Test 2 Renal, STDs, Drugs, Blood Flashcards
(106 cards)
1
Q
Disease that is spread by various sexual practicies between sexual partners
A
Sexually Transmitted Diseases
2
Q
Four Reasons Why the number of STDs has increased since 1960?
A
1) Age of first sexual activity has declined
2) The number of people at highest risk for STDs (15-25) has increased
3) Number of sexual partners per individual has increased
4) Methods of birth control have changed from rubbers and diaphragms to birth control pills and IUDs
3
Q
Name 7 possible Agents of Transmission of STDs
A
1) Bacteria
2) Chlamydia
3) Viruses
4) Fungi
5) Protozoa
6) Parasites
7) Unidentified microrganisms
4
Q
What are 6 common entry sites of STDs
A
1) mouth
2) genitalia
3) urinary meatus
4) rectum
5) skin
5
Q
True/False
Is it common for a person to be concurrently infected with more than one type of STD.
A
TRUE
Yes very common to have concurrent infections
Most very likely to have Chlamydia and Gonorrhea together
6
Q
Three groups STDs can be divided into include
A
1) Infections of External Genitalial
2) Vaginal Infections
3) Vaginal- Urogenital Systemic infections
7
Q
4 types Infections of External Genitalia include
A
1) HPV (Condylomata Acuminata)
2) Genital Herpes
3) Molluscum contagiosum
4) Chancroid
8
Q
3 types of Vaginal infections
A
1) Candidiasis
2) Trichomoniasis
3) Bacterial Vaginosis (nonspecific Vaginitis)
9
Q
Vaginal-Urogenital-Systemic Infections
A
1) Chlamydia Infections
2) Gonorrhea
3) Syphilis
10
Q
What sex organs does Gonorrhea effect?
A
Men- urethra
Women- cervix
11
Q
Gonorrhea increased its frequency in the 1960s because
A
1) Changing social values
2) Introduction of birth control pills
3) Increasing resistance to penicillin
4) Large numbers of military personnel in Southeast Asia, Iraq, and Afghanistan.
12
Q
How does disease transmission occur in gonorrhea
A
through contact with exudates from the mucous membranes of infected persons usually by direct contact. The gonococcus then attaches to and penetrates columnar epithelium and produces a patchy inflammatory response in the submucosal layer with a polymorphonuclear exudate.
13
Q
How does goonococci spread or how does it travel throughout the body?
Once it has spread to localized infection what may form on the skin?
A
Direct extension of the infection with gonococci occurs by way of the lymphatic system.
Once it has spread to other areas, localized infection occurs and may result in the formation of cysts and abscesses.
14
Q
What harm can the exudate of gonococcus cause to body tissue during transmission or spreading?
A
Purulent exudate containing the organism causes damage to tissue, and fibrous tissue replaces inflammed tissue. Hardened fibrous tissue may result in scarring and narrowing of the urethra, epididymis or oviducts.
15
Q
Incubation period
males?
Females?
A
Males- 3-7 days
females- variable and is usually ASYMPTOMATIC until complications begin.
16
Q
Symptoms of Gonorrhea in male urethra
A
Thick whitish-yellow discharge of pus from penis
Mild to intense burning during urination
40% of infected males are asymptomatic
17
Q
Untreated gonorrhea in males may develope into
A
1) Inflammation of prostate gland
2) Scarring of urethra
3) Intense irritation and swelling of testicles
4) Sterility, crippling, blindness and death
18
Q
Are women most likely to experience symptoms of cervical gonorrhea?
A
NO, 80% of women have mild or no symptoms and the disease may go unnoticed.
Supposedly, 600,000 asymptomatic female carries, 20% will develop major complications.
19
Q
Symptoms of cervical gonorrhea in women
A
sometimes vaginal discharge and burning sensation during urination
20
Q
Complications from cervical gonorrhea
A
1) PID
2) Sterility
3) Ectopic pregnancy
21
Q
Sexually active females should have what two test yearly?
