pharm 3 exam 2 review

🔥 Who provides the STI treatment guidelines?

CDC

🔥 What organism clue should make you think gonorrhea?

Gram-negative diplococcus (Neisseria gonorrhoeae)

🔥 How is uncomplicated gonorrhea treated if the patient weighs less than 150 kg?

Ceftriaxone 500 mg IM once.

🔥 How is uncomplicated gonorrhea treated if the patient weighs ≥150 kg?

Ceftriaxone 1 g IM once.

🔥 What do you add to gonorrhea treatment if chlamydia is present or has NOT been excluded?

Doxycycline 100 mg PO twice daily for 7 days.

What is used instead of doxycycline for associated chlamydia during pregnancy?

Azithromycin 1 g PO once.

🔥 What are the major counseling points after gonorrhea treatment?

No sex for 7 days after treatment; partners from the last 60 days should be treated/evaluated; gonorrhea is reportable.

What does primary syphilis classically look like?

A single PAINLESS chancre.

🔥 How are primary, secondary, and early latent syphilis treated?

Benzathine penicillin G 2.4 million units IM once.

🔥 How are late latent and tertiary syphilis treated?

Benzathine penicillin G 2.4 million units IM once weekly for 3 weeks.

What happens if a late-latent/tertiary syphilis penicillin dose is >2 days late according to the course?

Restart the treatment course.

🔥 How is neurosyphilis or ocular syphilis treated?

Aqueous crystalline penicillin G 3-4 million units IV every 4 hours for 10-14 days.

What alternatives were discussed for a nonpregnant penicillin-allergic patient with early syphilis?

Doxycycline for 14 days or tetracycline for 14 days.

🔥 What is the Jarisch-Herxheimer reaction?

Fever, headache, and muscle aches within about 24 hours after starting syphilis treatment.

When is the Jarisch-Herxheimer reaction most common?

Early syphilis because the bacterial burden is higher.

How is the Jarisch-Herxheimer reaction treated?

Antipyretics can relieve symptoms but do NOT prevent the reaction.

What are the major counseling points after syphilis treatment?

No sex for 7 days after treatment; partners from the previous 90 days should be treated; syphilis is reportable.

🔥 What is the main treatment for uncomplicated chlamydia?

Doxycycline 100 mg PO twice daily for 7 days.

How is chlamydia treated during pregnancy?

Azithromycin 1 g PO once.

What are the major counseling points after chlamydia treatment?

No sex for 7 days; partners from the last 60 days should be treated; chlamydia is reportable.

What important adverse effect is associated with erythromycin/azithromycin in young infants?

Infantile hypertrophic pyloric stenosis.

🔥 Painful genital ulcers/vesicles should make you think of what STI?

Genital herpes (HSV).

Can antiviral treatment cure genital herpes?

No. It treats/suppresses outbreaks but does not eliminate HSV.

How long is the first episode of genital herpes treated?

7-10 days with acyclovir, famciclovir, or valacyclovir.

How are recurrent HSV outbreaks managed?

Episodic treatment for outbreaks OR daily suppressive antiviral therapy.

How is severe/complicated HSV treated?

IV acyclovir.

What valacyclovir dose did the professor specifically emphasize for cold sores?

Valacyclovir 2 g PO twice daily for 1 day.

🔥 Which HPV types cause most genital warts?

HPV 6 and 11.

🔥 Which HPV types are strongly associated with cervical cancer?

HPV 16 and 18.

🔥 What is the Gardasil 9 schedule if vaccination begins at age 9-14?

2 doses: first dose, then another 6-12 months later.

🔥 What is the Gardasil 9 schedule if vaccination begins at age ≥15?

3 doses: day 1, month 2, and month 6.

What ages routinely receive HPV vaccination vs shared decision-making?

Routine through age 26; shared decision-making ages 27-45.

How is podofilox used for genital warts?

Use for 3 days, stop for 4 days, and repeat if needed for up to 4 cycles.

What is important counseling for imiquimod used for genital warts?

It can weaken condoms/diaphragms; avoid sex while the cream is on the skin.

What is important counseling for sinecatechins (Veregen)?

Avoid sex while applied; may weaken condoms/diaphragms; avoid in HIV/immunocompromised patients or genital herpes.

What major pregnancy warning applies to podophyllin resin?

It is highly teratogenic and should be avoided during pregnancy.

🔥 What organism causes trichomoniasis?

Trichomonas vaginalis = motile, flagellated protozoan.

🔥 What is the treatment for trichomoniasis emphasized in class?

Metronidazole 2 g PO once.

What counseling is important with trichomoniasis?

Treat sex partners; avoid sex for 7 days after treatment.

What important counseling applies to metronidazole/tinidazole?

Avoid alcohol because of a disulfiram-like reaction.

🔥 Is bacterial vaginosis considered an STI in this course?

No.

Do partners routinely need treatment for bacterial vaginosis?

No.

🔥 What is the main oral treatment for bacterial vaginosis?

Metronidazole 500 mg PO twice daily for 7 days.

What is important counseling for intravaginal clindamycin?

It is oil-based and can weaken condoms/diaphragms.

How is uncomplicated vulvovaginal candidiasis treated in a nonpregnant patient?

Fluconazole 150 mg PO once or a topical azole.

🔥 How is vulvovaginal candidiasis treated during pregnancy?

Topical azole for 7 days.

🔥 What is the difference between HIV PrEP and PEP?

PrEP = BEFORE ongoing high-risk exposure; PEP = AFTER a specific recent exposure.

What oral drugs were emphasized for HIV PrEP?

Truvada or Descovy.

What renal cutoffs were emphasized for PrEP?

Truvada: CrCl >60; Descovy: CrCl >30 mL/min.

🔥 When must HIV PEP be started?

