Exam 5 Flashcards
(289 cards)
1
Q
What are clinical manifestations of oropharyngeal candidiasis?
A
-painless, creamy white, plaque-like lesions on the buccal mucosa, hard or soft palate, oropharyngeal mucosa, or tongue surface
-dry mouth
-taste alterations
2
Q
What are the treatment options for oropharyngeal candidiasis?
A
-fluconazole 200 mg PO once, then 100-200 mg PO QD for 7-14 days
-topical agents (nystatin or clotrimazole)
3
Q
What are clinical manifestations of esophageal candidiasis?
A
-fever
-retrosternal burning pain or discomfort
-dysphagia
-odynophagia
-whitish plaques with superficial ulceration of esophageal mucosa with white surface exudates
4
Q
What is the treatment for esophageal candidiasis?
A
fluconazole 200 mg IV or PO QD for 14-21 days
5
Q
What are clinical manifestations of vulvovaginal candidiasis?
A
-white, thick vaginal discharge
-vaginal itching
-vaginal burning
-vulvar erythema
6
Q
What are the treatment options for uncomplicated vulvovaginal candidiasis?
A
-fluconazole 150 mg PO once
-topical azole for 3-7 days
-ibrexafungerp 300 mg PO BID for 1 day
7
Q
What are the treatment options for severe vulvovaginal candidiasis?
A
-fluconazole 100-200 mg PO QD
-topical antifungals
8
Q
What is the duration of therapy for severe vulvovaginal candidiasis?
A
7 days
9
Q
What is the treatment for azole-refractory C. glabrata vaginitis?
A
boric acid 600 mg vaginally QD for 14 days
10
Q
When is prophylaxis recommended for candidiasis?
A
frequent or severe recurrences of esophagitis or vaginitis (QD treatment)
11
Q
What are the clinical manifestations of cryptococcal meningitis?
A
-fever
-malaise
-headache
-nausea
-dizziness
-lethargy
-irritability
-impaired memory
-behavioral changes
12
Q
What is the treatment for the induction phase of cryptococcal meningitis?
A
amphotericin B 3-4 mg/kg IV QD and flucytosine 25 mg/kg PO QID for 2 weeks
13
Q
What is the treatment for the consolidation phase of cryptococcal meningitis?
A
fluconazole 800 mg PO QD for 8 weeks (400 mg if patient is stable with sterile CSF and on ART)
14
Q
What is the treatment for the maintenance phase of cryptococcal meningitis?
A
fluconazole 200 mg PO QD ≥ 1 year
15
Q
When should ART be initiated when treating cryptococcal meningitis?
A
between the induction and consolidation phases
16
Q
When can secondary prophylaxis be discontinued for cryptococcal meningitis?
A
-duration of therapy ≥ 1 year
-asymptomatic
-CD4 count ≥ 100 cells/mm^3 for 3 months on ART
17
Q
When should secondary prophylaxis be restarted for cryptococcal meningitis?
A
CD4 count < 100 cells/mm^3
18
Q
What are the clinical manifestations of histoplasmosis?
A
-fever
-fatigue
-weight loss
-hepatosplenomegaly
-cough
-dyspnea
19
Q
What are treatment options for mild to moderate histoplasmosis?
A
-itraconazole 200 mg PO TID for 3 days, then BID for ≥ 12 months
-posaconazole
-voriconazole
-fluconazole
20
Q
What is the treatment for severe histoplasmosis?
A
amphotericin B 3 mg/kg IV QD for ≥ 2 weeks, then itraconazole 200 mg PO TID for 3 days, then BID for ≥ 12 months
21
Q
When should primary prophylaxis of histoplasmosis be initiated?
A
-CD4 count < 150 cells/mm^3
-high risk due to occupational exposure or living in community with hyperendemic rate of histoplasmosis
22
Q
What is the treatment for primary prophylaxis of histoplasmosis?
A
itraconazole 200 mg PO QD
23
Q
When should ART be initiated for treatment of histoplasmosis?
A
ASAP
24
Q
When may primary prophylaxis of histoplasmosis be discontinued?
A
-ART
-CD4 count ≥ 150 cells/mm^3 for 6 months
25
When should secondary prophylaxis of histoplasmosis be initiated?
