Exam Five Flashcards
1
Q
OPC Preferred Treatment
A
fluconazole 200 mg LD, followed by 100 - 200 mg po daily
2
Q
OPC Treatment Duration
A
7-14 days
3
Q
EC Treatment
A
fluconazole 200 mg IV or PO daily
4
Q
EC Treatment Duration
A
14-21 days
5
Q
Prophylaxis for Candidiasis
A
only consider in patients with frequent or severe recurrences of esophagitis or vaginitis
6
Q
Cryptococcal Meningitis Preferred induction
A
amphotericin B + flucytosine PO QID
7
Q
Cryptococcal Meningitis Induction Duration
A
2 weeks
8
Q
Cryptococcal Meningitis Preferred Consolidation
A
fluconazole 800 mg PO daily ≥ 8 weeks
9
Q
Cryptococcal Meningitis Preferred Maintenance
A
fluconazole 200 mg PO daily ≥ 1 year
10
Q
Cryptococcal Meningitis Primary PPX
A
not recommended
11
Q
Cryptococcal Meningitis Secondary PPx
A
- required after induction/consolidation
12
Q
Histoplasmosis Preferred Treatment for Mild-Moderate Disease
A
- itraconazole 200 mg PO TID x 3 days
- Itraconazole 200 mg PO BID ≥ 12 months
- Start ART ASAP
13
Q
Histoplasmosis Preferred Treatment for Severe Disease
A
- liposomal amphotericin B 3 mg/kg IV daily for at least 2 weeks
- followed by itraconazole 200 mg PO TID x 3 days
- followed by itraconazole 200 mg PO BID for at least 12 months
14
Q
Histoplasmosis Primary PPX
A
- patients with CD4 count < 150
- itraconazole 200 mg daily
- stop when CD4 count ≥ 150 for 6 months and viral suppression
15
Q
Histoplasmosis Secondary PPx
A
- severe disseminated or CNS infection after completing ≥ 12 months
- itraconazole 200 mg po daily
16
Q
Histoplasmosis secondary PPx duration
A
- azole therapy > 1 year
- negative blood cultures
- serum or urine antigen undetectable
- viral suppression on ART
- CD4 count ≥ 150 for ≥ 6 months on ART
17
Q
MAC Preferred Treatment
A
- clarithromycin 500 mg PO BID + ethambutol 15 mg/kg PO daily
- azithromycin 500-600 mg PO daily + ethambutol 15 mg/kg PO daily
- ADD rifabutin 300 mg PO daily in severe disease
18
Q
MAC severe disease treatment
A
- add fourth drug
- levofloxacin 500 mg PO qd
- moxifloxacin 400 mg po qd
- amikacin 10-15 mg/kg IV daily
- streptomycin 1 g IV or IM daily
- linezolid, tedizolid, omadacycline
19
Q
MAC treatment durationn
A
- ≥ 12 months
- CD4 count should be ≥ 100 for ≥ 6 months before d/c
20
Q
MAC Primary PPX
A
- not recommended for those who start ART ASAP
- CD4 count <50 AND not receiving ART or remains viremic on ART
- Azithromyzin 1200 mg PO once weekly
- D/c if patient fully suppressed on ART
21
Q
MAC Secondary PPX
A
- clarithromycin 500 mg PO BID + ethambutol 15 mg/kg + rifabutin 300 mg PO daily
22
Q
MAC Secondary PPx d/c
A
- completed ≥ 12 months of therapy
- no s/sx of MAC disease
- sustained CD4 count > 100 in response to ART for ≥ 6 months
23
Q
PJP Preferred Treatment for Mod-Severe Disease
A
- TMP-SMX 15-20 mg/kg/day IV divided q6-8 h x 21 days f
24
Q
Steroids in PJP
A
pO2 < 70 mmHg on room air
25
Alternative treatment for Mild-Mod disease
- dapsone or primaquine
- atovaquone
26
TE Preferred treatment for acute infection
- pyrimethanine 20o mg once
- followed by weight based dosing
OR
- TMP-SMX 5 mg/kg IV or PO BID
27
TE Preferred Treatment for Chronic Maintenance
- pyrimethamine 25-50 mg PO daily + sulfadiazine 2000-4000 mg PO daily + lucovorin 10-25 mg PO daily
OR
- TMP-SMX DS one tablet PO BID
28
TE Primary Prophylaxis
- CD4 count < 100 AND IgG positive
- TMP/SMX DS daily
- dx when CD4 > 200 for > 3 months in response to ART OR
- CD4 is 100-200 and HIV below limits of detection
29
Who should be screened for HIV
- all pregnant women
- patients aged 13-64
- all patients initiating TB treatment
- all patients attending STD clinics
30
Which ARs need to be dose adjusted in renal insufficiency
All NRTIs except abacavir
31
NNRTIs class adverse effect
rash
32
Protease Inhibitors Class adverse effects
- GI intolerance
- insulin resistance
