EXAM ONE Flashcards
(297 cards)
1
Q
Ticks are the ___common vector to transmit infectious disease in North America, and ___ most common globally.
A
MOST, 2nd
2
Q
What are 3 Common Tick Borne Illnesses in the US?
A
- Lyme Disease
- Babesiosis
- Ehrlichiosis
3
Q
Which disease is caused by the Lone Star Tick?
A
Ehrlichiosis
4
Q
Tick-Induced Meat Allergy is also known as what?
A
Alpha-Gal Allergy
5
Q
T/F: Southern Tick-Associated Rash Illness STARI is another name for Lyme disease that occurs in the southeastern and south central US.
A
False
6
Q
Ticks have a ___ year lifecycle
A
2
7
Q
T/F: A New Host is required during each lifestyle stage
A
True
8
Q
Larva, Nymphs, and Adult Ticks feed on ___ for growth.
A
Blood
9
Q
What species is known as HARD Ticks?
A
Ixodid
10
Q
What species is known as SOFT Ticks?
A
Argasid
11
Q
The most common ticks and the main vectors for Lyme disease are what?
A
Ixodid Species
12
Q
What Tick species are known as rapid feeders and detach from their host 1 hour after feeding?
A
Argasid Species
13
Q
In 2021, which Oklahoma County met CDC Criteria for Deer Tick Endemic with Lyme disease?
A
Cherokee
14
Q
T/F: Ticks cause Lyme Disease
A
False
15
Q
T/F: Ticks are a Vector for Spirochete Bacteria that causes Lyme disease.
A
True
16
Q
List the 2 types of Deer Ticks
A
- Ixodes Scapularis
- Ixodes Pacificus
17
Q
What is the bacteria that causes Lyme disease?
A
Spirochete Borrelia Burgdorferi
18
Q
What are the symptoms of Lyme Disease?
A
- Bullseye Rash
- Flu-Like Syndrome
- Lymphadenopathy
19
Q
List the 5 steps in How to Remove a Tick
A
- If possible, wear gloves to protect yourself from tick exposure
- Position the tweezers as close to the patient’s skin as possible and grasp the tick
- Pull Up. Do NOT twist tweezers
- Clean the bite area with disinfectant
- Dispose of tick by drowning it in alcohol, sealing it in a bag, wrapping tightly in tape, or flushing it down the toliet
20
Q
T/F: You can use heat, nail polish, and Vaseline to remove a Tick.
A
False, AVOID all of these
21
Q
Which first aid should be applied to the bite site after Tick Removal?
A
- Isopropyl Alcohol
- Water
- Soap
22
Q
Define the S/S of Early Disseminated Classification of Lyme Disease
A
- Bullseye Rash
- Neurologic Symptoms: bell palsy, meningitis, radiuclopathy, encephalomyelitis
- Lyme Carditis
23
Q
Define the S/S of Late Classification of Lyme Disease
A
- Arthritis
- Neurologic Symptoms: encephalomyelitis, encephalopathy, peripheral neuropathy
- Acrodermatitis Chronica Trophicans
24
Q
Early Disseminated Classification in Lyme disease means what?
A
Localized Symptoms of Lyme Disease
25
Late Classification in Lyme disease means what?
Serious, taken root, progressive damage
25
Which patient is at greatest risk for developing Acrodermatitis Chronic Atrophicans?
Older European Female
26
Define Acrodermatitis Chronic Trophicans
Thinning out skin, red/blue hue, papery texture
27
T/F: All Ticks require referral to PCP
True
28
____ Care relies on OTC products and nonpharmacologic therapy
Preventive
29
List the 6 Non Pharmacological Prevention Methods
1. Clothe as much skin as possible
2. Avoid areas harboring ticks such as dense woods and brush
3. Limit time spent outside especially at dawn and dusk
4. Self inspect skin daily
5. Keep pets pest free
6. Apply inspect repellant
30
What are the 4 elements to consider with Insect Repellant?
1. Ingredients
2. Concentration
3. Formulation
4. Type and Length of Exposure
31
What agent is recommended as the drug of choice for prophylaxis of Lyme disease?
