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Infectious Diseases Module > EXAM FIVE COVERAGE > Flashcards

EXAM FIVE COVERAGE Flashcards

1
Q

What antivirals are used for Herpes Simplex HSV and Varicella Zoster VZV?

A
  1. Acyclovir
  2. Valacyclovir
  3. Penciclovir
  4. Famciclovir
  5. Docosanol (HSV Only)
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2
Q

What antivirals are used for Cytomegalovirus CMV?

A
  1. Ganciclovir
  2. Valganciclovir
  3. Foscarnet
  4. Cidofovir
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3
Q

Acyclovir

A
  1. 10x more potent against HSV than VZV
  2. Requires 3 phosphorylation steps for activation
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4
Q

Valacyclovir

A
  1. Prodrug of Acyclovir
  2. More potent PO valacyclovir = IV acyclovir
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5
Q

Famciclovir

A
  1. Renally eliminated
  2. Inhibits DNA Polymerase
  3. Has 3 OH Groups
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6
Q

Penciclovir

A

Topical Agent
1. Prodrug of Famciclovir

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7
Q

Docosanol

A

Topical Agent
1. Inhibits fusion of HSV

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8
Q

Acyclovir AEs

A
  1. Nausea
  2. HA
  3. Diarrhea
  4. Nephrotoxicity
  5. Neurotoxicity
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9
Q

Famciclovir AEs

A
  1. Nausea
  2. HA
  3. Diarrhea
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10
Q

Valacyclovir AEs

A
  1. Nausea
  2. HA
  3. Neurotoxicity
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11
Q

How to avoid Neurotoxicity for Acyclovir?

A

Infuse slowly, maintain hydration, avoid concomitant nephrotoxic agents

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12
Q

How to avoid Neurotoxicity for Acyclovir and Valacyclovir?

A

Infuse slowly, monitor in high doses of valacyclovir

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13
Q

Ganciclovir

A

Acyclic Guanosine Derivative
1. Same MOA as Acyclovir
2. IV

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14
Q

Valganciclovir

A
  1. Prodrug of Ganciclovir
  2. PO = Take with FOOD
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15
Q

Foscarnet

A

Inorganic pyrophosphate analog
1. Requires NO phosphorylation
2. Blocks pyrophosphate binding site, blocking DNA polymerase binding

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16
Q

Cidofovir

A

Cytosine Analog
1. Does NOT require activation for phosphorylation
2. Inhibits DNA polymerase

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17
Q

What is a MAJOR AE concern for Ganciclovir and Valganciclovir?

A

Myelosuppression

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18
Q

All Anti-CMV drugs are really eliminated causing probable nephrotoxicity, what are the possible forms of nephrotoxicity seen with each drug?

A

Ganciclovir/Valganciclovir: INCREASE SCr
Foscarnet: TUBULAR Damage
Cidofovir: Proximal TUBULE Damage

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19
Q

How do you prevent Nephrotoxicity with Foscarnet?

A
  1. Maintain adequate hydration
  2. Prehydrate with NS
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20
Q

How do you prevent Nephrotoxicity with Cidofovir?

A
  1. Pre and Post Hydration with 1L NS
  2. Probenecid – 3 DOSES on day of cidofovir infusion: it prevents tubule uptake and increase the half life of the drug
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21
Q

What is Letermovir?

A

Random Anti-CMV Agent
MOA: Maturation Inhibitor
Specifically for Prophylaxis

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22
Q

Baloxavir Marboxil = Xofluza

A
  1. Inhibits PA
  2. Approved for adults and adolescents >12
  3. Single weight based dose
  4. CHELATION Interaction
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23
Q

What are the Neuraminidase Inhibitors used in Influenza?

