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PR3151 - Therapeutics > STD > Flashcards

STD Flashcards

1
Q

Management of uncomplicated Gonorrhea (1st Line)
Normal weight (<150kg) = ?
Severely obese (>= 150kg) = ?

A

IM Ceftriaxone 500mg ONCE
IM Ceftriaxone 1g ONCE

If Chlamydial Infection is not excluded -> PO Doxycycline 100mg BD for 7d

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2
Q

Management of uncomplicated Gonorrhea (2nd Line)

A

IM Gentamicin 240mg ONCE + PO Azithromycin 2g ONCE (Long intracellular half life)

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3
Q

Management of Chlamydial Infection (1st Line)

A

PO Doxycycline 100mg BD for 7d

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4
Q

Management of Chlamydial Infection (If adherence is an issue)

A

PO Azithromycin 1g ONCE (Long intracellular half life)

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5
Q

Management of Chlamydial Infection (2nd Line)

A

PO Levofloxacin 500mg OD for 7d

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6
Q

Test of cure for Chlamydial Infection required?

A

NO (Low risk of resistance)

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7
Q

Test of cure for Gonorrhea required?

A

YES (Have chance of resistance)

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8
Q

Different stages of Syphilis (Treponema Palladium)

A

Primary (Localised - painless ulcer/ painful multiple lesions)
Secondary (More systemic - skin rash, alopecia, lymph node involvement)
Latent (Asymptomatic)
Tertiary (More systemic - lesions of joints, heart and aortic involvement)
Neurosyphilis (Bacteria gone into the CSF)

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9
Q

Management of Syphilis W/O Penicillin Allergy (Primary/Secondary/Latent < 1yr)

A

IM Benzathine Penicillin G 2.4MU ONCE

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10
Q

Management of Syphilis W/ Penicillin Allergy (Primary/Secondary/Latent < 1yr)

A

PO Doxycycline 100mg BD for 14 days

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11
Q

Management of Syphilis W/O Penicillin Allergy (Latent >1yr/Unknown duration/Tertiary)

A

IM Benzathine Penicillin G 2.4MU Once a week for 3 doses

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12
Q

Management of Syphilis W/ Penicillin Allergy (Latent >1yr/Unknown duration/Tertiary)

A

PO Doxycycline 100mg BD for 28 days

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13
Q

Management of Neurosyphilis W/O Penicillin Allergy

A

IV Crystalline Penicillin G 3-4MU q4hr over 10-14d

OR

IV Crystalline Penicillin G 18-24MU q24hr as continuous infusion over 10-14d

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13
Q

Management of Neurosyphilis W Penicillin Allergy

A

IV/IM Ceftriaxone 2g OD for 10-14d

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14
Q

Monitor for cure for Syphilis?

A

YES

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15
Q

What to monitor for cure of Syphilis (primary/secondary/latent)

A

Conduct non-treponemal test (VDRL/RPR) at 3, 6, 12, 18, 24 months after starting treatment.

VDRL & RPR titre should reduce by 4 fold (e.g. from 1:64 to 1:16)

If sx still present/failure to achieve titre reduction -> reevaluate syphilis status and treat accordingly

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16
Q

What to monitor for cure of Neurosyphilis

A

CSF every 6 months until it comes back to normal

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17
Q

Can genital herpes be eradicated?

A

NO. The HSV virus will stay dormant in the nerve ganglia cells.

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18
Q

What virus most commonly cause genital herpes

A

HSV-2 Mainly

HSV-1 (cause cold sores) possible due to oral sex

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19
Q

Genital herpes can spread even when a person is asymptomatic

A

YES

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20
Q

Are symptoms for genital herpes self-limiting

A

Vesicles develop over 7-10d and health in 2-4 wks

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21
Q

Management of 1st episode for HSV (Acyclovir)

A

PO Acyclovir 400mg TDS for 7-10d

More severe (immunocompromised that requires hospitalisation),
IV Acyclovir 5-10mg/kg q8hr for 2-7d followed by the oral regimen for a total of 10d

22
Q

Management of 1st episode for HSV (Valacyclovir)

A

PO Valacyclovir 1g BD for 7-10d (Greater F than Acyclovir)

23
Q

Mechanism of action of Acyclovir

A

Inhibit viral DNA polymerase –> inhibit DNA synthesis and replication

24
Q

What are the typical symptoms before onset of recurrent flare (HIV)

A

Prodrome - Mild itching, burning, tingling sensation

25
Q

Adverse drug reaction antiviral therapy?

A

GI Side effect. N/V/D. Kidney injury (recrystallisation of the drug which damages kidney tubules if not adequately hydrated)

26
Q

Benefits of chronic suppressive therapy for recurrent outbreaks

A
  1. Reduces the frequency of recurrences
  2. No symptomatic outbreaks
  3. Decrease the risk of transmission

Benefit is the most for immunocompromised HIV patients!

27
Q

Chronic suppressive therapy for recurrent outbreaks (Regimen)

A

Lower dose compared to the initial outbreak:
1. PO Acyclovir 400mg BD
2. PO Valacyclovir 500mg OD (For < 10 outbreaks per yr)
3. PO Valacyclovir 1g OD (For >= 10 outbreaks per yr)

28
Q

Episodic therapy during recurrent outbreaks

A

Lower dose compared to the initial outbreak:
1. PO Acyclovir 800mg BD for 5d
2. PO Acyclovir 800mg TDS for 2d
3. PO Valacyclovir 500mg BD for 3d
4. PO Valacyclovir 1g OD for 5d

29
Q

Counselling for HSV

A
  1. Pre-empt the patient (natural course of disease + increased risk of HIV)
  2. Reduce transmission
    - Transmission can occur even if they are asymptomatic
    - Encourage CST
    - Encourage condom use
    - Encourage abstinence from sex when symptomatic
30
Q

When does a person has AIDS?