Doxycycline
32
What is the prophylaxis dosing of Doxycycline for Lyme disease?
200 mg PO for 1 DOSE
33
T/F: Recommend Topical Antibiotics Neosporin for Tick Bites.
False, wash the area with soap, water, and isopropyl alcohol
34
What 5 Criteria must be met for a patient to qualify for Doxycycline prophylaxis for Lyme disease?
1. Tick identified as Ixodes Scapularis
2. The tick was attached for >36 hours
3. It has been <72 hours since the tick was removed
4. Local rate of borrelia burfadorferi in ticks >20%
5. The patient possess no contraindication to doxycycline
35
T/F: If one criteria for Doxycycline prophylaxis is not met, the patient does NOT qualify for therapy.
True
36
DEET is the active ingredient found in bug sprays, however improper use/ingestion may lead to what AEs?
1. Seizures
2. Ataxia
3. Hypotension
37
DEET Concentration _____% should be used for Tick Prevention
20-50
38
T/F: DEET Concentrations >50% suggests better efficacy.
False
39
T/F: DEET is safe to use in patients who are pregnant and lactating.
True
40
How often should you apply DEET?
q 4-8 hours
41
Why should you avoid DEET and Sunscreen combination products?
1. Sunscreen needs to be applied q2 hrs
2. DEET applied q 4-8 hrs
3. Overapplication of DEET may lead to toxicities
42
What is first line therapy for PO treatment of Lyme disease?
1. Doxycycline
2. Amoxicillin
3. Cefuroxime
43
What is the dosing of Doxycycline for Lyme disease?
1. 100 mg BID
2. 200 mg QD
44
What is the dosing of Amoxicillin for Lyme disease?
500 mg PO TID
45
What is the dosing of Cefuroxime for Lyme disease?
500 mg PO BID
46
If patients are unable to take first line PO medication for Lyme disease, what is the 2nd line PO option?
Azithromycin 500 mg PO QD
47
What is first line therapy IV treatment for Lyme disease and its dose?
Ceftriaxone 2 grams IV daily
48
What is 2nd line IV treatment options for Lyme disease and its dosing?
1. Cefotaxime 2 grams IV TID
2. Penicillin G 18-24 million units/day
49
When is IV treatment for Lyme disease indicated?
1. Inpatient Lyme Carditis
2. Parenchymal Neurologic Lyme Disease
3. Lyme arthritis unresponsive to PO Abx
50
What are the precautions of Doxycycline?
1. Patients <8 yrs
2. Pregnant Patients
51
T/F: Hyclate Salt (Vibramycin) is more acidic than Monohydrate Salt (Monodox) which may cause more stomach upset
True
52
T/F: Monohydrate Doxycycline capsules work when gastric pH is high
False, may not work when gastric pH is high
53
What is the patient education for Doxycycline?
1. Sit up right for 30 mins
2. Separate from antacids/multivitamins for 2 hours
3. Wear sunscreen
54
T/F: Amoxicillin has AEs of Diarrhea
True
55
T/F: Amoxicillin is not safe for patients who are pregnant or breastfeeding
False
56
T/F: Amoxicillin must be dose adjusted if comorbid renal impairment is present
True
57
What 3rd Generation Cephalosporins are used in the treatment of Lyme disease?
1. Cefuroxime: first line PO
2. Ceftriaxone: first line IV
3. Cefotaxime: alternative IV
58
What is the main tolerability problem with 3rd Gen Cephalosporins in Lyme disease treatment?
C. diff associated diarrhea
59
Azithromycin Indications in Lyme disease are what?
1. Patients unable to to take first line PO drugs for Lyme
2. Only for skin reactions.
60
Azithromycin treatment for Lyme disease is used only for _________.
Erythema Mirgrans
61
What are the precautions of Azithromycin?
1. Patients with pre-existing heart conditions
2. Patients taking anti arrhythmic drugs
62
Penicillin G is used when in Lyme disease?
IV Options for patients unable to receive Ceftriaxone
63
Which Doxycycline formulation may be better in a patient taking Omeprazole?
