Exam 5 - Opportunistic Infections (Erdman) Flashcards Preview

Therapeutics V Spring 2019 (P3 Spring) > Exam 5 - Opportunistic Infections (Erdman) > Flashcards

Flashcards in Exam 5 - Opportunistic Infections (Erdman) Deck (66):
1

Normal CD4 count in adults?

500 - 1200 cells/mm3

2

without ART therapy a patient with HIV will have a ______ decline in CD4 cells per year

50 - 100

3

when CD4 cell counts are < ______ and especially < ______ are associated with development of opportunistic infections

< 500 and < 200

4

When CD4 counts are < 500 pts may develop OIs such as what 5 infections/diseases?

bacterial pneumonia
vaginal candidiasis
thrush
shingles
oral leukoplakia

5

When CD4 counts are < 200 pts may develop OIs such as what 7 infections/diseases?

PCP
Kaposi Sarcoma
CMV
MAC
Lymphoma
Cryptococcal meningitis
Cryptospordium diarrhea

6

why avoid starting ART with an acute OI?

IRIS!! (immune reconstitution inflammatory syndrome)

worsening clinical manifestations (because body is getting better immune system really starts attacking the infection)

7

IRIS will typically develop within the first ______ weeks of initiation of ART if it is going to occur

4 - 8 weeks

8

Oropharyngeal cadidiasis/thrush:
use topical therapy when?

if INITIAL, mild or moderate episodes only

9

Oropharyngeal cadidiasis/thrush:
what are the topical options?

nystatin susp
Clotrimazole troches
miconazole buccal tab

10

Oropharyngeal cadidiasis/thrush:
topical or systemic is superior?

systemic fo sho

11

Oropharyngeal cadidiasis/thrush:
when you absolutely must use systemic therapy?

if concomitant candida esophagitis

12

Symptoms of esophageal candidiasis

retrosternal burning pain/discomfrot
dysphagia
odynophagia

13

Treatment of choice for esophageal candidiasis

fluconazole 100 mg PO IV or QD x 14 - 21 days
(IV when having issues swallowing for sure --- at least initially the move to PO!)

14

Options for Vulvovaginitis Cadidia infection:

topical azoles if skin involvement
PO fluconazole
(do longer fluconazole treatment regimens if severe/recurrent episodes)

15

Primary Prophylaxis for candida infections?

NOT RECOMMENDED!!
(only do daily secondary prophylaxis if severe/frequent esophagitis or vaginitis)

16

Cryptococcous Meningitis:
Sxs?

menigitis things: fever, HA, malaise..

17

Diagnosis of Cryptococcus meningitis done how?

lumber punctures/CSF analysis....

18

Cryptococcus Pneumonia
________ be excluded in AIDS patients

concomitant meningitis

19

Treatment of Cryptococcus Meningitis:
Overall into what different phases?

3 phases:
induction --> consolidation --> maintenance

20

Treatment of Cryptococcus Meningitis:
what does induction phase consist of?

IV liposomal amphotericin B + PO flucytosine x 2 weeks

21

Treatment of Cryptococcus Meningitis:
what does consolidation phase consist of?

PO fluconazole x 8 weeks

22

Treatment of Cryptococcus Meningitis:
what does maintenance phase consist of?

fluconazole x 1 yr

23

Treatment of Cryptococcus Meningitis:
When to do primary or secondary prophylaxis

priamary -- almost like never
secondary is like maintenance therapy...secondary prophylaxis CAN be stopped at some point..

24

what is PCP

pneumocystis jirovecii/carnii Pneumonia

25

main symptoms seen with PCP?

CHF like symptom of progressive dyspnea on exertion
annnnd
a NON-productive cough

26

Hypoxemia: deemed as pO2 < ______ mmHg

70

27

DOC regimen for PCP?

SMZ-TMP: HIGH DOSE x 21 days

28

possible adjunctive therapy for PCP?

prednisone

29

when to add prednisone for PCP?

when pO2 < 70 mmHg
also best to start with INITIATION of PCP therapy

30

should you do Primary prophylaxis for PCP?