-severe disseminated disease or CNS infection after maintenance therapy OR
-relapse
26
What is the treatment for secondary prophylaxis of histoplasmosis?
itraconazole 200 mg PO QD
27
When may secondary prophylaxis of histoplasmosis be discontinued?
-azole therapy for ≥ 1 year
-negative fungal blood cultures
-serum or urine histoplasma antigen below level of quantification
-ART
-CD4 count ≥ 150 cells/mm^3 for ≥ 6 months
28
When should secondary prophylaxis of histoplasmosis be restarted?
CD4 count < 150 cells/mm^3
29
What are clinical manifestations of mycobacterium avium complex (MAC)?
-disseminated multi-organ infection if not on ART
-fever
-night sweats
-weight loss
-diarrhea
-abdominal pain
-malaise/fatigue
30
What are treatment options for MAC?
-clarithromycin 500 mg PO BID and ethambutol 15 mg/kg PO QD
-azithromycin 500-600 mg PO QD and ethambutol 15 mg/kg PO QD
31
What drug can be added to a treatment regimen for severe MAC?
rifabutin 300 mg PO QD
32
When should more antibiotics be added to a treatment regimen for MAC?
-high risk of mortality
-likely drug resistance
-CD4 count < 50 cells/mm^3
-high mycobacterial loads in blood
-ineffective ART
33
What antibiotics can be added to a treatment regimen for MAC?
-levofloxacin or moxifloxacin
-amikacin or streptomycin
-linezolid, tedizolid, or omadacycline
34
When can duration of therapy for MAC be shorter?
CD4 count > 100 cells/mm^3 for ≥ 6 months
35
When should ART be initiated for treatment of MAC?
ASAP
36
When is prophylaxis not recommended for MAC?
if ART is initiated immediately after HIV diagnosis
37
When should primary prophylaxis of MAC be initiated?
-CD4 count < 50 cells/mm^3
-no ART or high viral load
38
What is the treatment for primary prophylaxis of MAC?
azithromycin 1,200 mg PO QW
39
When should primary prophylaxis of MAC be discontinued?
ART
40
When should primary prophylaxis of MAC be restarted?
CD4 count < 50 cells/mm^3
41
When should secondary prophylaxis of MAC be discontinued?
-completed ≥ 12 months
-asymptomatic
-CD4 count > 100 cells/mm^3 for > 6 months
42
When should secondary prophylaxis of MAC be restarted?
CD4 count < 100 cells/mm^3
43
What are clinical manifestations of pneumonitis jirovecii pneumonia (PJP)?
-dyspnea
-fever
-non-productive cough
-chest discomfort
-hypoxemia
44
What are treatment options for mild to moderate PJP?
-Bactrim 15-20 mg/kg/day PO TID
-Bactrim DS 2 tablets PO TID
-dapsone and trimethoprim
-primaquine and clindamycin
-atovaquone
45
For what drugs in the treatment of PJP do G6PD levels need to be checked?
-dapsone
-primaquine
-clindamycin
46
What are treatment options for moderate to severe PJP?
-Bactrim 15-20 mg/kg/day IV divided Q6-8H for 21 days
-primaquine and clindamycin
-pentamidine
47
When should adjunctive corticosteroid therapy be initiated for PJP?
pO2 < 70 mm Hg (within 72 hours of PJP therapy initiation)
48
What is the adjunctive corticosteroid treatment for PJP?
prednisone 40 mg PO BID for 5 days, then QD for 5 days, then 20 mg PO QD for 11 days
49
When should ART be initiated for treatment of PJP?
within 2 weeks of PJP diagnosis
50
When should primary prophylaxis of PJP be initiated?
-CD4 count 100-200 cells/mm^3 (if high viral load) OR
-CD4 count < 100 cells/mm^3
51
When should secondary prophylaxis of PJP be initiated?
all patients with acute episode of PJP
52
When can secondary prophylaxis of PJP be discontinued?
CD4 count ≥ 200 cells/mm^3 for > 3 months
53
When should secondary prophylaxis of PJP be restarted?
CD4 count < 100 cells/mm^3
54
What are clinical manifestations of toxoplasmosis?
-headache
-focal neurologic deficits
-fever
55
What are the treatment options for acute treatment of toxoplasmosis?
-pyrimethamine 200 mg PO once, then weight-based dosing
-Bactrim 5 mg/kg IV or PO BID
56
What is the duration of therapy for acute treatment of toxoplasmosis?