Doxycycline Hyclate (Vibramycin)
64
T/F: Age less than 8 years is contraindicated to Doxycycline.
False
65
T/F: Pregnancy is a contraindication to Doxycycline.
False
66
Patients should be educated to sit upright for ____ minutes after taking Doxycycline.
30
67
Third generation cephalosporins increase the risk for C. diff diarrhea because of their increased activity against which microorganisms?
Gram Negative Rods
68
Which third generation cephalosporin does not require dose adjustments in the setting of renal impairment?
Ceftriaxone
69
When used to treat Lyme disease, Penicillin G is administered via which route?
IV
70
What is the duration of therapy for Doxycycline in the treatment of Erythema Migrans?
10 days
71
What is the duration of therapy for Amoxicillin or Cefuroxime in the treatment of Erythema Migrans?
14 days
72
What is the duration of therapy for Azithromycin in the treatment of Erythema Migrans?
7 days
73
What is duration of therapy for Carditis/Neurologic Lyme disease?
14-21 days
74
What is duration of therapy for Acrodermatitis chronic atrophicans Lyme disease?
21-28 days
75
What is duration of therapy for Arthritis Lyme disease?
28 days
76
T/F: Doxycycline is safe when used for 14 days in the treatment of Lyme disease for Pregnant Patients.
True
77
What are common symptoms seen in Recurrent Lyme disease?
1. Fatigue
2. Musculoskeletal Pain
3. Neurocognitive Impairment
78
Are antibiotics recommended for Recurrent Lyme disease?
NO
79
T/F: Posttreatment Lyme disease syndrome will self-resolve over time and antibiotics are not recommended.
True
80
Doxycycline has been associated with which complications when used for inappropriate durations in pregnant patients?
1. Birth Defects
2. Premature Delivery
81
In terms of STIs, ____ patients are at greater risk for STI sequels including infertility, malignancy, and pain.
FEMALE
82
What are the components of the 5Ps Approach to Sexual History Collection?
1. Past History
2. Practices
3. Pregnancy
4. Partners
5. Protection
83
What are the CDC's 5 Public Health strategies for the prevention of STIs?
1. Risk Assessment
2. Vaccinate
3. Symptomatic
4. Patients
5. Partners
84
What is recommended by the CDC to protect patients from STIs?
1. Abstinence
2. Mutual Monogamy
3. Limit the Number of Sexual Partners
4. Condoms
85
Condoms function as _____ to prevent STI Transmission and are classified as MEDICAL DEVICES by the FDA.
Barriers
86
T/F: Avoid recommending spermicide-containing condoms because of irritation and lack of efficacy.
True
87
Typical Use of Condoms is correlated with _____ leading to compromised efficacy and therefore, is a concern in terms of STIs.
Breakage
88
T/F: Spermicides are effective antibiotics for the prevention of sexually transmitted infections.
False
89
What are the 3 types of Male Condoms?
1. Latex
2. Natural Membrane
3. Synthetic
90
Details about Latex Condoms
Cheap/Effective, cannot be used in patients with latex allergies
91
Details about Natural Membrane Condoms
DECREASED efficacy in protection against STIs due to porous nature
92
Details about Synthetic Condoms
Higher breakage rate, should be used 2nd line after Latex condoms
93
What is the hierarchy of Male Condoms?
Latex > Synthetic > Natural
94
T/F: Female condoms are equally efficacious as male condoms
True
95
For use of male condoms in STIs patients should be educated to trial different _____ before switching ____.
Brands; Types (latex vs synthetic)
96
What is the most common STI in the U.S.?
Human Papillomavirus HPV
97
Clinical HPV includes what 4 things?
1. Common Worts or Anogenital Worts
2. Respiratory Papillomatosis
3. Cervical Cancer Precursors
4. Cervical and Mucosal Cancers
98
HPV is what type of virus?
Double Stranded DNA virus that affects skin and mucosa
99
Common Worts caused by the virus, most of them are _____ .