YES! ALL HIV PTs start when CD4 count is less than 200

31

should you do Secondary prophylaxis for PCP?

must do it!

32

can you ever stop prophylaxis for PCP?

yes only when CD4 count has been above 200 for 3 consistent months

33

what infection can be affected by lifestyle choices a lot (can come from shell fish, raw/undercooked meat or soil or cat feces exposure)

toxoplasma gondii

34

main treatment for Toxoplasma?

pyrimethamine and sulfadiazine x 6 weeks and leucovorin

35

what is leucovorins role in toxoplasma treatment

it help minimize bone marrow suppression from pyrimethamine

36

what are the adjunctive therapy options for toxoplasma treatment and when to use them?

steroids - use for patients with mass effect from focal lesions or assoc. edema and
anticonvulsants - if history of of seizures (only to use during acute treatment)

37

when to do primary prophylaxis for toxoplasma?

when pt is seroPOSITIVE and do it when CD4 is < 100

38

Washing hands (after soil or cat liter handling) and fruits is important what type of patient?

Toxo IgG seroNEGATIVE toxoplasma

39

what does MAC stand for

mycobacterium avium complex

40

MAC occurs most when CD4 count is below what?

50!

41

MAC Symptoms:
Gradual onset or hit them like a train?

gradual onsest

42

Treatment of MAC should involve at least 2 or more __________ drugs

antimycobacterial

43

what are the main drugs used for treating MAC

Clarithromycin and Ethambutol
maybe rifabutin

44

treat disseminated MAC for how long?

> 12 months

45

If pt with disseminated MAC is not on ART..when do you start ART?

preferably as soon as ART is started

46

when treating MAC: watch out for drug interactions b/w rifabutin or clarithromycin and the use of what 2 specific ARTs mainly?

Protease inhibitors
and NNRTIs

47

when to do primary prophlaxis for MAC?

only do it it pts are NOT on fully suppressive ART and have CD4 count < 50

48

do secondary prophylaxis for who and how long after MAC?

everyone gets it for a year

49

DOC for oropharyngeal cadidiasis

fluconazole PO QD 7 - 14 days

50

Monitor ________ periodically during prolonged azole therapy

LFTs

51

Azoles can cause ______ or ______ as side effects

GI upset
hepatoxicity

52

Side effects of IV amphotericicin?

NEPHROtoxicity (BUN/SCr monitoring)
Hypokalema (electrolyte monitoring)
hypomagnesemia (electrolyte monitoring)
Infusion related reactions

53

Side effects of Flucytosine/monitor what?

Bone marrow suppression (CBC once or twice weekly)

54

T or F: you do not need to renal adjust flucytosine

false you hella do need to adjust

55

Alt. Therapy options for PCP?

Atovaquone
Primaquine
DAPSONE + TMP

56

SMX-TMP:
Side effects?

some reason a lot higher in pts with AIDS
Rash, fever, leukopenia/thrombocytopenia/ hepatitis, HYPERKALEMIA

57

Monitor what when giving SMX-TMP?

CBC/SCr and K (2 - 3 times per week)

58

what two drugs do you need to test for G6PD deficiency (because risk of methemoglobinemia/hemolysis)

Dapsone and Primaquine
(relevant to PCP)

59

ADEs of ethambutol?

optic neuritis
hepatoxicity

60

ADEs of rifabutin?

red/orange colored body fluids
hepatoxicity
uveitis

61

DOC for PCP prophylaxis?

BACTRIM DS PO QD

62

DOC for Toxoplasma primary prophylaxis?

BACTRIM DS PO QD

63

For Primary prophylaxis:
Dapsone alone is ok to cover PCP or Toxoplasma?

Dapsone is only ok alone for PCP;

Dapsone needs to be given with pyrimethamine if want to cover Toxoplasma

64

For secondary prophylaxis for Toxoplasma:
do what drugs?

(same as treatment)
pyrimethamine and sulfadiazine and leucovorin

65

drug of choice for MAC primary prophylaxis

Azithromycin once WEEKLY

66

drug of choice for MAC secondary prophylaxis

Clarithromycin/Ethambutol +/- rifabutin