≥ 6 weeks
57
What are the treatment options for maintenance therapy of toxoplasmosis?
-pyrimethamine 25-50 mg PO QD and sulfadiazine 2,000-4,000 mg PO BID-QID and leucovorin 10-25 mg PO QD
-Bactrim DS 1 tablet PO BID
58
When should primary prophylaxis of toxoplasmosis be initiated?
toxoplasma IgG positive with CD4 count < 100 cells/mm^3
59
What is the treatment for primary prophylaxis of toxoplasmosis?
Bactrim DS 1 tablet PO QD
60
When can primary prophylaxis of toxoplasmosis be discontinued?
-CD4 count > 200 cells/mm^3 for > 3 months in response to ART
-CD4 count 100-200 cells/mm^3 and low viral load for ≥ 3-6 months
61
When should primary prophylaxis of toxoplasmosis be restarted?
-CD4 count < 100 cells/mm^3
-CD4 count 100-200 cells/mm^3 and high viral load
62
When can secondary prophylaxis of toxoplasmosis be discontinued?
-CD4 count > 200 cells/mm^3 for > 6 months
-completed initial therapy
-asymptomatic
63
When should secondary prophylaxis of toxoplasmosis be restarted?
CD4 count < 200 cells/mm^3
64
What are risk factors for infections in immunocompromised patients?
-neutropenia
-immune system defects
-destruction of protective barriers
-environmental contamination/alteration of microbial flora
65
neutropenia
ANC < 1000 cells/mm^3
66
What are the most common causative bacteria for neutropenia?
-Staphylococcus aureus
-Enterobacterales
-Pseudomonas aeruginosa
67
cell-mediated immunity
-T-lymphocytes
-primary defense against intracellular pathogens
68
humoral immunity
-B-lymphocytes
-primary defense against extracellular pathogens
69
What can cause immune system defects?
-underlying disease
-immunosuppressive drugs
70
What are protective barriers or methods that protective barriers can destroy?
-skin
-mucous membranes
-surgery
71
How can mucous membranes be destructed?
-chemotherapy
-radiation
72
What type of bacteria does oropharyngeal flora rapidly change to in hospitalized patients within the first 48 hours?
Gram-negative bacilli
73
fever in neutropenic cancer patients
-single oral temperature of ≥ 38.3ºC OR
-oral temperature ≥ 38ºC for ≥ 1 hour
74
What are the characteristics of low-risk neutropenia patients?
-anticipated neutropenia ≤ 7 days
-clinically stable
-no medical comorbidities
-outpatient at fever onset
75
What is the outpatient treatment for low-risk neutropenia?
PO fluoroquinolone and Augmentin
76
When are IV antibiotics indicated for low-risk neutropenic patients?
-inadequate outpatient infrastructure OR
-not candidate for oral regimen
77
What IV antibiotics are used for neutropenia?
-Zosyn
-antipseudomonal carbapenem
-cefepime
-ceftazidime
78
What are the characteristics for high-risk neutropenia patients?
-anticipated neutropenia > 7 days
-clinically unstable
-medical comorbidities
-HSCT
-inpatient at fever onset
-ANC ≤ 100 cells/mm^3
79
When can IV vancomycin be added to a drug regimen for neutropenia?
-cellulitis
-pneumonia
-severe sepsis or shock
-Gram-positive bacteria
-suspected IV catheter infection
-MRSA
-resistant Streptococci
80
What antibiotics can be added to a neutropenia drug regimen for septic shock, Gram-negative bacteremia, or pnuemonia?
-aminoglycoside
-antipseudomonal fluoroquinolone
81
What bacteria should always be covered by antibiotics for the treatment of neutropenia?
Pseudomonas
82
What can be used as a high-risk neutropenia drug regimen for patients with a penicillin allergy?
-ciprofloxacin
-aztreonam
-vancomycin
83
What antibiotic is used for MRSA?
vancomycin
84
What antibiotics are used for VRE?
-daptomycin
-linezolid
85
What antibiotic is used for ESBL?
carbapenems
86
What antibiotics are used for KPC?
-meropenem/vaborbactam
-imipenem/cilastatin/relebactam
-ceftazidime/avibactam
87
When should targeted therapy be re-evaluated after empiric therapy for the treatment of neutropenia?