Asymptomatic
100
T/F: Although some HPV warts develop in childhood often self-resolve, some will persist into adulthood.
True
101
T/F: Warts in adulthood are less persistent and insidious.
False, MORE persistent/insidious
102
T/F: Invasive cancers may develop as a result of HPV infection.
True
103
Cervarix HPV Vaccine covers what subtypes?
16 and 18
104
T/F: Cervarix covers genitoanal warts.
False
105
Gardasil HPV Vaccine covers what subtypes?
6,11,16,18
106
T/F: Gardasil covers genitoanal warts
True
107
T/F: Gardasil 9 is significantly better than the other vaccines.
False, no phase 4 clinical data cannot make that assumption
108
What is the Routine Vaccination age for the HPV Vaccine?
9-14 yrs
Ideally 11-12 yrs
109
What is the dosing schedule for Routine Vaccination of HPV?
Administer 2 doses 6-12 months apart
110
What is the Catch-Up Vaccination age for the HPV Vaccine?
1. 15-26 years
2. 9-14 years <5 months apart
111
What is the dosing schedule for Catch-Up Vaccination and Shared Clinical Decision of HPV?
Administer 3 doses at 0, 2 , and 6 months
112
T/F: Heterosexual Males Catch-Up Vaccination phase is from 15-26 years old.
False, 15-21 years old
Up to 26 yrs for MSM
113
What is the Shared Clinical Decision age for the HPV Vaccine?
27-45 years
114
Per the CDC/ACIP, the 9vHPV vaccine may be least effective in which age group?
27-45 years
115
An 18 year old patient received dose #1 of the HPV vaccine January 2023 and dose #2 in February 2023. When should the patient receive dose #3?
June 2023
116
HPV Vaccination is contraindicated in what patients?
Yeast Allergy
117
T/F: HPV Vaccine has vasovagal reactions and should monitor the patients for 15 minutes after administration.
True
118
T/F: You can administer HPV in pregnant and breastfeeding patients.
False, only admin in breastfeeding patients NOT pregnant patients
119
T/F: HPV = HSV
False
120
_____ drugs are NOT currently indicated for the general management of HPV.
Antiviral
121
Before using treatment, patients must do what for HPV common worts?
1. Soak the affected skin in warm water for 5-10 mins
2. Use emery board or sandpaper to desquamate upper layers of the wort
122
What is used in the treatment of HPV Common Warts?
Salicyclic Acid
123
What are the indications for the use of Salicyclic Acid?
1. Uncomfortable warts
2. Affect physical appearance
3. Affect physical function
4. Thought to increase cancer risk
124
What are the contraindications to the use of Salicylic Acid?
1. Facial Warts
2. Areas of Poor Circulation
3. Areas of Ulceration or Poor Healing
4. Neuropathies
125
What are the tolerability issues associated with Salicylic Acid?
1. Wet wrinkly skin (maceration)
2. Skin shedding (desquamation)
126
T/F: It is recommended to start with 10-26% concentrations of Salicylic Acid, higher concentrations in naive patients can lead to increased side effects.
True
127
What is the most important pearl about Salicylic Acid?
Adherence, at least once DAILY x 12 weeks
128
T/F: Internal Warts: anal/vaginal/cervical are treated with pharmacotherapy.
False, they are not and need to be referred to provider
129
What 3 Agents are used for the treatment of Anogenital Warts?
1. Imiquimod
2. Podofilox
3. Sinecatechins
130
Efficacy of Imiquimod
10-70%
131
Efficacy of Podofilox
40-80%
132
Efficacy of Sinecatechins
~60%
133
Contraindications to the use of Imiquimod
1. Pregnancy
2. Autoimmune Disorders
134
Contraindications to the use of Podofilox
1. Pregnancy
135
Contraindications to the use of Sinecatechins
1. HIV
2. Immunocompromised
3. Genital Herpes
4. Pregnancy
136
AEs of Imiquimod
1. Hypopigmentation
2. Myalgia
137
AEs of Podofilox
1. Inflammation
2. Skin Erosion
138
AEs of Sinecatechins
1. Ulceration
2. Induration
3. Vesicular Rash
139
What are the Uncommon AEs of Sinecatechins that are concerning?