A
  1. Oseltamivir
  2. Zanamivir
  3. Peramivir
    Competitively inhibit neuraminidase activity
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24
Q

Oseltamivir PO = Tamiflu

A

AE: N/V, HA, take with FOOD

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25
Zanamivir INH = Relenza
AE: Cough, bronchospasm AVOID if airway disease or allergy with milk
26
Peramivir IV = Rapivab
AE: Diarrhea, Hyperglycemia, SJS
27
Influenza Big Picture
1. PA Endonuclease or Neuraminidase Inhibition 2. MUST initiate within 2 days of symptom onset 3. Oseltamivir and Peramivir RENALLY dosed
28
HBsAg
HBC surface antigen
29
HBVDNA
Viral Load
30
Anti-HBc
Antibody to HBV core
31
Anti-HBs
Antibody to HBV cell surface
32
Antigen of Surface HBs present greater than 6 months suggests chronic HBV but antibody to surface HBs present suggests what?
Immunity to HBV
33
Antibody to Core Particle present suggests what?
Past or present infection
34
What is the disease course for Hepatitis B?
Inflammation --> Fibrosis --> Cirrhosis
35
What are the FOUR major phases of Hepatitis B?
1. Immune Tolerant 2. Immune Clearance 3. Non-Replication 4. Reactivation
36
What two phases of Hepatitis B are considered active fighting phases and would require treatment?
Immune Clearance and Reactivation
37
Immune Clearance and Reactivation phases both have HIGH ALT and ACTIVE Inflammation, but how do they differ in terms of HBVDNA?
Immune Clearance = HIGH Reactivation = Intermediate-High
38
What are the 3 main options for HBV Treatment?
1. Tenofovir AF and DF 2. Entecavir 3. Peglated Interferon Alfa 2a
39
Tenofovir Disproxil Fumarate TDF
1. Adenosine nucleotide analog 2. KNOWN for nephrotoxicity and osteotoxicity (decrease in mineral density) 3. TDF best data in pregnant women
40
Tenofovir Alafenamid TAF
1. Adenoside nucleotide analog 2. NOT nephrotoxic or osteotoxic 3. TAF is safer and has some data in pregnant women
41
What are AEs that are seen in TDF and TAF?
1. Lactic acidosis
42
Entecavir
1. Guanosine Nucleoside Analog 2. Take on EMPTY STOMACH 3. Renal dose adjustment
43
What are the 3 main sites of activity for Entecavir, even thought it does NOT make it more potent that TDF/TAF?
1. Base Priming 2. Reverse Transcriptase 3. Synthesis of new HBVDNA
44
Pegylated Interferon Alfa 2a
1. Inhibits cellular growth, surface antigen expression, etc. multiple MOAs 2. WEEKLY INJECTION: same day around the same time
45
What are the AEs of Pegylated Interferon Alfa 2a
1. Fatigue, HA, Insomnia, Depression, Dizziness 2. Alopecia 3. N/V/D, Anorexia 4. Weakness, myalgia 5. Fever, increased bacterial infections 6. Cytopenias, hypo/hyperthyroidism, increased LFTs
46
HBV Big Picture
1. NO cure 2. Only start therapy in those with active inflammation, high HBVDNA, and high ALT
47
Monitoring for patient with HBV and NO treatment
1. HBVDNA 2. ALT 3. Biopsy every 6-12 months
48
Monitoring for patient with HBV and ON treatment
1. HBVDNA at 12 and 24 weeks after initiation and can extend to every 3-6 months 2. Monitor drug toxicities
49
An increase in HBVDNA can most often be explained by what?
Nonadherence to medication
50
What element of pathophysiology in HCV causes for the requirement of multiple medications for treatment?
RNA-Dependent RNA Polymerase that is prone to error leading to mutations