48-72 hours
88
What is the median time of dissolution of fever for neutropenia?
5-7 days
89
When should antifungal therapy be initiated for neutropenia?
-persistent fever OR
-development of new fever with undocumented infection after 4-7 days of broad spectrum antibiotics
90
What are antifungal treatments for neutropenia?
-amphotericin B (deoxycholate or liposomal)
-azoles
-echinocandins
91
What azoles can be used to treat neutropenia?
-fluconazole
-voriconazole
-posaconazole
-isavuconazole
92
What echinocandins can be used to treat neutropenia?
-micafungin
-caspofungin
-anidulafungin
93
What is the duration of therapy for antifungal therapy for neutropenia?
2 weeks
94
When should antiviral therapy be initiated for neutropenia?
-vesicular/ulcerative skin or mucosal lesions OR
-presumed or confirmed viral infection
95
What is the treatment for HSV/VZV?
-acyclovir
-valacyclovir
96
What patients are eligible for neutropenia prophylaxis?
-moderate- or high-risk patients with expected ANC ≤ 100 cells/mm^3 for > 7 days
-heme malignancies
-allogeneic and autologous hematopoietic stem cell transplants
-graft versus host disease with high-dose steroids
-alemtuzumab
97
What are treatment options for neutropenia prophylaxis?
-ciprofloxacin
-levofloxacin
-Bactrim
98
What is the HIV viral protein?
gp120
99
What are the stages of HIV infection?
-acute retroviral syndrome
-chronic HIV infection
-AIDS
100
What are the routes of transmission of HIV?
-exposure of mucous membrane or damaged tissue to infected body fluids
-bloodstream exposure to infected body fluids
-mother-to-child
101
What is the seroconversion window for the OraQuick In-Home test?
3 months
102
What is the CD4 cell count cutoff for HIV vs. AIDS?
200 cells/mm^3
103
What is the CD4 percentage cutoff for HIV vs. AIDS?
14%
104
What is the mechanism of action of nucleoside reverse transcriptase inhibitors?
synthetic purine and pyrimidine analogues resulting in elongation termination of growing proviral DNA chain
105
What medications are nucleoside reverse transcriptase inhibitors?
-abacavir
-emtricitabine
-tenofovir
-vudine
106
What is the mechanism of action of non-nucleoside reverse transcriptase inhibitors?
bind to allosteric site of reverse transcriptase enzyme (reduces functionality)
107
What medications are non-nucleoside reverse transcriptase inhibitors?
-vir-
108
What is the mechanism of action of protease inhibitors?
inhibit viral protease (prevents assembly, maturation, and release of new virions)
109
What is the suffix of protease inhibitors?
-navir
110
What is the mechanism of action of integrase strand transfer inhibitors?
inhibit HIV integrase (prevents proviral DNA integration into host cell genome)
111
What is the suffix of integrase strand transfer inhibitors?
-tegravir
112
What is the mechanism of action of attachment inhibitors?
binds to gp120
113
What drug is an attachment inhibitor?
temsavir
114
What is the mechanism of action of post-attachment inhibitors?
binds to domain D2 of CD4 receptor on T cells and interrupts post-attachment steps required for entry of HIV into host cell
115
What drug is a post-attachment inhibitor?
ibalizumab-uiyk
116
What is the mechanism of action of chemokine receptor (CCR5) antagonists?
-binds to CCR5 on CD4 receptors on T cells
-blocks binding of gp120
-prevents entry of HIV into host cell
117
What drug is a chemokine receptor (CCR5) antagonist?
maraviroc
118
What is the mechanism of action of capsid inhibitors?
binds to interface between capsid protein (p24) subunits (interferes with multiple steps of viral lifecycle)
119
What drug is a capsid inhibitor?
lenacapavir
120
What is the recommended dose of dolutegravir for integrase strand transfer inhibitor-naive?
50 mg PO QD
121
What is the recommended dose of dolutegravir for integrase strand transfer inhibitor-experienced?
50 mg PO BID
122
What HIV medication needs to be taken on an empty stomach at bedtime?
efavirenz
123
What HIV medication needs to be titrated from 200 mg BID to 400 mg QD?
nevirapine
124
What HIV medications need to be taken with food?