1. Lymphadenitis
2. Vulvovaginitis
3. Balanitis
140
How do you apply Imiquimod?
1. Wash off cream 6-10 hours after application
2. 3.75% appleid QD
3. 5% applied 3x per week
141
How do you apply Podofilox?
1. Applied as a cycle 3 days on and 4 days off
2. Repeat up to 4 weeks
3. Use no more than 0.5 mL/day
142
How do you apply Sinecatechins?
1. Apply TID
2. Do not wash off after use
143
T/F: Imiquimod may weaken condoms and diaphragms.
True
144
T/F: Podofilox can be used >10 cm2
False, Do not use in >10 cm2
145
A patient with which condition should avoid Salicylic Acid?
Fibromyalgia
146
Which product for genital warts must be washed off within 12 hours after application?
Imiquimod
147
Which product for genital warts must be applied as an on-off cycle?
Podofilox
148
Which product for genital warts has the greatest risk to cause skin discoloration?
Imiquimod
149
Which product for genital warts has the greatest risk of causing muscle pain?
Imiquimod
150
Sinecatechins should be avoided in patients living with HIV because:
It was not studied in patients living with HIV
151
Which product for genital warts should be applied every 8 hours?
Sinecatechins
152
When used appropriately, which product for genital warts possess the highest clearance rate?
Podofilox
153
Which anti-wart drug should be avoided in patients with an ASA allergy?
Compound W aka Salicylic Acid
154
Which product for genital warts may cause inflammation of the glans?
Sinecatechins
155
T/F: PrEP is for ALL sexually active adolescents and adults
True
156
T/F: Nonadherence is ok in with PrEP it will still be effective
False, ADHERENCE is ESSENTIAL, or there will not be a high enough blood concentration leading to HIV infection
157
T/F: Ineffective PrEP (non adherence) = new HIV infection
True
158
It takes ____ weeks for drug PrEP to accumulate in tissue.
3
159
It takes ___ days for drug PrEP to accumulate in the rectum.
7
160
It takes ___ days for drug PrEP to accumulate in the blood/vagina.
20
161
What are the 5 High Risk Behaviors that would qualify a patient for PrEP Treatment?
1. Unprotected sex with multiple partners
2. Sex with patient living with HIV
3. Commercial sex workers
4. IV drug use within the last 6 months
5. Recent STI within the last 6 months
162
What is Risk Compensation in terms of HIV/PrEP?
Increase in risk behaviors due to the perception that the patient is protected from HIV
163
T/F: PrEP ONLY works against HIV not any other STIs
True
164
What are the ingredients in Truvada?
Tenofovir Disoproxil Fumarate/Emtricitabine
165
What risk behaviors of HIV can use Truvada?
ALL 5 risk behaviors
166
When is Truvada contraindicated?
CrCl <60
167
What are the AEs of Truvada?
1. AKI
2. Bone Pain
3. Osteopenia
168
Risk for AEs is increased in Truvada with concomitant _____ or _____ use.
HCV treatment or NSAIDs
169
When is Truvada On Demand indicated?
Only indicated for MSM
170
How is Truvada on Demand taken?
2-1-1 Rule
-2 tabs before sex
-1 tab 24 hrs after sex
-1 tab 48hrs after sex
171
What are two toxicities associated with Truvada?
1. Renal Toxicity
2. Osteopenia
172
Which nonprescription analgesics should be avoided in a patient taking Truvada for PrEP because of the additive risk for acute kidney injury?
1. Ecotrin
2. Motrin
3. Aleve
173
What are the active ingredients of Descovy?
Tenofovir Alafenamide/Emtricitabine
174
When can Descovy be used?
1. MSM
2. Transgender Women who have sex with men
175
When is Descovy contraindicated?
CrCl <30
176
T/F: Descovy is unsafe in breastfeeding women but unknown in pregnant women.
True
177
What are the AEs with Descovy?
1. N/V/D
2. HA
3. Weight Loss
178
What is the uncommon concerning AE of Descovy?