51
What are the goals of treatment for HCV?
1. Reduce all cause mortality 2. Reduce liver-related complications 3. Achieve SVR12 = Cure
52
What are the NS5A Inhibitors used in HCV?
1. Ledipasvir 2. Pibrentasvir 3. Velpatasvir 4. Elbasvir +ASVIR
53
What are the NS5B Inhibitors used in HCV?
1. Sofosbuvir +BUVIR
54
What are the NS3/4A Inhibitors used in HCV?
1. Glecaprevir 2. Voxilaprevir +PREVIR
55
In the treatment of HCV, you MUST ALWAYS use >2 agents from different classes, therefore what are the 3 first line regimens for treatment NAIVE?
1. Ledipasvir/Sofosbuvir = HARVONI 2. Velpatasvir/Sofosbuvir = EPCLUSA 3. Glecaprevir/Pibrentasvir = MAVYRET
56
HARVONI is considered what type of coverage?
NARROW = covers only GT1
57
EPCLUSA and MAVYRET are considered what type of coverage?
BROAD = covers GT1-GT2-GT3
58
What is the dose and duration of HARVONI and EPCLUSA for GT1 treatment?
1 tablet Duration 12 weeks no matter if cirrhosis is present or not
59
What is the dose and duration of MAVYRET for GT1 Treatment?
3 tablet Duration 8 weeks no matter if cirrhosis is present or not
60
What is the duration of MAVYRET for GT2 and GT3 Treatment?
8 weeks
61
What is the duration of EPCLUSA for GT2 and GT3 Treatment?
12 weeks If cirrhosis =MUST check for resistance prior to starting
62
Harvoni, Epclusa, and Mavyret are all affected by strong CYP3A4 Inducers but what does Amiodarone do to them?
Sofosbuvir + any other direct acting antiviral = BRADYCARDIA AKA only MAVYRET not affected
63
What two ingredients and drugs are affected by ACID Suppressants?
Velpatasvir = EPCLUSA Ledipasvir = HARVONI
64
What DDI affects Harvoni, Epclusa, and Mavyret and must require dose adjustments?
Statins
65
What are the 3 MOST COMMON AEs of DAA?
1. HA 2. Fatigue 3. Nausea
66
What are characteristics that make patients with HCV more difficult to treat?
1. Presence of Cirrhosis 2. Previous treatment failure 3. GT1a over GT1b 4. Presence of resistance mutations
67
What is Ribavirin?
MOA: Inhibit initiation and elongation of viral fragments through RNA polymerase 1. TAKE WITH FOOD 2. ANEMIA AE MAJOR 3. AVOID IN PREGNANCY and 6 MONTHS post Old Agent
68
Monitoring for HCV Pre-Treatment HBV Reactivation
1. HCV has suppressive activity against HBV 2. Pre-Screen before starting HCV treatment
69
Monitoring for HCV During Treatment
1. LFTs 2. CBC if on RIBAVIRIN
70
Monitoring for HCV POST Treatment
1. SVR12 - 12 weeks after treatment completed - sustained virology response 12 weeks after
71
What are the Replicative Enzymes in HIV?
1. Reverse Transcriptase = replication 2. Integrase = permanent infection 3. Protease = cleaves polybprotein making it infectious
72
HIV binds to 1 or 2 coreceptors on the CD4 cell, what are those 2 sites?
1. CXCR4 2. CCR5
73
After binding to the CD4 cell, attachment and fusion occurs how?
Attach via gp120 subunit on HIV envelope attaches to CD4 Fusion via HIV envelope subunit gp41 fuses to CD4 cell
74
After attachment and fusion, reverse transcriptase does what?
Convert HIVRNA to HIVDNA
75
HIVDNA then travels to the nucleus of CD4 where ___ integrates HIVDNA into human DNA
Integrase
76
Replication and Assembly of new HIVRNA move to the cell surface which is non-infectious, however, immature HIV buds off the CD4 cell and HIV releases ____ that cleaves the long protein chains making it mature and infectious?
