AGNP BOARD EXAM QUESTIONS Sexually Transmitted Diseases Prescribing_2021_82 Questions With Correct Answers And Rationale

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AGNP BOARD EXAM QUESTIONS Prescription (82 Questions) Question: Which of the following is NOT recommended as an alternative treatment for bacterial vaginosis? Intramuscular ceftriaxone (Rocephin) ... Correct Clindamycin (Cleocin) vaginal cream Metronidazole (Flagyl) vaginal cream Tinidazole (Tindamax) orally Explanation: Intramuscular ceftriaxone (Rocephin) is not indicated in the treatment of bacterial vaginosis. Metronidazole (Flagyl) vaginal cream may be used if metronidazole oral is ineffective or not well tolerated. Alternative regimens include several tinidazole regimens or clindamycin (oral or intravaginal). Question: The recommended empiric treatment of pelvic inflammatory disease is: penicillin G benzathine (Bicillin) intramuscularly plus ceftriaxone (Rocephin) intramuscularly. azithromycin (Zithromax) orally plus ceftriaxone (Rocephin) intramuscularly. ceftriaxone (Rocephin) intramuscularly plus doxycycline (Vibramycin). Correct metronidazole (Flagyl) plus ofloxacin (Floxin). Explanation: The recommended empiric treatment for mild to moderate symptoms of pelvic inflammatory disease (PID) is ceftriaxone (Rocephin) 250 mg intramuscularly plus doxycycline (Vibramycin) 100 mg twice daily x 14 days with or without metronidazole (Flagyl) 500 mg PO twice daily x 14 days. All regimens used to treat PID should also be effective against Neisseria gonorrhoeae and Chlamydia trachomatis because negative endocervical screening for these organisms does not rule out upper-reproductive tract infection. Question: For the treatment of chlamydia, azithromycin (Zithromax) should be given: as one-time dose. Correct daily for 3 days. daily for 5 days. daily for 7 days. Explanation: For the treatment of chlamydia, azithromycin (Zithromax) should be given as a single dose, 1 gram orally. Azithromycin (Zithromax) is classified as a macrolide. It is active against most isolates of Chlamydia trachomatis, Neisseria gonorrhoeae, and Streptococcus pneumoniae. Question:Clindamycin (Cleocin) to treat bacterial vaginosis should NOT be used in combination with: atorvastatin. prednisone. estradiol. Correct ibuprofen. Explanation: Clindamycin (Cleocin) may decrease hormonal contraceptive efficacy and should not be coadministered with estradiol. The other choices are not known to cause drug-drug interactions when administered with clindamycin. Question: When treating latent syphilis, treatment outcomes do NOT include the prevention of: asymptomatic progression of the disease. neurosyphilis. sexual transmission. Correct transfer to a fetus in pregnancy. Explanation: Because latent syphilis is not transmitted sexually, the objective of treating patients in this stage of disease is to prevent complications (neurosyphilis and progression of disease) and transmission from a pregnant woman to her fetus. Question: The most commonly reported side effects of azithromycin (Zithromax) for treatment of chlamydia are: alopecia and headache. blurred vision and tinnitus. diarrhea and nausea. Correct dry mouth and tachycardia. Explanation: The most common treatment-related side effects of azithromycin (Zithromax) are related to the gastrointestinal system with diarrhea/loose stools, nausea, and abdominal pain. Most of the adverse reactions leading to discontinuation were related to the gastrointestinal tract. Potentially serious adverse reactions of angioedema and cholestatic jaundice have been reported. Question: The most common reason for persistent gonococcal infections is: inappropriate prescribing of the correct treatment regimen. treatment failure due to high resistance rates. failure of the patient to abstain from unprotected sexual intercourse. Correct lack of test-of-cure and follow-up after treatment. Explanation: A high prevalence of Neisseria gonorrhoeae infection has been observed among men and women previously treated for gonorrhea. Rather than signaling treatment failure,most of these infections result from reinfection caused by failure of sex partners to receive treatment or the initiation of sexual activity with a new infected partner. This indicates