Hypercholesterolemia
179
Based on PK data, which PrEP regimen was theorized to be more effective as PrEP for men who have sex with men?
Truvada: dispositing in the mucosal tissue
Descovy: CD4 cells
Both are equally effective
180
Descovy may increase what?
Serum triglycerides
181
Compared to Truvada, Descovy is safe to use when CrCl is what?
30-60
182
Vocaria is what?
Cabotegravir Oral
183
Apretude is what?
Cabotegravir IM Shot
184
When is Cabotegravir indicated?
1. Difficulty taking oral PrEP
2. Request injection instead
3. Patients with severe CKD
185
T/F: Apretude is seen as 2nd line therapy for those that qualify.
True
186
What are the AEs of Apretude?
1. Injection Site Rxns
2. N/V/D
3. Abdominal Pain
187
Only the _____ of Cabotegravir is approved for PrEP
ER IM Injection
188
The oral tablet of Cabotegravir may be considered for __ month of optional induction therapy
1
189
What is the CrCl cutoff with Apretude?
>15
190
T/F: Apretude is more effective than Truvada for MSM
True
191
Why Apretude 2nd Line Therapy?
Concern of integrate inhibitor resistance if PrEP fails
192
T/F: Apretude is an IM injection into the deltoid.
False, into gluteal
193
T/F: Before starting Apretude for PrEP, patients must take Vocabria for a 4 week lead in.
False
194
Apretude for PrEP may be a good choice in patients with:
Chronic Kidney Disease
195
What should be monitored quarterly with PrEP?
1. HIV PCR
2. Bacterial STI
3. Adherence
4. DDIs
5. Pregnancy Test
196
What should be monitored semi-annually with PrEP?
Renal Function
197
What should be monitored Annually with PrEP?
If on Descovy, lipid panel
198
T/F: MPox is an endemic in central/western Africana aand not considered an STI
True
199
MPox is what type of virus
Orthopoxivirus
200
Transmission of MPox from animal to animal occurs via what?
Fluids, lesions, bites, or ingestion
201
Transmission of MPox from human to human occurs via what?
Biologic fluids (semen) and lesions
202
What are the forms of Human Transmission via Direct Contact?
1. Skin to Skin during intercourse
2. Sexual transmission through exchange of body fluids
203
What are the forms of Human Transmission via Indirect Contact?
Contact with contaminated materials like clothing or bedding
204
Once infected, the Incubation Period is ____ weeks
2
205
MPox is most similar to ____.
Smallpox
206
MPox incubation typically takes 14-21 days, and how is that seen?
Asymptomatic 1-14 days
Symptoms 14-21 days
Full Blown Disease >21 days
207
Define characteristics of Prodromal Phase
1. HA, fever, fatigue, muscle pain
2. Swollen Lymph Nodes are a hallmark
3. Nonspecific Infection
208
Define characteristics of Eruptive Phase
1. Rash develops within 1-4 days of prodrome
2. Macule - Papule - Vesicle - Pustule - Scab
209
Define Macule
Small red dots, NOT raised
210
Define Papule
RAISED dots, filled with fluid
211
Define Vesicle
Clear FLUID
212
Define Pustule
PUS FILLED
213
Define Scab
Popped pustule, oxidized
214
The common terms for vesicle is ____.
Blister
215
What types of Eruptive Phase cutaneous manifestations last 1-2 days?
1. Macules
2. Papules
3. Vesivles
216
What types of Eruptive Phase cutaneous manifestations last 5-7 days?
Pustules
217
What types of Eruptive Phase cutaneous manifestations last 7-14 days?
Scabs
218
T/F: No matter early of late stage, the cutaneous manifestations show up quickly and disappear quickly.
False, late phase lesions last longer and take longer to get rid of 14-21 days
219
What is used to confirm the diagnosis of MPox?
PCR to detect MPox DNA
220
T/F: Most patients will respond to supportive care OTC analgesics
True
221
What is used for supportive care of Pain in MPox?