Protease
77
What are the drug targets in HIV treatment?
1. Entry Inhibition 2. Reverse Transcriptase and Nucleosides 3. Integrase 4. Protease
78
What are the specific targets that fall under Entry Inhibition targets?
1. CCR5 on CD4 cell 2. gp120 on HIV cell 3. Domain 2 on the CD4 cell 4. gp41 on the HIV cell
79
List the drugs that are classified as Entry Inhibitors
1. Maraviroc 2. Fostemsavir 3. Ibalizumab 4. Enfuirtide
80
Maraviroc
CCR5 Antagonist 1. ONLY drug to work on CD4 Cell 2. Salvage Therapy 3.BID AE: Orthostatic Hypotension
81
Fostemsavir
Attachment Inhibitor 1. Hydrolyzed to Temsavir - Prodrug 2. PO BID AE: QT Prolongation
82
Ibalizumab
Post Attachment Inhibitor 1. Causes conformational change prevents HIV binding to CD4 2. Salvage Therapy 3. IV AE: Infusion Related
83
Enfuvirtide
Infusion Inhibitor 1. Prevents the fusion of HIV envelope and the CD4 cell 2. SQ BID AE: Nodules at Injection Site
84
Would you use entry inhibitors as initiation therapy for HIV?
NO they are SALVAGE therapy and ALL can be taken without regard to food
85
List the drugs that are classified as Nucleoside Reverse Transcriptase
1. Abacavir 2. Emtricitabine 3. Lamivudine 4. Tenofovir AF 5. Tenofovir DF 6. Zidovudine
86
What is the class adverse effect for Nucleoside Reverse Transcriptase NRT?
MITOCHONDRIAL toxicity Lactic Acidosis most common
87
What is the AE of Abacavir and what should be tested before initiating therapy?
AE: Hypersensitivity, fever TEST HLAB5701 REQUIRED
88
What are the AEs of Emtricitabine and Lamivudine?
NONE, well tolerated
89
What are the AEs of Tenofovir AF and Zidovudine?
TAF: Increased LDL Zidovudine: Anemia, neutropenia
90
How often should NRTs be dosed?
QD or BID TAF/TDF are QD Zidovudine is BID the rest are either
91
List the drugs that are Non-Nucleoside Reverse Transcriptase
1. Doravirine 2. Ertavirine 3. Efavirenz 4. Rilpivirine
92
NNRTs work by causing conformational change and inactivating RT, but how do NRTs differ?
NRTs stops chain elongation and blocking HIVDNA creation
93
What is the class adverse effect of NNRTs?
RASH
94
What is the AE and dosing of Doravirine?
PO QD Sleep Disturbance
95
What is the AE and dosing of Efavirenz?
PO QD HS Sleep disturbance, vivid dreams, hungover feeling
96
What is the AE and dosing of Ertavirine?
PO BID Severe Rash
97
What is the AE and dosing of Rilpivirine?
PO QD with 400 CALORIES Sleep disturbance, vivid dreams
98
List the drugs that are Integrase Inhibitors
1. Bictegravir 2. Cabotegravir 3. Dolutegravir 4. Elvitegravir 5. Raltegravir
99
What is the MOA of Integrase Inhibitors?
Bind to Mg or Mn cofactor on integrase enzyme and inhibits the activity of the enzyme
100
Bictegravir
PO QD AE: False Increase in SCr FIRST LINE
101
Cabotegravir
IM q4wks AE: Injection site
102
Dolutegravir
PO QD AE: HA, insomnia, false increase in SCr
103
Elvitegravir
PO QD with FOOD HIGHEST risk of resistance, least used
104
Raltegravir
PO QD or BID AE: myopathy
105
List the drugs that are Protease Inhibitors
1. Atazanavir 2. Darunavir
106
What is the MOA of Protease Inhibitors?
Bind near active site of protease enzyme and inhibits cleavage of proteins aka inhibits maturation and infective quality
107