A

CD4 T cell count < 200mm^3

OR

Uncommon infections that affect the CNS, eyes, lungs (pneumocystic pneumonia), skin and GI tract & Cancer (Lymphoma, Kaposi Sarcoma)

31
Q

What is defined as a response to therapy for HIV? (CD4)

A

CD4 count increase by 50-150mm^3 in 1st year of therapy

32
Q

The utility of CD4 count as a surrogate marker?

A
  1. Indicator of immune function
  2. Progression of disease
  3. Response to therapy
  4. Starting and discontinuing prophylactic treatment for opportunistic infection (e.g. pneumocystis pneumonia)
33
Q

Effective regimen decreases viral load in ___ weeks

A

8-24 weeks

34
Q

When to measure CD4 count? (HINT: Need time to restore back the CD4 count)

A

Baseline

Every 3 to 6 months after treatment initiation

Every 12 months after an adequate response

35
Q

When to measure viral load?

A

Baseline

Within 2 - 4 wks (not later than 8 weeks) after treatment initiation or
modification, thereafter, every 4 to 8 weeks until viral load
suppressed

36
Q

When to start ART?

A

As soon as the patient is diagnosed with HIV! To reduce morbidity, mortality & transmission

37
Q

1st line initiation therapy for HIV

A

2 NRTI + 1 INSTI

  1. Tenofovir + Emtricitabine + Bictegravir
  2. Tenofovir + Emtricitabine + Dolutegravir
  3. Abacavir + Lamivudine + Dolutegravir
38
Q

Alternative initiation therapy for HIV

A

Emtricitabine + dolutegravir

NOT for individuals with:
- High viral load (HIV RNA >500,000 copies/mL) OR
- HBV coinfection OR
- Resistance strains

39
Q

List Nucleoside Reverse Transcriptase Inhibitors (NRTI)

A

No fix pattern

Tenofovir, Emtricitabine, Abacavir, Lamivudine, Zidovudine

40
Q

List Integrase Strand Transfer Inhibitor (INSTI)

A

(-Tegravir)

Bictegravir, Dolutegravir, Raltegravir, Elvitegravir

41
Q

List Protease Inhibitors (PI)

A

(-Navir)

Ritonavir, Lopinavir, Atazanavir, Darunavir, Fosamprenavir

42
Q

How is NRTI eliminated?

A

Renal elimination, little concerns for drug interactions (except abacavir)

43
Q

What are the major ADRs for NRTI?

A

For All:
1. Mitochondria toxicities (Zidovudine highest risk) - Lactic acidosis & hepatic steatosis & lipoatrophy
2. GI distrubance: N/V/D

Individual agent:
1. Lamivudine & Emtricitabine – minimal toxicity
2. Tenofovir: – Renal impairment, decrease in bone mineral density
3. Abacavir: Hypersensitivity reaction in patients with HLA-B*5701. Concern for association with MI – not be used in high cardiovascular risk patients.
4. Zidovudine – bone marrow suppression –> anaemia or neutropenia.

44
Q

What are the major ADRs for INSTI?

A

For All:
1. Weight gain, N/V/D, headache
2. Rare depression, and suicidal ideation in psychiatric patients

Individual agent:
1. Bic & Dolu: Inc SCr
2. Raltegravir- pyrexia, creatine kinase elevation (rhabdomyolysis)

45
Q

What are the major DDIs for INSTI?

A

Bioavailability lowered by concurrent administration of polyvalent
cations

CYP 3A4 substrates (Bictegravir, dolutegravir and elvitegravir)

46
Q

What is the main advantage of using Non-nucleoside Reverse Transcriptase Inhibitors?

A

Long half-lives

47
Q

What is the main disadvantage of using Non-nucleoside Reverse Transcriptase Inhibitors?

A
  1. Low genetic barrier to resistance
  2. Skin rash, SJS (R < E)
  3. Potential for CYP450 drug interactions (some are inducers
    and some are inhibitors)
  4. QTc prolongation
48
Q

What are the major ADRs for NNRTI?

A
  1. Metabolic condition (worsen HLD)
  2. Neuropsychiatric (dizziness, depression, insomnia, abnormal dreams, hallucination)
49
Q

List Non-nucleoside Reverse Transcriptase Inhibitors (NNRTI)

A

Efavirenz, Rilpivirine (preferred)

50
Q

The role of Ritonavir

A

PK Enhancer

Potent CYP3A4, 2D6 inhibitor; frequently combined with other PI to “boost” their levels (eg Lopinavir/ritonavir)

51
Q

What are the major ADRs for PI?

A
  1. Metabolic complications (dyslipidemia, insulin resistance) - Atazanavir lesser
  2. GI side effects (N/V/D)
  3. Liver toxicity (especially with chronic hepatitis B or C)
  4. CYP3A4 inhibitors and substrates: potential for DI
  5. Morphologic Complications: Fat maldistribution (Lipohypertrophy)
  6. Increased risk of osteopenia/osteoporosis
52
Q

What must be done before the use of CCR5 inhibitor?

A
  1. Need co-receptor tropism assay before initiation
  2. Must be CCR5 predominant to use maraviroc (not to use if
    CXCR4 or dual/mixed tropism)

PR3151 - Therapeutics (8 decks)

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