1. NSAIDS- systemic
2. APAP- systemic
3. Local Topical Corticosteroids/Anesthetics
4. Opioids- refractory
222
T/F: You can use local topical corticosteroids/anesthetics on genital tissues and large surfaces.
False, avoid both
223
T/F: Opioid use for refractory pain is appropriate in patients in the late stage with scabs/lesions.
True
224
What is used for supportive care of Proctitis in MPox?
1. Stool Softener
2. Gabapentin
225
What is used for supportive care of Pruritus in MPox?
1. Oral antihistamines
2. Calamine lotion
3. Petroleum Jelly
4. Colloid Oatmeal
226
What is used for supportive care of Oral Lesions in MPox?
1. Saltwater Rinse
2. Chlorhexidine
3. Local Anesthetics
227
T/F: Metamucil can be recommended for MPox proctitis.
False
228
T/F: Tramadol may be considered for severe MPox pain.
True
229
Which anesthetic is safe to use for oral lesions?
Benzocaine
230
T/F: Tecovirimat is FDA approved for MPox.
False, FDA approved for smallpox but not Mpox
231
What is the contraindication for the use of Tecovirimat?
CrCl <30 for IV FORM ONLY
232
Dosing of Tecovirimat
Weight based 14 day treatment
233
Tecovirimat should be avoided with concomitant use of ______ or ______.
1. Repaglinide
2. Midazolam
234
T/F: Tecovirimat strongly induces CYP3A4 and inhibits CYP2C9/2C19.
False, weakly
235
Concomitant use of Repaglinide and Tecovirimat leads to what?
More hypoglycemia
236
Concomitant use of Midazolam and Tecovirimat leads to what?
Reduced anti-anxiety
237
What is the AE that is seen in PO and IV formulations of Tecovirimat?
HA
238
How should Tecovirimat be taken?
Take with a full glass of water 30 minutes after a 600 calorie meal
239
T/F: MPox vaccine is FDA approved for smallpox and Mpox via subQ injection.
True
240
T/F: MPox vaccine is FDA approved for MPox Intradermal injection.
False, expanded use authorization
241
What is the MPox Vaccine dosing for SQ route?
0.5 mL x 2 doses 4 weeks apart
242
What is the MPox Vaccine dosing for Intradermal route?
0.1 mL x 2 doses 4 weeks apart
243
MPox Vaccine will have local injection site reactions that will persist for ___ weeks.
3
244
T/F: Proven concern from myocarditis and pericarditis if MPox Vaccine administered within 12 weeks of mRNA COVID-19 vaccine.
False, unproven
245
T/F: Tecovirimat is nephrotoxic
False
246
T/F: MPox vaccine may be administered IM
False
247
T/F: MPox vaccine is more effective when given intradermally than subcutaneously.
False
248
Young adult males should avoid receiving which vaccine within 4 weeks of the Mpox vaccine?
Covid-19
249
T/F: MPox vaccine is contraindicated in patients living with AIDS.
False
250
Pre-Exposure Vaccination Criteria MPox
1. Gay, bisexual, MSM, transgender, nonbinary or gender diverse with>1 partner or new diagnosis of STIs
2. Persons having sex: commercially, MPox transmission is high
3. Clinical/healthcare workers caring for patients with MPox
251
Post Exposure Vaccination Criteria MPox
Within 4 days post exposure
1. Contact of someone with Mpox
2. Sexual partner within last 2 weeks
3. Areas where MPox is circulating and person has multiple partners
4. Healthcare personnel with moderate to high risk exposure
252
T/F: Influenza is an RNA Virus
True
253
Define Flu A
Most common, may cause seasonal or pandemic flu
254
Define Flu B
Second most common, seasonal outbreaks only
255
Define Hemagglutinin
Helps the flu virus bind to host receptors and enter host cells
256
Define Neuraminidase
Once the host cells are infected they start to create new flu virus, neuraminidase is the enzyme that helps to release new flu virus from the infected host cells
257
What is the main target for antiviral flu medications?
Neuraminidase
258
What is the main target for flu vaccinations?