- lipodystrophy
33
Precautions of PIs
- many not recommended in severe hepatic inpairment
- greater pill burden
34
Which drugs are used for boosting
- ritonavir and cobicsistate
35
INSTIs Class Affect
weight gain
36
Precautions and interactions with INSTIs
- UGT1A1 glucuronidation
- cation chelation
- elvitegravir needs to be boosted
- raltegravir and elvitegravir develops resistance easily
37
Attachement Inhibitor Precautions
- fostemsavir is contraindicated with strong CYP3A4 inducers
38
Efavirenz special administration
empty stomach at bedtime
39
Neviripine special administration
dose titration over 14 days
40
Etravirine special administration
with food
41
Atazanavir special administration
with food
42
Elvitegravir special administration
with food
43
Cabotegravir special administration
IM
44
Ibalizumab special administration
IV
45
Lenacapavir special administration
subq
46
Dose of dolutegravir
- 50 mg daily (INSTI naive)
- 50 mg BID (INSTI experienced)
47
When to not initiate ART immediatley
- TB or cryptococcus meningitis
48
Labs needed for abacavir
HLA B 5701 testing
49
Labs needed for maraviroc
- tropism testing
50
Which drug binds to ergosterol and causes an ion leak?
amphotericin B
51
Main adverse effect with Amphotericin B
- renal damage
52
Which drug inhibits squalene epoxidase?
terbinafine
53
Which drug inhibits 14-alpha-demethylase
Azoles
54
Which drug decreases triazole levels
rifampin (inducers)
55
Which drug interacts with CYP2C19?
voriconazole
56
Which azole is glucuronidated?
posaconazole
57
Which drug inhibits synthesis of beta 1,3 glucan cell wall component of fugi
echinocandins
58
Which drug inhibits thymidylate synthase
flucytosine
59
Which drug inhibits leucyl transfer RNA synthase
Tavaborole (think boron)
60
MOA of isoniazid
- blocks mycolic acid synthesis
- activation of KatG
61
MOA of pyrazinamide
- conversion to pyrazinoic acid by pncA
-inhibition of Pan D leading to inhibition of CoA
62
MOA of ethambutol
- mycobacterial arabinosyl transferases
- synergistic with rifampin
63
MOA of rifampin
binds to RNA polymerase deep within the DNA/RNA channel and blocks path of elongating RNA
64
Bedaquiline MOA
inhibits ATP synthase
65
Pretonamind MOA
- generates reactive NO species leading to direct poisoning of the respiratory complex
66
Which drug is a nicotinic acetylcholine receptor agonist?
Spinosad
67
Which drug is a nerve membrane sodium channel toxin?
perethrins
68
Which drug binds to tubulin as a cap?
albendazole, mebendazole
69
Which drug is a depolarizing neuromusclar blocking agent
pyraantel pamoate
70
Which drugs interfere with heme polymerization
4-aminoquinolones (chloroquine/hydroxychloroquine)
71
Which drug is hydroxylated by CYP 2D6 and produces H2O2
8-aminoquinolones (primaquine)
72
Which drug inhibits PfPI3K?
artemisinin
73
amphotericin B first line
- cryptococcus
- blastomyces
- histoplasma
- mucor
74
Flucytosine first line
cryptococcus
75
Itraconazole first line
- blastomyces
- histoplasmosis
76
Voriconazole first line
aspergillus
77
Echinocandins first line
- c. galbrata, c. krusei, c. lusitaniae, c. auris
78
Caspofungin adverse effects
- histamine mediated symptoms
79
Candidemia Treatment
- micafungin 100 mg IV daily
- caspofungin 70 mg IV LD, then 50 mg daily
- andiulafungin 200 mg IV LD, then 100 mg daily
- fluconazole 800 mg LD, then 400 mg PO/IV daily
80
Oral Candidemia Treatment
- step down when clinically stable and been on therapy for 48 hours
81
Candidemia treatment duration
14 days after. first negative blood culture
82
Neutropenic Candida Treatment
- caspofungin 70 mg LD, then 50 mg daily
- micafungin 100 mg daily
- anidulafungin 200 mg LD, then 100 mg daily
- amphotericin b lipid formulation 3-5 mg/kg/day
83
Asymptomatic histoplasmosis or mild moderaate disease with symptoms < 4 weeks for immunocompetent
no treatment
84