A
1) Paptest/thin prep
2) Gonorrhea test
22
Q
Name 3 other types of gonorrhea
A
1) Rectal
2) throat
3) Gonorrhea in babies and children
23
Q
Explain Treatment of Gonorrhea
A
Most cases of gonorrhea can completely and quickly cured without damage if diagnosed and treated soon after infection. However resistant strains have developed and no body immunity develops so re-infection can occur repeatedly.
24
Q
The CDC recommends that all gonococcal infections be treated as if……………
A
The organism were antibiotic resistant and that a chlamydia infection coexisted with gonorrhea. IN 1995, 31.6% of gonorrhea patients were resistant to both penicillin and tetracycline.
25
What are two antibiotics that Gonorrhea has developed Resistance too?
1) Penicillin
| 2) Tetracycline
26
Describe Chlamydia organism
Chlamydia trachomatis organism has some features of a virus and bacteria
1) Larger and more complex than virus
2) Live inside other cells to reproduce
3) Like bacteria, chlamydia can be killed by antibiotics
27
Types of Chlamydia
A, B, Ba, "& C= cause eye infections that result in blindness world wide each year, mostly in Asia and Africa.
28
How is Clamydia spread in:
1) underdeveloped countries
2) Developed countries
Clamydia is spread
1) in underdeveloped countries by unsanitary living conditions
2) Developed countries spread mostly by sexual transmission.
29
Clamydia is the most common STD in the United States?
True....
30
What organs are affected by Clamydia?
Same as gonorrhea... sex organs.
urethra, epidiymis, oviducts
Males: Urethra, inflamation of prostrate gland, scarring of urethra
Females: cervical, PID, sterility, ectopic pregnancy
31
Clamydia incubation period for a male
in males inccubation period is 1-3 weeks. Many chlamydia infections remain asymptomatic but infectious for years.
32
Most common complication from chlamydia?
| How long after infection will it occur?
1) urethritis
| 2) occurs 5-21 days after sexual activity with a carier
33
What are Chlamydia symptoms in men?
| What happens if Chlamydia goes untreated in males?
1) mucus discharge and pain on urination.
| 2) If chlamydia goes untreated infection may lead to infection of prostate gland, epididymis, testicles and sterility.
34
What are Chlamydia symptoms in women?
| What are complications of Chlamydia in women?
1)Most women have NO symptoms!
Some may have mild inflammation of the cervix.
2)Complications is usually PID
35
What are symptoms in babies due to chlamydia transmission during birth canal passage
may result in eye (ophthalmia neonatorum), ear or lung infections.
36
What is Non-Gonoccoccal Urethritis (NGU)
inflammation or infection of the urethra from causes other than gonorrhea most often by strains of C. trachomatis that act on columnar epithelium in a manner similar to that of the gonococcus.
Symptoms similar to gonorrhea but milder, onset less abrupt, and less mucus discharge. ****Also termed "acute urethral syndrome" in females.
37
Another name for Non- Gonoccoccal Urethritis (NGU)
****Also termed "acute urethral syndrome" in females.***
38
Pelvic Inflammatory Disease
PID is an infection of the fallopian tubes. May extend outside the pelvic area and involved the abdomen.
39
Name three causes of PID
1) most common complication of gonorrhea or chlamydia
2) Other organisms not sexually transmitted
3) IUDs for birth control
40
What are 6 symptoms of PID
1) low abd pain
2) increased menstrual cramping
3) low back pain
4) pain while having sex
5) vaginal discharge
6) Fever
41
True or False:
Diagnosis of PID is difficult to make because numerous other problems have similar symptoms. 40% of patients with PID are incorrectly diagnosed.
TRUE
42
5 possible Complications of PID include
1) infertility caused by scarring of the fallopian tubes
2) tubal pregnancy
3) Abscesses in abdomen, persistent pain
4) Hysterectomy (premature)
5) depression
43
Hepatitis
is an inflammation of the liver and may be caused by toxic chemicals, alcohol or viral infections which are often sexually transmitted.
44
What are four types of Hepatitis
Hepatitis A- formerly called "infectious hepatitis"
Hepatitis B- formerly called "serum hepatitis"
Hepatitis D- delta hepatitis found only in combo w "B"
Hepatitis C- Can not be "tracked to other hepatitis's
45
which hepatitis was formerly called infectious hepatitis
Hepatitis A
46
Which hepatitis was formerly called serum hepatitis
Hepatitits B
47
Which two hepatitis are commonly found together?