Protease Inhibitors as a class cause N/V/D but how should the drugs be administered?
WITH FOOD
108
Atazanavir
PO W/MEAL w/ or w/o PKN booster AE: HYPERbilirubinemia, lipid sparing if unboosted
109
Darunavir
PO QD/BID W/FOOD and MUST BE BOOSTED AE: Sulfa rash
110
List the drugs that are PKN Boosters
1. Cobicistat 2. Ritonavir Both are strong CYP450 inhibitors
111
Cobicistat
With Protease Inhibitor or Elvitegravir AE: false increase in SCr
112
Ritonavir
PO with FOOD and Protease Inhibitor AE: GI, dyslipidemia
113
Atazanavir DDI Acid Suppressants
Protease Inhibitor Antacids: take them 2hrs before or 1 hr after H2RAs: take at the same time or 10hrs after PPIs: AVOID
114
Rilpivirine DDI Acid Suppressants
NNRT Antacids: take 2 hrs before or 4 hrs after H2RAs: take 12hrs before or 4 hrs after PPIs: AVOID
115
What drug class interactions via Chelation and should be separates with Mg, Al, Fe, Ca, Zn 2 hrs before or 6 hrs after administration?
INSTs = Integrase Inhibitors
116
NNRTs interact with what type of CYP3A4?
ALL of them interact with 3A4 substrates Efavirenz and Etravirine interact with 3A4 inducers
117
INSTIs interact with what type of CYP3A4?
Bictegravir, Folutegravir, and Elvitegravir interact with 3A4 substrates
118
Protease Inhibitors interact with what type of CYP3A4?
ALL of them interact with 3A4 Substrates and Inhibitors
119
Entry Inhibitors interact with what type of CYP3A4?
Maraviroc and Fostemsavir interact with 3A4 substrates
120
PKN Boosters interact with what type of CYP3A4?
Cobicistat and Ritonavir interact with 3A4 inhibitors
121
What are 3A4 inducers that we worry about?
Rifamycins, carbamezepine, oxcarbazepine, anti-epileptics, and St. Johns wort
122
Statin metabolism is inhibited by Protease Inhibitors and PKN Boosters, what statins can be used in and which ones are CI'd?
Atorvastatin and Rosuvastatin = Preferred Lovastatin and Simvastatin = CI
123
Corticosteroid metabolism is inhibited by Protease Inhibitors and PKN Boosters, which ones can be used while the rest should be avoided?
Beclomethasone and Flunisolide
124
Warfarin has interactions with what two drugs?
Efavirenz and Ritonavir
125
In terms of Cobicstat and Ritonavir, what DOACs should be AVOIDED and NEVER used with them?
Dabigatran = AVOID w/ Cobicstat NEVER USE RIVAROXABAN
126
For NRTs when should you renally dose adjust?
TDF = CrCl <50 Others = CrCl <15
127
PDE5 Inhibitor metabolism is inhibited by Protease Inhibitors and PKN Boosters, what is the max dose that can be used?
Sildenafil = 25 mg q48hrs Tadalafil = 10 mg q72hrs Vardenafil = 2.5 mg q72hrs
128
What is the Gold Standard Test for HIV?
Antigen/Antibody Test
129
HIV Pathophysiology is infected CD4 cells resulting in a decline in immune function, what amount of CD4 is indicative of AIDS?
<200
130
Anti-Retroviral Therapy ART is consisted of what?
2 NRT backbone + 3rd agent from a different class (NNRT/PI/INSTI)
131
What are the first line regimens of ART for HIV?
1. Biktarvy =TAF+Emtricitabine+Bictegravir 2. Descovy + (Trivicay) = TAF+Emtricitabine + (Dolutegravir) 3. Triumeq = Abacavir+Lamivudine+Dolutegravir 4. Dovato = Lamivudine+Dolutegravir
132
Biktarvy Considerations
Single Tablet Regimen MOST USED
133
Descovy + Tivicay Considerations
2 TINY tablets MUST be taken TOGETHER
134
Triumeq Considerations