a need for improved patient education and treatment of sex partners. If the patient’s last potential sexual exposure was >60 days before onset of symptoms or diagnosis, the most recent sex partner should be treated. To avoid reinfection, sex partners should be instructed to abstain from unprotected sexual intercourse for 7 days after they and their sexual partner(s) have completed treatment and after resolution of symptoms. Question: The recommended treatment for chlamydia infection when azithromycin (Zithromax) or doxycycline (Doryx) is contraindicated is: clindamycin (Cleocin). erythromycin (Ery-Tab). Correct metronidazole (Flagyl). tetracycline (Sumycin). Explanation: First-line therapies for the treatment of chlamydia infection include azithromycin (Zithromax) or doxycycline (Doryx). Alternative therapies include levofloxacin (Levaquin), erythromycin base, erythromycin ethylsuccinate, or ofloxacin (Floxin). Question: An alternative intramuscular medication for ceftriaxone (Rocephin) in the treatment of pelvic inflammatory disease is: cefoxitin. Correct penicillin G benzathine (Bicillin). gentamicin. streptomycin. Explanation: Cefoxitin, a second-generation cephalosporin, has better anaerobic coverage than ceftriaxone (Rocephin), and in combination with probenecid and doxycycline is effective in achieving short-term clinical response in women with pelvic inflammatory disease. Ceftriaxone has better coverage against Neisseria gonorrhoeae. The addition of metronidazole (Flagyl) will also effectively treat bacterial vaginosis, which is frequently associated with PID. Question: The generic name for Flagyl is: fluconazole. methazolamide. metronidazole. Correct tinidazole. Explanation: The generic name for Flagyl is metronidazole. Flagyl is classified as a nitroimidazole. In addition to the treatment of bacterial vaginosis, it is used in the treatment of parasite infections, Clostridium difficile, and Helicobacter pylori. The brand name for fluconazoleis Diflucan (an antifungal); methazolamide is Neptazane (a diuretic); tinidazole is Tindamax (an antiparasitic, antibacterial). Question: Tinidazole (Tindamax), used in the treatment of trichomoniasis, is classified as an: antiprotozoal and antiviral. antifungal and antiparasitic. antifungal and antibacterial. antiparasitic and antibacterial. Correct Explanation: Tinidazole (Tindamax) is a synthetic antiparasitic and antibacterial agent indicated for the treatment of trichomoniasis caused by Trichomonas vaginalis. Tindamax is metabolized by the CYP450 3A4 substrates and is excreted primarily unchanged in the urine. The half-life of Tindamax is 12-14 hours. Question: When treating trichomoniasis, tinidazole (Tindamax) compared to metronidazole (Flagyl): is more cost effective. reaches higher drug concentrations in the urinary tract. Correct has a shorter-half life. has more gastrointestinal side effects. Explanation: Tinidazole (Tindamax) is generally more expensive than metronidazole (Flagyl). Tinidazole reaches higher drug concentrations in serum and the genitourinary tract, has a longer half-life (12.5 hours versus 7.3 hours), and has fewer gastrointestinal side effects than metronidazole. Question: Treatment of gonococcal urethritis in a child who weighs less than 45 kg is: azithromycin (Zithromax). ceftriaxone (Rocephin). Correct doxycycline (Vibramycin). erythromycin (Ery-Tab). Explanation: The recommended treatment for gonococcal urethritis in a child weighing less than 45 kg is ceftriaxone (Rocephin). Azithromycin (Zithromax) can be added if the child weighs more than 45 kg. Doxycycline (Vibramycin) and erythromycin (Ery-Tab) are not efficacious for the monotherapy treatment of gonococcal infections. Question: Topical regimens for treatment of herpes simplex are: safer and less expensive than oral treatment. less efficacious than oral treatment. Correct only recommended for herpes labialis.not effective for reducing pain or viral shedding. Explanation: Topical treatment of genital herpes offers minimal clinical benefit and its use is discouraged. The use of topical therapy for herpes labialis (cold sores) is not recommended. Oral therapy is preferred for treatment of recurrent herpes simplex labialis over topical antiviral creams. Antiviral