be considered if what?
<48 hrs following flu exposure:
1. Within 14 days following flu vaccine
2. Immunosuppressed
3. Contraindicated to flu vaccine