Very large single tablet regimen MUST ASSESS HLA before
135
Dovato Consideration
DUAL THERAPY Single tablet regimen Do NOT USE if HIVRNA >500,000 copies/mL
136
What are the APPROVED DUAL therapy options for HIV?
1. Dovato = approved for naive patients only 2. Juluca (Dolutegravir/Rilpivirine) = approved for experienced patients only 3. Cabreuva (Cabotegravir/Rilpivirine) = IM
137
What is the most important factor in maintain suppression?
ADHERENCE
138
What should you AVOID for HIV THERAPY?
1. Two agents from classes that is not NRT 2. Dual therapy that is not approved 3. 3 NRTs = resistance 4. 2 PKN boosters = ONLY need ONE 5. Lamivudine + Emtricitabine = both are cytosine analogs aka antagonistic
139
What are monitoring considerations for HIV therapy?
HIV RNA CD4 CMP CBC STIs
140
Pre-Exposure Prophylaxis PrEP Regimen Options
1. Truvada = at risk through sex or IV drug use 2. Descovy = at risk through sex excluding receptive vaginal sex 1 TAB PO QD Adults and Adolescents >35 kg
141
How often do you have to re-test for HIV?
EVERY 3 MONTHS
142
Post Exposure Prophylaxis PEP
Best if initiated within 72 hrs of exposure TDF/Emtricitabine + Either Raltegravir or Dolutegravir x 28 days
143
What are the recommended regimens for infants born to mothers with HIV?
PAIR 2 NRTs + 3rd Agent 2 NRT: 1. TDF + Emtricitabine - nephrotoxicity possible 2. Abacavir + Lamivudine - test HLA 3rd Agent: 1. Raltegravir = BID 2. Dolutegravir = CNS AE, teratogen? 3. Atazanavir + Ritonavir =interaction with acid suppressant 4. Darunavir + Ritonavir = BID
144
When is Intrapartum Zidovudine recommended?
HIVRNA>1,000 C-Section delivery
145
Postpartum, must start ART ASAP what are the two regimens?
1. HIVRNA <50 copies/mL = Zidovudine PO BID x 4 WEEKS 2. HIVRNA >50 copies/mL = Zidovudine + Lamivudine + Raltegravir or Neirapine BID x 6 WEEKS
146
How many tests can safely exclude HIV for infants?
2 Negative Tests
147
Mycobacterim Avium Complex MAC Manifestations
Fever, night sweats, weight loss Greatest risk CD4 <50
148
MAC Primary Prophylaxis
1. Initiate ART 2. If unable to start ART = Azithromycin 1200 mg weekly = preferred Clarithromycin 500 mg BID
149
MAC Treatment
1. Macrolide (Azithro or Clarithro) + Ethambutol 2. Rifamycin considered as 3rd agent is needed Duration = 12 months
150
Toxoplasmic Encephalitis Manifestation
Toxoplasma Gondii - Protozoan Parasite Encephalitis most common Most Common with CD4 <100
151
Toxoplasmic Encephalitis Primary Prophylaxis
Indicated in those with positive IgG and CD4 <100 1. Bactrim PO Daily - DC once CD4 >200
152
Toxoplasmic Encephalitis Treatment
Acute 6 WEEKS = Sulfadiazine + Pyrimethamine + Leucovorin Chronic >6 Months = LOW dose Sulfadiazine + Pyrimethamine + Leucovorin - DC when CD4 >200 and asymptomatic for 6 MONTHS
153
What is the AE of Dapsone?
Hemolytic Anemia Check G6PD FIRST
154
What is the AE of Atovaquone?
GI, disgusting flavor
155
What is the AE of Sulfadiazine?
Rash, sulfa
156
What is the AE of Pyrimethamine?
Pantocytopenia
157
Cytomegalovirus Manifestations
Retinitis most common followed by colitis Highest risk in CD4 <50
158
What is the primary prophylaxis for Cytomegalovirus?
ART
159
What is the treatment of Cytomegalovirus Retinitis?
Induction: 2 wks IV ganciclovir or PO valganciclovir BID Maintenance: PO valganciclovir QD Duration = 3 MONTHS until CD4 <100
