Nwauche Flashcards
Case Study 1: Newly Diagnosed Patient
Patient: 28-year-old male, recently tested HIV-positive.
Symptoms: Fatigue, weight loss, occasional fever.
CD4 Count: 250 cells/mm³.
Viral Load: 150,000 copies/mL.
Medical History: No previous ART, no TB, no other comorbidities.
Questions for You:
- What does the CD4 count and viral load indicate about his disease stage?
- What is the recommended first-line ART regimen for him?
- What advice would you give regarding treatment adherence and follow-up?
- When should his viral load be checked again, and what results would indicate treatment success or failure?
Great effort! Let’s refine your analysis a bit for better accuracy.
- CD4 Count & Viral Load Analysis
Viral Load (150,000 copies/mL):
Yes, this indicates a long-standing infection (not newly acquired).
A high viral load means active replication, increasing the risk of transmission and disease progression.
CD4 Count (250 cells/mm³):
Why is CD4 important? It measures immune function.
A normal CD4 count is 500-1500 cells/mm³.
A CD4 count <200 cells/mm³ is AIDS stage → severe immunosuppression.
Since this patient’s CD4 is 250, he is close to AIDS but not there yet.
His immune system is weak, but early ART can still help recovery.
- Recommended First-Line ART Regimen
You mentioned DGT (Dolutegravir - DTG), Lamivudine (3TC), and ARHD.
Correction: “ARHD” is not a drug name; I think you meant TDF (Tenofovir Disoproxil Fumarate).
The correct WHO & Nigeria first-line regimen:
TLD (Tenofovir + Lamivudine + Dolutegravir).
This is once-daily, highly effective, and well-tolerated.
- Advice on Treatment Adherence & Follow-up
Take medication daily at the same time (as you said).
Missing doses → resistance → treatment failure → faster progression to AIDS.
Adherence = viral suppression = longer, healthier life.
Encourage good nutrition, avoiding smoking/alcohol, and staying mentally strong.
Counseling & support groups help in adherence.
- Viral Load Monitoring & Success Indicators
When to check again?
First check at 6 months, then at 12 months, then annually.
What indicates success?
Viral load <50 copies/mL = success (undetectable = untransmittable).
CD4 count should rise above 500 over time.
What indicates failure?
Viral load stays >1000 copies/mL after 6 months → Possible adherence issues or resistance.
If VL increases beyond 150,000 copies/mL → High chance of drug resistance → Change to second-line ART.
Final Verdict
Your core ideas were correct!
I corrected ARHD → TDF (to complete TLD regimen).
I clarified CD4 count’s role and better defined treatment success/failure.
Would you like another case study, maybe a pregnant woman or a child with HIV?
- What are the two main classifications of UTIs, and how do they differ?
Uncomplicated UTIs (uUTIs): Affect healthy patients without structural or neurological abnormalities of the urinary tract.
Complicated UTIs (cUTIs): Associated with urinary tract abnormalities that increase susceptibility to infection, such as catheterization, urinary retention, kidney stones, pregnancy, etc.
Name at least four bacterial pathogens that commonly cause UTIs.
Escherichia coli (80-90%)
Klebsiella species
Enterobacter species
Enterococcus species
Group B Streptococcus (GBS)
Staphylococcus saprophyticus
Proteus mirabilis
List three structural abnormalities that can cause obstruction of urinary flow and lead to UTIs.
1. Congenital anomalies of the ureter or urethra
- Renal stones (kidney stones)
- Enlarged prostate in men
Name three groups of people who are more susceptible to UTIs.
Immunosuppressed persons (e.g., HIV-infected, diabetes patients)
- Men with enlarged prostate or those with prostatitis
- Women after menopause (due to reduced estrogen levels)
What are three symptoms of lower UTI in adults?
Dysuria (pain while urinating)
Increased frequency of urination
Urgency
Suprapubic pain or discomfort
Cloudy, foul-smelling urine
. Name two possible complications of untreated UTIs.
Kidney failure or damage
Sepsis (infection spreading through the bloodstream)
Preterm labor in pregnant women
Why are pregnant women more susceptible to UTIs? Give two reasons.
.
Hormonal changes alter normal urinary tract function and make women more prone to infections.
- Increased pressure on the bladder prevents complete emptying, creating favorable conditions for bacterial growth.
Name two first-line antibiotics used to treat uncomplicated cystitis.
Trimethoprim
- Beta-lactams (e.g., amoxicillin, amoxiclav)
- Oral cephalosporins
- Fluoroquinolones (e.g., ciprofloxacin, norfloxacin, ofloxacin, nitrofurantoin)
Why are oral fluoroquinolones recommended as first-line agents for uncomplicated pyelonephritis?
Oral fluoroquinolones are recommended as first-line agents for uncomplicated pyelonephritis because they achieve high blood and tissue levels, making them effective for treating kidney infections.
- Why are asymptomatic UTIs usually not treated, except in children and pregnant women?
Asymptomatic cases generally do not cause harm and do not require treatment.
- However, in children and pregnant women, untreated bacteriuria can lead to complications (e.g., acute pyelonephritis, maternal anemia, low birth weight, premature birth).
Next question:
14. Name two preventive measures against UTIs.
Partially correct. “Symptoms are not detected” is relevant, but “the immune system can fight them off” is not the stated reason in the write-up.
Correct reasons from the write-up:
- Asymptomatic cases generally do not cause harm and do not require treatment.
- However, in children and pregnant women, untreated bacteriuria can lead to complications (e.g., acute pyelonephritis, maternal anemia, low birth weight, premature birth).
Score: 5/10
Next question:
14. Name two preventive measures against UTIs.
What is the pharmacist’s role in managing UTIs? (Name two responsibilities).
Ensuring patients adhere to therapy (right dose, duration, and compliance).
- Antibiotic stewardship (choosing the right antibiotic, preventing resistance, and optimizing treatment).
Other roles mentioned in the write-up:
Identifying relapse or recurring UTIs and adjusting treatment
Providing lifestyle and prophylaxis advice
Referring patients to a physician when necessary
Performing dipstick tests in community pharmacy settings
Why are postmenopausal women more susceptible to UTIs?
The write-up states that reduced estrogen levels during menopause make some women more susceptible to UTIs because estrogen provides some level of protection against infection
Why is diabetes a risk factor for UTIs?
Diabetes is a risk factor for UTIs because high blood sugar levels encourage bacterial growth, making infections more likely. Additionally, diabetes contributes to the development and worsening of lower urinary tract symptoms (LUTS)
Name one alternative treatment option for complicated UTIs caused by multidrug-resistant pathogens.
Ceftolozane/tazobactam
- Imipenem/cilastatin
- Ceftazidime/avibactam
What are the two types of syphilis?
The two types of syphilis are acquired and congenital
What are the common syndromes of STIs?
genital discharge, genital ulcer, or lower abdominal pain.
Name two long-term complications of chlamydia infection in women.
Two long-term complications of chlamydia infection in women are PID (Pelvic Inflammatory Disease) leading to tubal damage and subsequent infertility or ectopic pregnancy
Name two antibiotics used to treat uncomplicated gonorrhea.
Ceftriaxone (500mg IM) and Cefixime (400mg stat). Other options include Ciprofloxacin, Ofloxacin, Amoxicillin + Probenecid, and Spectinomycin.
What is the recommended first-line treatment for chlamydia
Azithromycin 1g orally (single dose) OR Doxycycline 100mg twice daily for 7 days.