creams have a small but statistically significant effect on the duration of cold sores. Pain and viral shedding may be significantly decreased with the use of penciclovir cream. Question: The recommended treatment of neonatal chlamydia infection is: amoxicillin (Amoxil). cefotaxime (Claforan). erythromycin base (PCE). Correct metronidazole (Flagyl). Explanation: The recommended treatment for neonatal chlamydia infection is erythromycin base (PCE) or ethylsuccinate (EryPed). Azithromycin (Zithromax) is an alternative recommendation. Topical antibiotic therapy alone is inadequate for treatment of ophthalmia neonatorum caused by chlamydia and is unnecessary when systemic treatment is administered. Question: To prevent gonococcal ophthalmia neonatorum in the neonate, the recommended treatment is: bacitracin ophthalmic. ciprofloxacin (Ciloxan) ophthalmic. erythromycin (Ilotycin) ophthalmic ointment. Correct gentamicin (Garamycin) ophthalmic ointment. Explanation: To prevent gonococcal ophthalmia neonatorum, erythromycin (Ilotycin) ophthalmic ointment should be instilled into both eyes of all newborn infants; this procedure is required by law in most states. Ocular prophylaxis is warranted because it can prevent sight-threatening gonococcal ophthalmia, has an excellent safety record, is easy to administer, and is inexpensive. The recommended prophylactic regimen prevents gonococcal ophthalmia. Erythromycin is the only antibiotic ointment recommended for use in neonates. Question: Sinecatechins 15% (Veregen) ointment for treatment of condyloma acuminata: is safe for use in children 6-12 years of age. must be applied three times daily and washed off within an hour to prevent irritation. should be washed off prior to sexual intercourse or application of a tampon. Correct must be applied by the provider to prevent contact with normal skin. Explanation:Sinecatechins (Veregen) ointment is a topical ointment indicated for the self-treatment of external genital and perianal warts (Condylomata acuminata) in immunocompetent patients 18 years and older. It is also known as Polyphenon E, and is a standardized extract of green tea, which has immunostimulatory, antiproliferative and antitumor properties. Treatment is to be applied three times per day to all external genital and perianal warts. It is not necessary to wash off the ointment from the treated area prior to the next application. Sexual contact should be avoided while the ointment is on the skin, or the ointment should be washed off prior to these activities or application of tampons. Question: The most commonly reported side effect in the short- and long-term administration of acyclovir for genital herpes is: anhedonia. nausea. Correct malaise. paresthesia. Explanation: The most commonly reported side effect in the short- and long-term administration of acyclovir (Zovirax) for suppression of genital herpes is nausea. Headache and diarrhea are also frequently reported. Acyclovir (Zovirax) is indicated in the acute and chronic suppression of genital herpes, acute treatment of herpes zoster, and treatment of chicken pox in children 2 years and older. Question: In the treatment of syphilis caused by Treponema pallidum, the preparation, dose and length of treatment are most likely to be determined by: diagnostic confirmation and ability to follow-up. disease stage and clinical manifestations. Correct cost of medication and ability to follow-up. disease stage and diagnostic confirmation. Explanation: Treponema pallidum is a spirochete bacterium with subspecies that cause treponemal diseases such as syphilis. Selection of the appropriate penicillin preparation is important, because Treponema pallidum can reside in sequestered sites (e.g., the CNS and aqueous humor) that are poorly accessed by some forms of penicillin. The preparation used (i.e., benzathine, aqueous procaine, or aqueous crystalline), dosage, and length of treatment depend on the stage and clinical manifestations of the disease. Question: Valacyclovir, used in the suppression of genital herpes, is: a prodrug of acyclovir. Correct an oral form of penciclovir. not well tolerated. less bioavailable than acyclovir. Explanation: [Show More]

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