-etavirine
-rilpivirine
-atazanavir
-elvitegravir
125
What HIV medication requires an oral lead-in phase for ≥ 28 days?
cabotegravir
126
What HIV medication is administered IV?
ibalizumab
127
What HIV medication is administered subcutaneous?
lenacapavir
128
What are adverse effects of nucleoside reverse transcriptase inhibitors?
-mitochondrial toxicity
-lactic acidosis
129
What is an adverse effect of non-nucleotide reverse transcriptase inhibitors?
rash
130
What are adverse effects of protease inhibitors?
-GI intolerance
-insulin resistance
-lipodystrophy
131
What is an adverse effect of integrase strand transfer inhibitors?
weight gain
132
How long should antacids be separated from PO INSTIs?
6 hours
133
What HIV medication cannot be administered with aluminum and magnesium?
raltegravir
134
What HIV medication is contraindicated with PPIs?
rilpivirine
135
What are the preferred benzodiazepines with protease inhibitors and cobicistat?
-lorazepam
-oxazepam
-temazepam
136
What is the preferred corticosteroid with protease inhibitors and cobicistat?
beclomethasone
137
What are the preferred statins with protease inhibitors and cobicistat?
-atorvastatin
-rosuvastatin
-pitavastatin
-pravastatin
138
What is the dosing of PDE5 inhibitors with protease inhibitors and cobicistat?
low doses Q48-72H
139
How long should polyvalent cation supplements be separated from integrase inhibitors?
6 hours
140
What class of HIV medications requires dosing adjustment in renal insufficiency?
nucleoside reverse transcriptase inhibitors
141
What lab is required prior to initiation of abacavir?
HLA-B*5701 allele genetic testing
142
What lab is required prior to initiation of maraviroc?
tropism assay
143
What is the website for HIV treatment guidelines?
https://clinicalinfo.hiv.gov
144
What are first-line initial treatment regimens for HIV?
-bictegravir/tenofovir alafenamide/emtricitabine (Biktarvy)
-dolutegravir/tenofovir alafenamide or tenofovir disoproxil fumarate/emtricitabine or lamivudine
-dolutegravir/lamivudine (Dovato)
145
In what patients can dolutegravir/lamivudine not be administered to?
-HIV RNA > 500,000 copies/mL
-HBV co-infection
-ART started before results of HIV genotypic resistance testing or HBV testing available
146
What viral load is needed for successful resistance test results?
> 500 copies/mL
147
What HIV drug class has the lowest genetic barrier to resistance?
NNRTIs
148
What HIV drug class has the highest genetic barrier to resistance?
boosted PIs
149
What are PEP treatment regimens?
-emtricitabine/tenofovir disoproxil fumarate 200/300 mg PO QD for 28 days AND
-raltegravir 400 mg PO BID OR dolutegravir 50 mg PO QD for 28 days
150
What are PrEP treatment regimens?
-emtricitabine/tenofovir disoproxil fumarate 200/300 mg PO QD
-emtricitabine/tenofovir alafenamide 200/25 mg PO QD (MSM and transgender women who have sex with men)
-cabotegravir 600 mg IM once, then 1 month later, then Q2M
151
What do fungal cells contain in the cell membrane instead of cholesterol like in mammalian cells?
ergosterol
152
What enzyme do allylamines inhibit?
squalene epoxidase
153
What step does squalene epoxidase catalyze?
squalene --> squalene epoxide
154
What enzyme do azoles inhibit?
14 alpha-demethylase
155
What step does 14 alpha-demethylase catalyze?
lanosterol --> ergosterol
156
What drug class do amphotericin B and nystatin belong in?
polyenes
157
What is the mechanism of action of polyenes?
-bind to ergosterol to form pores for ions to leak out of cells
-withdraw ergosterol from membrane
158
What drug class does terbinafine belong in?
allylamines
159
What is the suffix of echinocandins?
-fungin
160
What is the mechanism of action of echinocandins?
inhibit synthesis of beta(1-3) glucan synthase
161
How are echinocandins selective for fungal cells?
mammalian cells lack beta(1-3) glucan synthase
162
What drug class does flucytosine belong in?
antimetabolites
163
What is the mechanism of action of flucytosine?
inhibit thymidylate synthase
164
How is flucytosine selective for fungal cells?
mammalian cells cannot convert flucytosine to active metabolite
165
What is the mechanism of action of ibrexafungerp?
inhibits glucan synthase
166
What is the mechanism of action of tavaborole?
inhibits leucyl transfer RNA synthetase (leuRS)
167
How are amphotericin B and flucytosine synergistic agents?
amphotericin B creates pores to allow flucytosine to enter fungal cells more easily
168
What is the first step of metabolism of flucytosine?
flucytosine --> 5-FU (catalyzed by cytosine deaminase)
169
What are the second and third steps of flucytosine metabolism?