Hepatitits D and B
48
Hepatitis B is more likely to develop in American's?
TRUE..... 200,000/500,000 develop HEP B and also Hep C is becoming rapidly increasing as well.
49
Hepatitis A
Where is it found?
How is it transmitted?
excreted in the feces, not in other body fluids and may be spread by
1) direct contact
2) food handlers
3) drinking water
4) Food- raw or steamed clams, oysters/mussels
50
Hepatitis B
Where is it found?
How is it transmitted?
Virus is found in all body fluids of infected persons, blood semen, saliva, and urine.
Spread by
1) Intimate contact w infected persons
2)exposure to body fluids
3) piercing of skin by contaminated instruments
4) Shared illicit drug equipment
5) Sexual transmission, contact w mucous membranes w breaks in skin.
51
Hepatitis D
Where is if found?
How is it transmitted?
Only occurs with what other Hepatitis?
Can not initiate an infection by itself but acts togehter with hepatitis B to produce a disease more severe that that caused by B alone. Found in blood, semen, saliva, and urine/body fluids
Spread same was as B
1) Intimate contact w infected persons
2)exposure to body fluids
3) piercing of skin by contaminated instruments
4) Shared illicit drug equipment
5) Sexual transmission, contact w mucous membranes w breaks in skin.
52
Hepatitits C (non-A, non-B)
Refers to cases that can not be traced to A, B, or D viruses.
There may be more than one agent responsible.
Spread by:
1) transfused blood (major)
2) close contact/sexual contact
53
Symptoms of Hepatitis
```
low grade fever
tired, malaise
n/v/d
distaste for cigarettes
urine turns dark
feces pale colored
skin becomes yellow
liver swells and becomes tender
```
54
Treatment of hepatitis
No specific treatment for hepatitis other than bed rest, avoidance of drugs, alcohol and fats, inactivity and gamma globulin and isolation
55
How to prevent Hepatitis
Hep A- other family members may receive gamma globulin
Hep B- exposed persons may be given a blood product w a high concentration of Hep B antibody (immune globulin HBIG), HB vaccine for long term prevention
56
Two vaccines available for Hepatitis
Hep A and Hep B
57
Human Immunodeficiency Virus
recognized as a distinct clinical entity in 1981 when clusters of Kaposi's sarcoma and Pneumocystis carinii pneumonia were observed in California and New York.
1) Pneumocystis carinii pneumonia
2) Kaposi's sarcoma
58
Where are 3/4 of the world's HIV-1 cases found
Sub-Saharan Africa
59
World's fourth most common cause of death and most deadly infectious disease?
AIDS
60
Name 3 routes of transmission of HIV/AIDs virus?
1) Sexual
2) Blood borne
3) Maternal- infant
61
What are blood-borne transmission routes of AIDs/HIV
1)injection drug use
transfusion of infected blood or blood products
parenteral workplace exposure
62
Maternal-infant transmission can occur during which phases?
1) gestation
2) during birth process
3) after birth through breast-feeding
63
Epidemiology of AIDS
NOW Homosexual Men count for 45% of men (use to be 75%)
By 2000
Adult men 68%
Women 31%
Children
64
Rate of growth in AIDS cases is more rapid among women than among any other epidemiologic group
TRUE
65
Most common means of transmission of infection in women of AIDs
Heterosexual contact
| NOT IV drug use
66
Human Immunodeficiency Virus
family of pathogenic retroviruses, member of the lenti-virus (slow virus) group.
67
Two Types of HIV
Type 1 found worldwide and most common
| Type 2 restricted to West Africa
68
HIV-2
West Africa only!
| Lower levels of viremia until late in the clinical course
69
HIV structure
Two copies of the single-stranded ribonucleic acid genome packaged inside a capsid.. Genome differs from person to person. Strains in individual patients appear to mutate with time, in addition patients may be infected with several HIV strains.
70
Why is it difficult to develop effective vaccine for HIV?
Genome differs from person to person, virus replicated diffrently inside each human. Mutate with time.