As soon as possible and within 72 hours after exposure.

🔥 How long is HIV PEP continued?

4 weeks.

What PEP regimen was emphasized?

Emtricitabine/tenofovir + an integrase inhibitor such as raltegravir or dolutegravir.

🔥 In hormonal contraception, which hormone does most of the pregnancy prevention?

Progestin.

What is estrogen's main role in combined hormonal contraception?

Cycle control/stabilization of the endometrium.

🔥 What symptoms suggest TOO MUCH estrogen in a birth-control patient?

Bloating/breast tenderness, dysmenorrhea, headache, menorrhagia, and nausea.

🔥 What symptoms suggest TOO LITTLE estrogen?

Amenorrhea, decreased libido, vasomotor symptoms, and early/mid-cycle breakthrough bleeding.

🔥 What symptoms suggest TOO MUCH progestin?

Acne, oily skin, hirsutism, increased appetite/weight gain, bloating, and mood changes.

🔥 What symptoms suggest TOO LITTLE progestin?

Dysmenorrhea, menorrhagia, and late-cycle breakthrough bleeding.

🔥 What does early/mid-cycle breakthrough bleeding suggest, and what do you change?

Too little estrogen → increase estrogen.

🔥 What does late-cycle breakthrough bleeding suggest, and what do you change?

Too little progestin → increase progestin.

Who provides the contraception guidelines emphasized in class?

CDC.

🔥 What are major benefits of combined hormonal contraceptives?

Improve menstrual problems/acne and reduce endometrial and ovarian cancer risk.

🔥 What are major risks of combined hormonal contraceptives?

Increased blood pressure, VTE, MI/stroke risk, and breast-cancer risk; they do not protect against STIs.

🔥 What smoking situation is Category 4 for combined hormonal contraception?

Age ≥35 AND smoking ≥15 cigarettes/day.

What migraine history makes estrogen-containing contraception Category 4?

Migraine WITH aura.

What thrombotic/cardiovascular histories are major reasons to avoid combined hormonal contraception?

High-risk VTE/thrombophilia, stroke, ischemic heart disease, or major cardiovascular disease.

What other major situations make combined hormonal contraception inappropriate?

Current breast cancer, uncontrolled hypertension, severe liver disease, major surgery with prolonged immobilization, and very early postpartum.

🔥 What contraception can generally be used immediately postpartum when estrogen is undesirable?

Progestin-only contraception.

How long should estrogen-containing combined contraception generally be avoided postpartum at minimum?

At least the first 3 weeks (less than 21 days).

🔥 What happens to combined hormonal contraceptives when a CYP enzyme inducer is started?

They are metabolized faster → contraceptive effectiveness decreases.

Which antibiotic is the classic enzyme inducer that decreases hormonal-contraceptive effectiveness?

Rifampin (and rifabutin).

🔥 What happens to lamotrigine concentrations when combined oral contraceptives are used?

Lamotrigine levels decrease because its metabolism increases.

🔥 What warning symptoms should a patient taking combined hormonal birth control watch for (ACHES)?

Abdominal pain, Chest pain, severe Headache, Eye/vision problems, Severe leg pain.

What should a patient do if an ACHES symptom occurs?

Stop the combined contraceptive and seek medical evaluation.

What is Necon?

A monophasic combined oral contraceptive containing estrogen + norethindrone.

What is Heather?

A norethindrone progestin-only pill (mini-pill).

🔥 If a norethindrone mini-pill is >3 hours late, what is needed?

Backup contraception for 2 days.

What is Slynd?

A drospirenone-only progestin pill.

🔥 What missed-dose window does Slynd have?

About 24 hours.

🔥 What special adverse effect should you remember with drospirenone?

Hyperkalemia because it has spironolactone-like antimineralocorticoid activity.

Why may drospirenone be useful for acne/hirsutism/oily skin?

It has antiandrogen activity.

What is Xulane?

A combined hormonal contraceptive patch.

How is Xulane normally used?

New patch weekly for 3 weeks, then 1 patch-free week.

🔥 What two weight-related issues were emphasized for Xulane?

Reduced efficacy above ~90 kg and increased VTE concern/contraindication at BMI ≥30 in the course.

What is Natazia?

A four-phasic combined pill containing estradiol valerate + dienogest.

🔥 How long is backup contraception needed when starting Natazia?

9 days.

What is unusual about Natazia compared with most pills?

It is four-phasic, and the first 2 pills contain estrogen only.

How is NuvaRing normally used?

Leave inserted for 3 weeks, then remove for week 4.

🔥 If NuvaRing has been out for >3 hours, what is needed?

Reinsert it and use backup contraception for 7 days.

What are the 2 contraceptives emphasized as FDA-approved for menorrhagia?

Natazia and Mirena.

Which contraceptives were emphasized for Premenstrual Dysphoric Disorder (PMDD)?

Yaz and Yasmin.

🔥 What is the standard Depo-Provera dose?

Medroxyprogesterone 150 mg IM every 3 months.

🔥 What is the major boxed warning/problem with Depo-Provera?

Bone mineral-density loss; prolonged use should generally be limited when possible.

What other major adverse effect is strongly associated with Depo-Provera?

Weight gain.

What fertility issue occurs after stopping Depo-Provera?

Ovulation may be delayed for roughly 10 months.

What is ParaGard?

A nonhormonal copper IUD.

What menstrual change is common with ParaGard?

Heavier/prolonged bleeding and cramping.

How does a hormonal IUD often change bleeding over time?

Spotting initially; may eventually cause amenorrhea.

🔥 When should Plan B (levonorgestrel) ideally be taken?

Within 72 hours after unprotected intercourse.

How long may Plan B still have some effect?

Up to 5 days, but efficacy decreases with time.