Virology Flashcards
at what age can you use valacyclovir
12
how long to recover from HSV 1 primary vs recurrent infxn
primary = 1-3 wks
recurrent = 7-10d
how long to recover from primary vs secondary genital herpes
primary = 2-4wks
recurrent = 8-10dh
when shoudl you consider suppressive tx fro HSV2
if getting 6 or more recurrent episodes/ yr
for those with genital HSV in pregnancy, what should be done
if active outbreak or prodrome during delivery = c section
otherwise, start suppressive tx at 36wks with acyclovir or valacyclovir
what are the options for PrEP?
daily tenofovir DF or AF + emtricitabine or PRN 2 tabs 2-24hr before and 1 tab daily until 48 hrs fater
what are the options for nPEP
tenofovir DF/ emtricitabine + raltegravir or dolutegravir
tenofovir DF or AF/ emtricitabine + darunavir/ ritonavir
x28d
when might you get symptoms of HIV infection after exposure
2-6wks post exposure
which ARVs cause dyslipidemia
TAF, EFV (efavirenz), boosted PIs
which tenofovir causes more renal tubular dysfxn and bone mineral density loss
TDF
which NRTI causes hypersensitivity rxns
abacavir
name the NRTIs
LATTEZ
lamivudine, abacavir, tenofovir DF, AF, emtricitabine, ziidovudine
what do the INSTIs end with
-gravir
what do the PIs end with
-avir
which ARV increases metformin concentrations
bictegravir
which ARV class should be taken apart from cations
INSTIs
cobicistat inhibits which CYP enzyme
3A4
cobicistat is used to boost (3 drugs)
atazanavir, darunavir, elvitegravir
name the 4 initial recommended ARV regimens to start
TAF/FTC + BIC
ABC/3TF + DTG
TDF or TAF + FTC or 3TC + DTG
3TC + DTG (only if viral load <100k)
which ARV should be avoided until HLA is known
abacavir (HLA-B701)
which ARV should be taken with food
generally PIs, elvitegravir, dolutegravir
which NNRTI is preferred for use except in pregnancy
efavirenz
if pts CrCl <60, which AVR should be avoided?, which can be used if >30 or on dialysis
avoid TDF
can use TAF
which tenofovir is assocaited w/ renal tubular dysfxn
TDF
which ARTs should be avoided in psych illness
efavirenz and CVD: ABC, DRV, LPV/rilpivirine
which ARTs should be avoided in dyslipidemia
boosted PI, efavirenz, elvitegravir/ cobicistat
which tenofovir improves lipid levels
TDF
which ARTs should be used in hep B coinfection
tenofovir AF or DF + emtricitabine or lamivudine (tenofovir inhibits hepatitis)
then dd either PI + enhancer or INSTI or NNRT
which parinatal ART should be started in infants born to HIV infected mothers
zidovudine
which ART class lacks CYP interactions
INSTI
if CD4<200, what should be started?
prophylaxis for PCP with TMP/SMX
when should assessment of viral load be done after starting ART
2-8wks
what is preferred regimen for pts trying to get pregnant with HIV
2NRTIs + ritonavir boosted PI or iNSTI, reserve fusion inhibitors for those who failed tx on other 1st line options
what is the preferred tx for <200 CD4 or prophylaxis for PCP
TMP/SMX
T or F: mothers with HIV can breastfeed
F- HIV can be transmitted through breastmilk
what age is croup most common in
6mths-3yrs
when should CS start working for croup
2-3hrs
when should epi start working for croup, how long does it last
10 min, lasts 2hrs
what croup severities require epi
severe only
what is 1st line for high risk pt tx for covid
paxlovid x5d or remdesivir IV x2d
if a patient is to use paxlovid, they must present within ____. If it is remdesivir, they must present within ____
5d for paxlovid, 7d for remdesivir
what is the eGFR cut off for paxlovid and remdesivir
<30
<60 (paxlovid only 1 tab of nirmatrelvir)
what is second line tx for mild covid
fluvoxamine x15d (w/in 7d) or budesonide x14d
which CYP enzyme does ritonavir inhibit
CYP3A4 - effect lasts for 2 days after stopping (v strong)
what are some common AEs of paxlovid
metallic taste, elevated BP, HA, muscle pain, N/V/D
long term hepatotoxicity w/ ritonavir
T or F: remdesivir and paaxlovid are not safe in pregnancy
F- both are safe
when do neuraminidase inhibitors have to be started? what is the usual treatment duration?
within 48hrs
treat for 5 days
which patients should receive antiviral tx regardless of time since sx onset for influenzaa
Pts >1yr of age + chronic condition or immuncomp or other RF
Pts >65yrs in which influenza is strongly suspected
Pts requiring hospitalization
Serious, complicated, or progressive (regardless of pt’s previous health status)
what is the 1st choice antiviral for influenza for most pts
oseltamivir x5d
which neuraminidase inhibitor requires renal dosing adjustment
oseltamivir
zanamivir may be used in influenza instead of oseltamivir if
pt >7yrs without lung issues + failed oseltamivir and no enteral access or has influenza B
when is peramivir used in influenza
if =>18yrs and can’t inhale and has IV access
which antivirals are used for influenza prophylaxis, for how long?
Oseltamivir 75mg daily (renal adjustment required) x10d
Zanamivir 10mg daily x10d
Baloxavir = same as tx once
influenza vaccination is recommended in those _____ months old
> 6mths
6-23mths = cell culture inactivated type, otherwise IIV4-SD
=>65yrs = HD
PEP and nPEP should be started within
72hrs
what is preferred and alt tx for gonorrhea
ceftriaxone IM + azithromycin x1 dose (esp if pharyngeal or MSM)
cefixime IM + azithro ok if not MSM or pharyngeal
alt: azithro + gentamicin or ciprofloxacin
gentamicin + doxycycline
which STIs is a test of cure recommended
gonorrhea, chlamydia, syphilis
T or F: sexual partners of gonorrhea and chlamydia do not need to be treated
F- both need to be treated even if asymp (all partners w/in 60d)
in gonorrhea and chlamydia, pt should abstain from sex for __________
7 d after tx started
when is a test of cure recommended for chlamydia
if adherence concerns, alt tx needed, child abuse, pregnancy
what is the preferred tx for chlmydia
azithromycin x1dose
docycycline x7d
what is the alt tx for chlamydia if pt is pregnant
amoxicillin x7d
azithromycin x1dose
how long should you abstain from sex after syphilis
7d after COMPLETING tx
what is the preferred tx for pubic lice
permethrin 1%
mixed pyrethrins
what is the preferred tx for scabies
permethrin 5% cream
what is preferred tx for syphilis
benzathines penicillin G IM
alt: doxycycline or ceftriaxone
what is preferred tx for CNS or ocular syphilis
penicillin G IV