5-FU --> 5-FUMP --> 5-FdUMP (catalyzed by PRT and ribonucleotide reductase)
170
What is the function of dTMP?
extends fungal DNA for cell growth
171
What activates isoniazid?
KatG
172
What is the mechanism of action of isoniazid?
-forms products with NAD+ and NADP+
-inhibits enzymes (InhA) that use NAD+ and NADP+
-inhibits mycolic acid synthesis
173
What is the mechanism of action of rifampin?
-binds to RNA polymerase within DNA/RNA channel
-blocks path of elongating RNA
174
What is the mechanism of action of ethambutol?
-inhibits mycobacterial arabinosyl transferase
-results in buildup of arabinan (inhibits formation of arabinogalactan and lipoarabinomannan)
175
What activates pyrazinamide?
low pH and pncA
176
What is the mechanism of action of pyrazinamide?
inhibits panD which leads to inhibition of coenzyme A synthesis
177
What is the mechanism of action of bedaquiline?
inhibits ATP synthase
178
What is a resistance mechanism of bedaquiline?
mutations in atpE
179
What activates pretomanid?
deazaflavin-dependent nitroreductase (Ddn)
180
What are the mechanisms of action of pretomanid?
-forms reactive metabolite that inhibits mycolic acid production (aerobic conditions)
-generates reactive nitrogen species (anaerobic conditions)
181
At what stage of tuberculosis does a tuberculin skin test (TST) become positive?
infection eliminated with acquired immune response
182
At what stage of tuberculosis does an interferon-gamma release assay (IGRA) become positive?
infection eliminated with acquired immune response
183
At what stage of tuberculosis does a culture become intermittently positive?
subclinical TB disease
184
At what stage of tuberculosis does a sputum smear become positive?
active TB disease
185
At what stage of tuberculosis does a patient become infectious?
subclinical TB disease
186
At what stage of tuberculosis does a patient present with symptoms?
subclinical TB disease
187
At what stage of tuberculosis should treatment be initiated?
latent TB infection
188
What TB drug should be avoided or used with caution if a patient has HIV and latent TB?
rifampin
189
What drugs are polyresistant TB not resistant to both of?
isoniazid and rifampin
190
What drugs are used for the intensive phase of a standard six-month treatment of TB?
-rifampin 600 mg
-isoniazid 300 mg
-ethambutol 800 - 1600 mg
-pyrazinamide 1000 - 2000 mg
191
How long is the intensive phase of a standard six-month treatment of TB?
8 weeks
192
What drugs are used for the continuation phase of a standard six-month treatment of TB?
-rifampin 600 mg
-isoniazid 300 mg
193
How long is the continuation phase of a standard six-month treatment of TB?
18 weeks
194
What drugs are used for the intensive phase of a rifapentine-based four-month treatment?
-rifapentine 1200 mg
-isoniazid 300 mg
-moxifloxacin 400 mg
-pyrazinamide 1000 - 2000 mg
195
How long is the intensive phase of a rifapentine-based four-month treatment?
8 weeks
196
What drugs are used for the continuation phase of a rifapentine-based four-month treatment?
-rifapentine 1200 mg
-isoniazid 300 mg
-moxifloxacin 400 mg
197
How long is the continuation phase of a rifapentine-based four-month treatment?
9 weeks
198
What type of patients does Aspergillus primarily cause disease in?
immunocompromised hosts
199
What are the two most common Cryptococcus bacteria?
-Cryptococcus neoformans
-Cryptococcus gattii
200
What organ does Cryptococcus primarily affect?
CNS
201
What fungi is amphotericin a first-line agent for?
-Cryptococcus
-Blastomyces
-Histoplasma
-Mucor
202
What are common adverse effects of amphotericin?
-nephrotoxicity
-hypokalemia
-hypomagnesemia
203
What is the bioavailability of flucytosine?
high
204
Does flucytosine penetrate into the CSF?
yes
205
How much of flucytosine is excreted unchanged in the urine?