Hemagglutinin
259
Flu incubates for ___ days and a patient is infectious for about ___ days.
2 and 7
260
S/S of Influenza
1. Myalgia
2. HA
3. Nonproductive cough
4. Sore Throat
5. Fever that develops quickly
261
When would laboratory confirmation of influenza is recommended when?
1. Low prevalence of flu
2. High risk for transmission among patients such as nursing homes
262
T/F: RDT = POC
False, RDT is a subtype of POC
263
T?F: RDT POC Flu Tests are Clinical Laboratory Improvement Amendment CLIA Waived Tests
True
264
T/F: Pharmacists do not need to follow the manufacture instructions verbatim on POC Flu Tests?
False, you must follow it precisely
265
T/F: POC Flu Tests look for influenza antigens not viral DNA/RNA.
True
266
What is the most important step of the PPCP that applies to Influenza?
Follow Up
267
When should you follow up with a patient for influenza?
1-2 days after POC, if they are worsening refer them to PCP
268
If the patient received LAIV <7 days, RDT POC for flu may be ____ ____.
Falsely positive
269
What 3 population types are not candidates for POC Flu testing?
1. Vulnerable Populations
2. Lung Disease
3. Signs of Critical Illness
270
What are 3 forms of Nonpharmacologic Therapy are used in influenza?
1. Rest
2. Drink plenty of fluids
3. Palliate symptoms with cough drops, warm tea, or warm soup
271
T/F: A patient with rhinorrhea, watery eyes, and palate itching presents to the pharmacy, they should be tested for flu.
False
272
Which flu vaccine may cause a false positive on RDT POC flu test?
FluMist
273
Healthy adults with >48 hours of symptoms need what type of flu treatment?
No Rx therapy
274
Healthy adults with <48 hours of symptoms need what type of flu treatment?
Consider Rx therapy
275
Hospitalized, severe symptoms, and high risk need what type of flu treatment?
Recommend Rx therapy
276
Is HTN alone a high risk complication in influenza that would deem necessary treatment?
No
277
T/F: Do not use adamantes for the prevention or treatment of influenza.
True
278
What are the 3 Neuraminidase Inhibitors and their ROA?
1. Oseltamivir: capsule or suspension
2. Zanamivir: inhalation
3. Peramivir: IV
279
What is the MOA of Neuraminidase Inhibitors?
Prevent the neuraminidase enzyme from releasing virions from infected host cells
280
What is the dosing of Adults >13 yrs for Oseltamivir?
75 mg PO BID
281
What is the dosing of Oseltamivir for CrCl 31-60?
30 mg PO BID
282
What is the dosing of Oseltamivir for CrCl 11-30?
30 mg PO QD
283
What is the dosing of Oseltamivir for CrCl <10?
Not recommended
284
How should you take Tamiflu?
With food
285
T/F: Stop oseltmaivir if the patient develops a rash.
True
286
What is the drug of choice for influenza in pregnant patients?
Tamiflu
287
When is Zanamivir Contraindicated?
Milk protein Allergy
288
When should Zanamivir be avoided?
1. Asthma
2. COPD
289
When is Zanamivir recommended?
Only in adults who have failed Oseltamivir
290
When is Peramivir recommended?
Patients unable to take oral medications
291
What is the MOA of Baloxavir/Xofluza?
Disrupts RNA trasncription to prevent flu virus replication
292
What is the FDA approved use of Xofluza?
>12 yrs presenting with symptoms WITHIN 48 hours and HIGH RISK for developing serious symptoms
293
What is the dose of Xofluza for weight <80 kg?
40 mg one time dose
294
What is the dose of Xofluza for weight >80 kg?
80 mg one time dose
295
Prophylaxis of Influenza pre-exposure can be considered if what?
1. High risk during 14 days after vaccination
2. High risk if not vaccinated and close contact with flu
3. High risk and contraindicated to vaccination
296
Prophylaxis of Influenza post-exposure can be considered if what?
<48 hrs following flu exposure:
1. Within 14 days following flu vaccine
2. Immunosuppressed
3. Contraindicated to flu vaccine