160
What is the treatment of Cytomegalovirus Colitis?
IV ganciclovir 3-6 weeks
161
Pneumocystis Pneumonia Manifestation
Pneumocystic Jiroveci PJP Highest Risk CD4 <200 Pneumonia symptoms
162
What is the primary/secondary prophylaxis for Pneumocystis Pneumonia?
Bactrim PO QD - continue until CD4 >200 for 3 months
163
What is the treatment for Pneumocystis Pneumonia?
Mild-Mod = Bactrim PO TID Severe = Bactrim IV TID + CORTICOSTEROIDS Duration 21 DAYS REGARDLESS OF SEVERITY
164
Oropharyngeal/Esophageal Candidiasis Manifestation
C. Albicans Creamy white plaques
165
What is the primary prophylaxis of Oropharyngeal/Esophageal Candidiasis?
NOT recommended
166
What is the treatment of Oropharyngeal/Esophageal Candidiasis?
PO FLUCONAZOLE Oropharyngeal = 1-2 weeks Esophageal = 2-3 weeks
167
Cryptococcal Meningitis Manifestations
Cryptococcus Neoformans or C.Gatti Highest risk CD4 <100
168
What is the primary prophylaxis for Cryptococcal Meningitis?
NOT recommended
169
What is the treatment for Cryptococcal Meningitis?
Induction = 2 weeks IV Liposomal Amphotericin B + Flucytosine Consolidation = 8 weeks Fluconazole 800 PO QD Maintenance = 1 year Fluconazole 200 PO QD
170
When can you DC Cryptococcal Meningitis therapy?
>1 yr since anti fungal infection Asymptomatic CD4 >100 On effective ART
171
Disseminated Histoplasmosis Manifestations
Histoplasma Capsultaum Greatest Risk CD4 <150
172
What is primary prophylaxis of Disseminated Histoplasmosis?
None
173
What is the treatment of Disseminated Histoplasmosis?
Induction: Liposomal Amphotericin B >2 weeks Maintenance: Itraconazole for <12 months
174
When can you DC Disseminated Histoplasmosis therapy?
Azoles x 1 year Negative fungal blood culture Absent serum or urine histo antigen Not Detectable HIVRNA CD4 >150
175
Immune Reconstitution Inflammatory Syndrome IRIS
Hyper-Inflammatory Response to Infection Can occur with rapid change from high HIVRNA/low CD4 to lowHIVRNA/high CD4
176
IRIS is most often seen with what and what therapy is recommended?
MAC and supportive care
177
In Fungal infections, drugs that target cell wall synthesis have what specific target?
(B1,3)-D-Glucan synthase
178
In Fungal infections, drugs that target cell membrane synthesis have what specific target?
Squalene Epoxidase or Lanosterol Demethylase
179
Squalene --> ___ --> Erogsterol
Lanosterol
180
List the drugs that are Cell Wall Inhibitors in Fungal Infections
1. Caspofungin 2. Micafungin 3. Anidulafungin
181
What is the MOA of Cell Wall Inhibitors in Fungal infections?
Inhibition of B(1,3)-D-Glucan Synthase Weakens cell wall, prevents growth
182
List the drugs that are Allylamine/Benzylamines
1. Terbinafine 2. Butenadine 3. Naftifine
183
What is the MOA of Allylamine/Benzylamines?
Squalene Epoxidase Inhibitor Call membrane cannot be maintained, buildup of squalene is toxic to fungal organism
184
Allylamine/Benzylamines are administered how?
ONLY Systemically/Superficially to treat dermatophytosis
185
List the drugs that are Imidazole Azoles
1. Ketoconazole 2. Miconazole 3. Clotrimazole SUPERFICIAL ONLY
186
List the drugs that are Triazole Azoles
1. Fluconazole 2. Voriconazole 3. Itraconazole 4. Posaconazole 5. Isavuconazonium
187
What is the MOA of Azoles?