85% - 95%
206
What fungi is flucytosine a first-line agent for?
Cryptococcus
207
What is a common adverse effect of flucytosine?
bone marrow suppression
208
What are monitoring parameters for flucytosine?
-CBC
-platelets
-SCr
-BUN
209
What is the bioavailability of fluconazole?
high
210
Does fluconazole penetrate into the CSF?
yes
211
Does fluconazole require dosing adjustment in renal insufficiency?
yes
212
What body weight is fluconazole dosing based on?
total body weight
213
What are indications for fluconazole?
-noninvasive candidiasis
-invasive candidiasis
-bone marrow transplant prophylaxis
-Cryptococcal meningitis
214
What is the dose of fluconazole for invasive candidiasis caused by C. albicans?
800 mg (12 mg/kg) loading dose, then 400 mg (6 mg/kg) QD
215
What is the dose of fluconazole for invasive candidiasis caused by C. glabrata?
1200 - 1600 mg loading dose, then 800 mg QD
216
What are common adverse effects of fluconazole?
-headache
-nausea
-anorexia
-QTc prolongation
-elevation of hepatic transaminases
-adrenal insufficiency
217
What fungi is fluconazole a first-line agent for?
-Candida albicans
-Candida parapsilosis
-Candida tropicalis
-Candida lusitaniae
-Coccidioides
218
What are itraconazole and voriconazole predominantly metabolized by?
CYP450 enzymes
219
What is the active metabolite of itraconazole?
hydroxyitraconazole
220
How does clearance change with higher doses of itraconazole?
decreases
221
What is absorption of itraconazole dependent on except for oral solutions?
gastric acidity
222
What are indications for itraconazole?
-histoplasmosis
-blastomycosis
223
What are common adverse effects of itraconazole?
-hepatotoxicity
-congestive heart failure (boxed warning)
-QTc prolongation
224
What dosage form of posaconazole is absorption affected by gastric pH?
oral suspension
225
What is the preferred oral formulation of posaconazole?
delayed release tablets
226
When should posaconazole and voriconazole be avoided?
CrCL < 50 mL/min
227
What are common adverse effects of posaconazole?
-N/V
-abdominal pain
-diarrhea
-QTc prolongation
-increased LFTs
-hypokalemia
-rash
-pseudohyperaldosteronism
228
What dosage form of voriconazole does not require dosing adjustments for renal insufficiency?
oral formulations
229
What drugs do not affect the oral bioavailability of voriconazole?
-H2RA
-PPI
-antacid
230
What are indications for voriconazole?
-invasive aspergillosis
-Candida infections
231
What are common adverse effects of voriconazole?
-visual disturbances
-elevated LFTs
-QTc prolongation
-phototoxic skin reactions
-diffuse painful periostitis
232
What fungi is voriconazole a first-line agent for?
Aspergillus
233
Which azole has the least number of drug interactions?
isavuconazole
234
What is a contraindication for isavuconazole?
familial short QT syndrome
235
What fungi are echinocandins first-line agents for?
-C. glabrata
-C. krusei
-C. lusitaniae
-C. auris
236
What are common adverse effects of caspofungin?
-histamine-mediated symptoms
-fever
-phlebitis at infusion site
-N/V
-headache
237
What is the route of administration for micafungin?
IV
238
Does micafungin require dosing adjustments for renal insufficiency?
no
239
What are common adverse effects of micafungin?
-hyperbilirubinemia
-nausea
-diarrhea
-eosinophilia
-rash, pruritis, urticaria
240
What is the indication for ibrexafungerp?
vulvovaginal candidiasis
241
What is a contraindication for ibrexafungerp?
pregnancy
242
When should effective contraception be used for ibrexafungerp treatment?
during and for 4 days after treatment
243
What is the drug of choice for C. albicans?
fluconazole
244
What is the drug of choice for C. glabrata?
echinocandin
245
What is the drug of choice for C. parapsilosis?
fluconazole
246
What is the drug of choice for C. tropicalis?
fluconazole
247
What is the drug of choice for C. krusei?
echinocandin
248
What are the drugs of choice for C. lusitaniae?
fluconazole and echinocandin
249
What is the drug of choice for C. auris?