71
HIV infects which type of cells?
CD4 cells, primarily T-helper/inducer lymphocytes.
| May also infect other cells that carry the CD4 recptors such as monocytes and macrophages.
72
what are initial target cells during Sexual transmission of HIV ?
Langerhan's cells.
Cells are derived from macrophage line and are found in genital and tonsillar submucosal tissues, also express CD4 on their surfaces.
73
Cells that are thought to act as important cellular reserviors for HIV allowing viral infection to spread to the brain and other organs
infected circulating monocytes
74
Explain route of transmission of HIV in cells once infected...
once HIV is bound, either to CD4 lymphocytes or dendritic cells, it is transported to regional lymphoid tissues. With completion of fusion of HIV to the CD4 receptor, the virus begins to replicate in the lymphoid tissue and later disseminated in the blood.
Once HIV binds and enters host cell it produces a DNA copy of its RNA genome throught reverse transcriptase. Viral DNA is incorporated into the host cell and the DNA is reporduced every time the cell divides
75
How long does it take HIV to be detected in the blood?
7 to 10 days after initial exposure, extremely high levels of viremia are common in early infection.
76
Cardnal Manifestation of HIV infection?
Progressive loss of CD4 T lymphocytes
Lymphocytes that are less than 200 cells per micro liter of blood are associated with development of opportunistic infections and is very predictive of HIV complications
77
Transmission of HIV
```
body fluids
blood
semen
vaginal secretions
breast milk
saliva
urine
CSF
tears
lymph node tissues
brain and other organs with large numbers of infected lymphocytes and macrophages are considered potentially infectious.
```
78
```
Which contain highest concentrations of HIV?
body fluids
blood
semen
vaginal secretions
breast milk
saliva
urine
CSF
tears
lymph node tissues
brain and other organs with large numbers of infected lymphocytes and macrophages are considered potentially infectious.
```
Blood and semen usually contain highest concentrations of HIV
79
Primary modes of transmission of HIV
```
Sexual contact
Blood exposure by:
1) IV drugs
2) perinatal exposure
3) transfusion
```
80
If a patient has idiopathic thrombocytopenia and generalized lymphadenopahty what other testing should be encouraged?
HIV testing
81
How long does detectable antibody to HIV develope in the majority of infected individuals?
2 months of exposure, some patients may take 6 months to seroconvert.
82
What test should you run to confirm HIV
| How many should you do?
ELISA can carry a false negative
| Only report ELISA results if confirmed by Western blot or another confirmatory test.
83
Whater are common causes/reasons for False-postive ELISA?
Multiparity
multiple blood transfusions
autoimmune diseases
84
HIV infection occurs by
Bloodstream or mucous membrane contact with infected fluid
85
Describe Clinical Presentation of HIV
entering circulation of mucosa
HIV carried to regional lymph nodes
Causes intense viremia
Leads to lymphadenopathy
Activates CD4 cells accumulate in lymph nodes
Causes abrupt decline in CD4 T lymphoctes in acute infection.
Infectious mononucleosis like syndrome developes within 2 to 6 weeks after exposure and resolves spontaneously.
86
What are some signs among women and young people that would warrent testing for HIV?
Women with recurrent vaginal infections such as vaginal candidiasis or carcinoma of the cervix, young people w shingles, sever or recurrent HSV infections, certain dermatologic disorders such as seborrheic dermatitis, psoriasis, warts, molluscum contagiosum
87
first drug introduced as antiviral to help fight HIV
ZDV (zidovudine)
88
What is goals of ART
1)Reduction in morbidity and mortality of HIV infection
improvement in quality of life
2)complete suppression of the HIV viral load for as long as possible
3)Improvement of immunologic function
89
Does ART (antiretroviral therapy) eradicate the virus?
NO- Current drugs only prevent infection of new cells, but do not eradicate previously infected cells.
GOALS- HAART, continue therapy until infected cells have died and to block new rounds of viral replication
90
What are three classes of drugs available for treatment of HIV infection?
1) Nucleoside Reverse Transcriptase Inhibitors (NRTIs)
2) Protease Inhibitors
3) Nonucleoside Reverse Transcriptase Inhibitors (NNRTIs)
91
Nucleoside Reverse Transcriptase Inhibitors
| NRTIs
first specific antiretroviral agent.
