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HIV Diploma > PEP > Flashcards

PEP Flashcards

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1
Q

What are the baseline post exposure investigations for the source?

A

HIV Rapid and ELISA
HBsAg
HCV Ab
RPR/TPHA

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2
Q

What are the baseline post exposure investigations for the exposed?

A

HIV Rapid and ELISA
HBsAb
HCV Ab
Beta-HCG
RPR/TPHA (if source +ve)
Creat (TDF)
FBC (AZT)

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3
Q

When is HIV prophylaxis required?

A

Exposure to infectious bodily fluids or sexual exposure
Within 72 hours

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4
Q

When is HIV prophylaxis not required?

A

Exposed +ve
Source -ve and window period excluded

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5
Q

When is HBV prophylaxis required?

A

Exposure to infectious bodily fluids, sexual exposure and human bites

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6
Q

How do you give HBV prophylaxis

A
  1. HBV vaccine
    3 doses at monthly intervals
    Within 7d of non-sexual exposure
    Within 14d of sexual exposure
  2. HBIG 500IU
    Within 72 hours
    Immediately protective, 75% efficacy, lasts 3-6m
    Do not delay >24h
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7
Q

When is HBV prophylaxis not required?

A

Exposed +ve
Exposed vaccinated with HBsAb >10IU
Source -ve

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8
Q

When do you give emergency contraception?

A

Within 5d of sexual exposure

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9
Q

When is emergency contraception not required?

A

Exposed is pregnant
Exposed uses other contraceptives
Prepubescent girls without breast development

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10
Q

When do you give STI prophylaxis?

A

Within 72h of sexual exposure

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11
Q

When do you give tetanus prophylaxis?

A

Wounds, cuts, bite
Within 48h

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12
Q

When is tetanus prophylaxis not required?

A

3 doses of tetanus vaccine previously

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13
Q

What counselling must be given post exposure?

A

Potential conditions
PEP risks, benefits, effectivity, instructions, side effects
Investigations
Follow up appointments
Emotional support
Condom use up to 4 months post exposure

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14
Q

What is the follow up schedule post exposure?

A

2 weeks: creat (TDF), FBC (AZT)
6 weeks: HIV rapid and ELISA, HCV PCR, pregnancy test if no menses
4 months: HIV rapid and ELISA, HBsAg, RPR/TPHA

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15
Q

What makes an exposure high risk?

A

Larger fluid qualities
High VL

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16
Q

What is the law regarding HIV testing of alleged offenders?

A

Within 90d of offence

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17
Q

What is the PEP regimen?

A

TLD 300/300/50

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18
Q

What is the PEP regimen if DTG is not tolerated?

A

TDF/FTC 300/200
PLUS
Atazanavir 300/100 dy
OR
Lopinavir/r 200/50 2 tablets bd

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19
Q

What is the PEP regimen if TDF is not tolerated?

A

AZT 300mg bd
PLUS
3TC 150mg bd

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20
Q

What are the common side effects of PEP drugs?

A

TDF - nephrotoxicity
DTG - insomnia
AZT - N+V, headache, insomnia, fatigue
Atazanavir - UC hyperbilirubinemia, hepatitis, rash
Lopinavir - GIT intolerance

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21
Q

When can consent be given by a child for HTS?

A
  1. > 12yo
  2. <12yo with sufficient maturity
  3. Patient, caregiver or HOD
22
Q

How do you initiate PEP <18m?

A

Do PCR
Initiate PEP
Follow up PCR within 48h
-ve continue PEP
+ve ART and confirm with PCR

23
Q

How do you initiate PEP >18m?

A

Do HIV rapid
-ve initiatie PEP
+ve ART and confirm with PCR/VL

24
Q

How do you intiate PEP >24m?

A

Adult testing algorithm

25
Q

What can you do if a child is exposed to another woman’s breastmilk?

A

Aspirate via NGT

26
Q

What is the PEP regimen in children <10yo <20kg?

A

AZT/3TC/LPV/r

27
Q

What is the PEP regimen in children <10yo >20kg?

A

AZT/3TC/DTG

28
Q

What is the PEP regimen in children >10yo <35kg?

A

AZT/3TC/DTG

29
Q

What is the PEP regimen in children >10yo >35kg?

A

TLD

30
Q

What do you give an exposed infant that is NPO?

A

IV AZT

31
Q

What is a contraindication for LPV/r in neonates?

A

Neonate <2w
Prem <42w GA

32
Q

What is the alternative if AZT is poorly tolerated in a child?

A

d4T

33
Q

What is the alternative in a child >2yo <20kg with LPV/r poorly tolerated?

A

RAL

34
Q

What is the AZT dose in infants?

A

<35w GA: 2mg/kg/d bd
>35w <3kg: 4mg/kg/d bd
>35w >3kg: 12mg bd

35
Q

How many mg is 1ml oral AZT?

A

10mg

36
Q

What is the 3TC dose in infants?

A

<28d: 2mg/kg/d bd
>28d: 4mg/kg/d bd

37
Q

When do you follow up for STI exposure?

A

At 1/52 (incubation)
At 3-4m (antibodies)

38
Q

What is the standard treatment for STIs?

A

CTX 250mg imi
Azithro 1g po
Flagyl 2g po

39
Q

What are the drug doses for CTX in children?

A

<25kg 125mg im
>25kg 250mg im

OR 80mg/kg/d

40
Q

What are the drug doses for azithromycin in children?

A

<45kg 20mg/kg
>45kg 1g

41
Q

What are the 2 emergency contraceptives available in SA?

A
  1. Hormonal OCP
  2. Copper IUD
42
Q

What hormonal OCP can you give for emergency contraception?

A

Levonorgestrel (Escapelle) 1.5mg stat
OR
Levonorgestrel + ethinyl estradiol (Ovral) 2 doses immediately and at 12 hours

Always offer maxalon, repeat dose 30min after vomiting

43
Q

What factors affect hormonal OCP?

A

Woman >80kg/BMI>30
Enzyme inducers decrease levonorgestrel

Double the dose

44
Q

What is the advice regarding tetanus prevention in immunocompromised individuals?

A

All should get TIG regardless of immunisation history

45
Q

What is the difference concerning HIV testing in an occupation exposure?

A

HIV rapid is confirmed with an HIV ELISA

46
Q

Can you still treat a patient with HIV prophylaxis after 72 hours?

A

Yes if high risk.
- deep
- needle was in artery/vein
- visible blood
- AHD in source

47
Q

Which bodily fluids are non-infectious

A

If NOT bloodstained!

Tears
Sweat
Urine
Stool
Saliva

48
Q

What are the drug doses for flagyl in children?

A

1-3y 500mg
3-7y 800mg
7-10y 1g
>10y 2g

49
Q

What is a contraindication for atazanavir?

A

Rifampicin
PPIs

50
Q

Is there any difference in the metronidazole dose for STI prevention in first trimester pregnancy?

A

Metronidazole 400mg bd for 1/52 preferred

HIV Diploma (3 decks)

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