Inhibit lanosterol demethylase, stopping progression to ergosterol Cell Dies
188
Lanosterol Demethylase is a CYP450 enzyme and therefore,
Imidazole affect human CYP450 more than triazoles and are only used topically
189
List the drugs that are Polyenes
1. Amphotericin B 2. Nystatin
190
What is the MOA of Polyenes?
Binds to ergosterol and forms pores causing intracellular contents to leak out CAN also bind to human cholesterol cells
191
Flucytosine
Activity in fungal cell nucleus Competes with RNA synthesis
192
Griseofulvin
Inhibits mitotic spindle formation and cell division
193
Echinocandins AE
Infusion Related Reactions
194
Ibrexafungerp is a Major 3A4 substrate
AVOID inducers
195
Allylamines/Benxylamine Systemic Terbinafine can cause increased what?
Increased LFTs Monitor at 4 weeks
196
Triazoles are teratogenic and have what AE as a class?
QT Interval Changes
197
Fluconazole Pearls/AEs
100mg for oropharyngeal candidasis 800 mg for cryptococcal meningitis QT PROLONGATION Good diffusion into CNS
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Voriconazole AEs
1. VISUAL DISTURBANCES 2. Photoxicity, rash 3. QT Prolongation
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Itraconazole Capsule vs Solution
Capsule = ADMIN WITH FOOD Solution = ADMIN ON EMPTY STOMACH
200
What are the AEs of Itraconazole?
1. CHF 2. QT PROLONGATION
201
Posaconazole AEs/PEARLS
ADMINISTER W/HIGH FAT meal 1. Hyperaldosteronism 2. QT PROLONGATOIN
202
Isavuconazonium AE MUST KNOW
QT SHORTENING
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Amphotericin AEs
1. INFUSION REACTION 2. RENAL IMPAIRMENT: irreversible tubular damage
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Dose and Nephrotoxicity of CONVENTIONAL Amphotericin
1 mg/kg/day MOST SEVERE
205
Dose and Nephrotoxicity of LIPOSOMAL Amphotericin
3-5 mg/kg/day Less severe
206
Dose and Nephrotoxicity of LIPID COMPLEX Amphotericin
5 mg/kg/day Less severe
207
Flucytosine AE/Pearl
BONE MARROW TOXICITY PO, Q6hr, weight based NEVER use as monotherapy
208
Griseofulvin AE
HEPTATOXICITY
209
Echinocandins do not have coverage on what organisms?
1. Histo. capsulatum 2. Crypto. neoformans 3. Coccidioides 4. Blastomyces
210
Itraconazole does not have coverage on what organisms?
Candidas glabrata
211
Fluconazole does not have coverage on what organisms?
1. Candidas glabrata 2. Aspergillus fumigatus
212
Flucytosine does not have coverage on what organisms?
1. Aspergillus fumigatus 2. Histo. capsulatum 3. Coccidioides 4. Blastomyces
213
Candida Species most common site of infection?
BLOOD
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What is the first line treatment for Candida Species?
Echinocandins
215
What is the first line treatment for Aspergillus Species?
Voriconazole for 6-12 weeks
216
What is first line treatment for Blastomyces?
Pulmonary: Itraconazole and Amphotericin B CNS: Fluconazole
217
What is first line treatment for Coccidiodomycoses?
Pulmonary: Itraconzole or Fluconazole CNS: Fluconazole
218
What is first line treatment for Cryptococcus?
CNS: Amphotericin B + Flucytosine followed by Fluconazole Pulmonary: Fluconazole
219
What is first line treatment for Histoplasmosis?
Pulmonary: Itraconazole or Amphotericin B

Infectious Diseases Module (5 decks)

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