Zidovudine
NRTIs are nucleoside analogs that act at an early stage of viral replication by competitively binding to HIV reverse transcriptase enzyme.
Can be classified as either thymidine analogs or nonthymidine analogs.
NRTIs are ineffective as monothereapy and are used in combination w other NRTIs, NNRTIs, and protease inhibitors
92
Side effects of NRTIs (Nucleoside Reverse Transcriptase Inhibitors)
```
Peripheral neuropathy
Pancreatitis
Hypersensitivity syndrome has been described in 3 to 5% of patients
Mitochondrial toxicity
Lipodystrophy
Changes in body morphology
```
93
Nonnucleoside Reverse Transcriptase Inhibitors
| NNRTIs
Target reverse transcriptase enzymes but structurally are not related to naturally occurring nucleosides.
NNRTIs act by binding noncompetititvely with viral reverse transcriptase.
Have an intermediate potency against HIV in acutely infected cells and are synergistic with NRTIs.
94
One important limitation to NNRTIs
rapid development of drug resistance
95
Benifits versus side effects of NNRTIs
Benefits: tolerated and lack peripheral neuropathy that is associated w NRTIs.
Common side Effect: rash
Elevated liver functions tests/severe
Significant drug interactions between NNRTIs with protease inhibitors usually requiring adjustments of dose of protesase inhibitor.
96
Protease Inhibitors (late phase)
protease inhibitors act at late phase in the replicative cycle of HIV.
Inhibition of the viral protease enzyme by these drugs results in the release of immature viral particles incapable of infecting other cells.
Protease inhibitors reduce the production of infectious virions from chronically infected host cells.
NRTIS and NNRTIs act primarily on newly infected cells.
97
Most potent anti-HIV agents available
| HOW?
Protease inhibitors are most potent anti-HIV agents available with the ability to decrease circulating HIV RNA levels by greater than 2 log 10 with an increase in CD4 lymphocyte counts
Synergistic when used in combo with NRTIs.
98
Side effects of NRTIs
Well distributed in lymph system and have no hematologic or neuropathic toxicities.
Draw backs: Protease inhibitors are variable oral bioavailability due to relatively poor absorption and extensive first pass metabolism
Side effects: diarrhea, nausea, paresthesias. Development of diabetes mellitus and dyslipidemias
99
Nucleotide Inhibitors
all in clinical trials and not approved by FDA yet.
| Examples Adefovir, Indinavir
100
When to initiate HAART therapy
Previously treat early treat hard however now there has been increasing concern regarding longer term complications of HAART which include:
liposystrophy syndrome
diabetes
dyslipidemias
multi drug resistance
These complications led to delay in the initiation of HAART in many asymptomatic individuals
101
Potential benefits for early treatment of HAART
easier control of viral replication
preservation of immune function
delayed progression to AIDS
less risk of drug toxicity
102
Risk of early HAART thereapy include
earlier development of drug resistance
unknown long term drug toxicities
limited choices of future anti-retrovirals
reduced quality of life
103
Problems emerging in HIV Lipodystrophy
hyperglycemia/diabetes- new onset dm, diabetic ketoacidiosis, associated w protease inhibitors, beta cell damage resulting in peropheral insulin resistance
fat redistribution- abdominal, and wasting in arms/legs, again protease inhibitors, buffalo hump, hypercortisolism
hyperlipidemia- inreased tris, cholesterol, fat redistribution, hyperglycemia, dyslipidemias, strongly associated with Protease inhibitors
104
Premature myocardial infarctions and strokes are associated with:
How can you possibly prevent these from occuring?
elevated cholesterol levels in HIV infected persons
| but if you change from protease inhibitor to a nonprotease inhibitor you might improve lipids.
105
Risk factors associated wit Lactic acidosis
```
high fatality rate
female gender
obesity
prolonged history of NRTIs
lactici acidosis from mitochondrial toxicity
```
106
What are clinical manifistations of mitochondrial toxicity
```
fatigue
n/v
abd pain
hepatomegaly
treatment unclear
```
