PSYCHIATRY

Unhealthy Drug

..opioid, cannabis, stimulant, sedative hypnotic

..tobacco

..alcohol

Depression (Lifeline 800.273.8255, text 998)

GENERAL

Healthy Diet + Physical Activity

CARDIOVASCULAR

Hypertension (annually: age 40+, African, hypertension, overweight/obese; otherwise age 18-39 every 3-5 yrs)

Overweight/Obesity

Lipid (age 35+ male, risk factors)

Abdominal Aortic Aneurysm (age 65-75 if ever smoker)

Statin for cardiovascular disease 10 year risk 10+%)

INFECTION

Sexually Transmitted Infection Prevention (safe sex: limit partner, verify status, use condom)

HIV (exposure, age 15-65 x 1+, pregnant, Man Sex with Man HIV+ partner, IV drug use, or transactional/commercial sex, inconsistent condom use when not in a mutually monogamous relationship, every 3-6 mo)

..Pre-Exposure Prophylaxis (PrEP): Man Sex with Man, HIV+ partner, inconsistent condom use, syphilis/gonorrhea/chlamydia within 6 mo)

    PrEP reduces relative risk by 54% (73% if compliance is >=70%) so still limit partners, verify status, and use condom

Hepatitis B (exposure, born Asia/Africa, IV Drug Abuse, Men having Sex with Men, pregnant)

Syphilis (exposure, Man Sex with Man, prostitute, HIV+ living partner)

Hepatitis C (age 18-79 x 1+, exposure, born 1945-65, transfuse/transplant, IV Drug Abuse, liver disease)

Chlamydia + Gonorrhea (exposure, female sexually active age <=24 or age 25+ with new/multiple partner(s), symptoms)

Latent Tuberculosis (former resident in country at risk, homeless, prison)

Immunizations (may obtain at pharmacy)

.. Pediatric

..Adult

  COVID x 2+ when to get a booster

  flu: annual (LIVE VERSION NOT RECOMMENDED FOR PREGNANT or IMMUNOCOMPROMISED), inactive version recommended for immunocompromised)

  TDaP: every 10 years

  MMR (NOT RECOMMENDED FOR PREGNANT OR IMMUNOCOMPROMISED)

  VAR x 2 if no history of vaccination or disease (NOT RECOMMENDED FOR PREGNANT OR IMMUNOCOMPROMISED)

  HepB x 3 (if

  PCV15 or PCV20 (if age >=age65 and no history of any pneumococcal vaccination, new CDC recommendation)

..Additional Immunizations for Specific Populations

  Pregnant: 1 TDaP each pregnancy week 27-36  (CONTRAINDICATED: LIVE FLU, MMR, VAR, HPV SO DO NOT GET)

  Immunocompromised: shingles RZV, pneumococcal (CONTRAINDICATED: LIVE FLU, MMR, VAR SO DO NOT GET)

  Chronic Liver Disease: hepA

  Healthcare Personnel: shingles RZV

  Men who have Sex with Men : shingles RZV age 50+, HPV <=age26, monkeypox if exposure https://myturn.ca.gov/

CANCER

Breast Cancer

..mammogram (biennial age 50-74) +/- annual age 40+ (preferred)

  if silicone implants, in addition to mammogram with additional views also post-operatively MRI or ultrasound at 5-6 years then every 2-3 years (implant rupture risk during mammography s 1%)

..BRCA gene (also for Ovarian Cancer)

  known family BRCA mutation

  Ashkenazi Jewish woman: breast or ovarian cancer in 1st degree relative or two 2nd degree relatives

  1st degree relative(s) with breast cancer: two relatives or one relative with bilateral

  1st or 2nd degree relatives: three with breast cancer or comorbid breast and ovarian cancers or two with ovarian cancer

  male family member with breast cancer

..endocrine Rx new including for

   age 65+ with 1 first-degree relative with breast cancer

   age 45+ with more than 1 first-degree relative with breast cancer or 1 first-degree relative who developed breast cancer before age 50

   age 40+ with a first-degree relative with bilateral breast cancer

   presence of atypical ductal or lobular hyperplasia or lobular carcinoma in situ on a prior biopsy

Cervical Cancer (every 3 yrs age 21-65; every 5 yrs age 30-65 if Pap and HPV normal)

  please reschedule if menstruating and ideally abstain from sex 48 hours prior to pap

Colon Cancer (newly lowered age 45-75, especially black/native, family history, male, obese, diabetes, smoker, alcohol)

..Options

   high-sensitivity guaiac fecal occult blood test (HSgFOBT) or FIT fecal immunochemical test annually

   stool DNA-FIT (ColoGuard) every 1 to 3 years

   virtual colonoscopy (computed tomography colonography) every 5 years

   flexible sigmoidoscopy every 5 years

   flexible sigmoidoscopy every 10 years + annual FIT

   colonoscopy screening every 10 years (preferred)

     risk of perforation is 1%

Lung Cancer (updated: age 50-80 + 20 pack yrs + smoker <=15 yrs)

Prostate Cancer (age 55-69) option for annual blood/exam age 50+ (age 35+ if African or family history)

ABUSE

Intimate Partner Violence (childbearing age female)

ENDOCRINOLOGY

Diabetes (age 35-70 overweight/obese, Family History, ethnicity: African, Native, Asian, Hispanic, Pacific Islanders)

Osteoporosis (age 65+ female)

DERMATOLOGY

Skin Cancer if fair skinned (shade 10AM-4PM, cover, SPF 30+)

  inform doctor if any suspicious lesions including using ABCDE pneumonic:

  Asymmetry, Border irregular, Color black or varying, Diameter >5mm, Evolving/Enlargement/Elevation

PREGNANCY PLANNING

folic acid 400-800ug daily

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Guideline Clearinghouse

Prevention and Wellness