echinocandin
250
What are the drugs of choice for Cryptococcus?
fluconazole, amphotericin, and flucytosine
251
What is the drug of choice for Blastomyces?
itraconazole
252
What is the drug of choice for Histoplasma?
itraconazole
253
What is the drug of choice for Coccidioides?
fluconazole
254
What is the drug of choice for Aspergillus?
voriconazole
255
What is the drug of choice for Mucor?
amphotericin
256
What is the primary defense against superficial Candida infections?
cell-mediated immunity
257
What is the mechanism of action of pyrethrins?
bind to voltage-gated sodium channels in parasite nerve cells
258
What is the mechanism of action of spinosad?
nicotinic acetylcholine receptor agonist
259
What is the mechanism of action of benzimidazoles?
inhibit formation of microtubules
260
What is the mechanism of action of pyrantel pamoate?
depolarizing neuromuscular blocking agent
261
What are the mechanisms of action of artemisinin?
-forms free radicals
-inhibits PfPI3K
262
What is the mechanism of action of chloroquine?
-binds to heme to form FP-chloroquine complex
-caps hemozoin molecules to prevent further biocrystallization of heme
263
What is the mechanism of action of primaquine?
spontaneous oxidation to O-PQm which produces H2O2
264
What is the mechanism of action of doxycycline in malaria?
blocks protein translation in apicoplast
265
What are treatment options for malaria prophylaxis in all malaria-endemic regions?
-atovaquone/proguanil
-doxycycline
-tafenoquine
266
When should atovaquone/proguanil and doxycycline be started for malaria prophylaxis?
1-2 days before departure
267
How long should atovaquone/proguanil be continued for malaria prophylaxis?
7 days after leaving malaria endemic region
268
When should be atovaquone/proguanil be avoided?
-CrCl < 30 mL/min
-pregnant women
-women breastfeeding infants < 5 kg
-children < 5 kg
269
How long should doxycycline be continued for malaria prophylaxis?
4 weeks after leaving malaria endemic region
270
When should doxycycline be avoided?
-pregnant women
-children < 8 years old
-tetracycline allergy
-women prone to vaginal yeast infections
271
When should tafenoquine be started for malaria prophylaxis?
3 days before departure
272
How long should tafenoquine be continued for malaria prophylaxis?
1 week after leaving malaria endemic region
273
When should tafenoquine be avoided?
-G6PD deficiency or no test results
-pregnant or breastfeeding women
-psychotic disorders
-children
274
What are treatment options for malaria prophylaxis in regions with chloroquine-sensitive malaria?
-chloroquine
-hydroxychloroquine
275
When should chloroquine and hydroxychloroquine be started for malaria prophylaxis?
1-2 weeks before departure
276
How long should chloroquine and hydroxychloroquine be continued for malaria prophylaxis?
4 weeks after leaving malaria endemic region
277
What treatment is administered for malaria prophylaxis in regions primarily with Plasmodium vivax?
primaquine
278
When should primaquine be started for malaria prophylaxis?
1-2 days before departure
279
How long should primaquine be continued for malaria prophylaxis?
7 days after leaving malaria endemic region
280
When should primaquine be avoided?
-G6PD deficiency or no test results
-pregnant or breastfeeding women
281
What treatment is administered for malaria prophylaxis in regions with mefloquine-sensitive malaria?
mefloquine
282
When should mefloquine be started for malaria prophylaxis?
≥ 2 weeks before departure
283
How long should mefloquine be continued for malaria prophylaxis?
4 weeks
284
When should mefloquine be avoided?
-mefloquine allergy
-active/recent depression
-recent history of psychiatric disorders or seizures
-cardiac conduction abnormalities
285
What are treatment options for chloroquine or unknown resistance uncomplicated malaria?
-artemether-lumefantrine
-atovaquone-proguanil
-quinine sulfate AND doxycycline, tetracycline, or clindamycin
286
What is the treatment option for chloroquine, no mefloquine, or unknown resistance uncomplicated malaria?
mefloquine
287
What are the treatment options for chloroquine sensitive uncomplicated malaria?
-chloroquine
-hydroxychloroquine
288
What are the treatment options for anti-relapse treatment for P. vivax and P. ovale infections?
-primaquine phosphate
-tafenoquine
289
What is the treatment for severe malaria?
IV artesunate
