Exam 5 - Opportunistic Infections Kania Flashcards
(28 cards)
normal CD4 counts in adults (range)
800-1200
CD4 counts < ___, and especially < ___ are associated with the development of OIs
< 500
< 200
Initiation of ART during an acute OI is very useful in the management of OIs for which effective therapy is not available, what 3 did she list? (page 5)
-PML
-cryptosporidosis
-Kaposi’s sarcoma
3 disadvantages of immediately starting ART in the setting of an acute OI (page 5)
-IRIS
-overlapping or additive drug toxicities
-drug interactions between ART and OI therapy
IRIS is more likely to occur in pts with low CD4 counts (< ___ cells/mm3) and high HIV RNA levels (> _____ copies/mL)
< 50
> 100,000
if IRIS happens, it is most common within the first ___-___ weeks of ART
a. 1-2 weeks
b. 2-4 weeks
c. 4-8 weeks
d. 12-16 weeks
c. 4-8 weeks
Most clinicians wait for a clinical response to OI therapy, usually ___ weeks, before initiating ART. What is the one exception?
-2 weeks
-Start ART within 2 weeks of starting TB tx if CD4 < 50 or within 8 weeks if CD4 count is higher
IRIS tx: mild disease -> use _____ for fever and pain; use _______ _______ for bronchospasms
NSAIDs
inhaled corticosteroids
IRIS tx severe disease: prednisone ____-____ mg/kg or equivalent) for ____-____ weeks, followed by taper
1-2 mg/kg; 1-2 weeks
T or F: steroids are commonly used in cryptococcal meningitis and Kaposi’s sarcoma
F
oropharyngeal candidiasis (thrush) preferred tx: fluconazole ____ mg loading dose, followed by ____-____ mg PO daily for ____-____ days
200; 100-200; 7-14 days
two bolded topical agents for tx of oropharyngeal candidiasis (no doses)
nystatin suspension
clotrimazole troches
esophageal candidiasis preferred tx: fluconazole ____ mg (up to ____ mg) IV or PO daily for ____-____ days
200; 400; 14-21 days
2 weeks
Amphotericin B 3-4 mg/kg IV once daily +
flucytosine 25 mg/kg PO QID for 2 weeks
a. preferred induction for cryptococcus
b. preferred consolidation for cryptococcus
c. preferred maintenance for cryptococcus
a. preferred induction for cryptococcus
Fluconazole 800 mg PO daily (400 mg PO daily in stable patients with sterile CSF culture and on ART)
a. preferred induction for cryptococcus
b. preferred consolidation for cryptococcus
c. preferred maintenance for cryptococcus
b. preferred consolidation for cryptococcus
Fluconazole 200 mg PO daily for 1 year or
longer
a. preferred induction for cryptococcus
b. preferred consolidation for cryptococcus
c. preferred maintenance for cryptococcus
c. preferred maintenance for cryptococcus
which of the following is NOT preferred treatment for mycobacterium avium complex (MAC)?
a. ethambutol
b. azithromycin
c. clarithromycin
d. TMP-SMX
d. TMP-SMX (this is for PJP)
two preferred treatments for mycobacterium avium complex (MAC) (2; no doses)
clarithro or azithro plus ethambutol
if more severe disease in MAC, add _______ 300 mg PO daily
a. emtricitabine
b. rifampin
c. rifabutin
d. fluconazole
c. rifabutin
tx for disseminated MAC should be administered for at least ____ months
12
DOC for PJP prophylaxis (2)
TMP-SMX DS PO daily
TMP-SMX SS PO daily
which of the following is NOT recommended for alternative therapy for PJP prophylaxis?
a. TMP-SMX DS PO MWF
b. Dapsone 100 mg PO daily
c. clarithromycin 500 mg PO twice daily
d. atovaquone 1500 mg PO daily with food
e. aerosolized or IV pentamidine 300 mg/month
c. clarithromycin 500 mg PO twice daily
(this is alternative therapy for MAC primary prophylaxis)
toxoplasma gondii: which of the following is not used IN COMBO for weight-based dosing?
a. pyrimethamine
b. TMP-SMX
c. leucovorin
d. sulfadiazine
b. TMP-SMX
toxoplasma gondii tx: __________ 200 mg PO x 1 followed by weight based dosing
a. fluconazole
b. clotrimazole
c. itraconazole
d. pyrimethamine
d. pyrimethamine
