Fungal and Viral Infections Flashcards
(58 cards)
1
Q
General Info on mycobacteria
A
causes typical/atypical illnesses, acute and chronic
LIFECYCLE
- slow growth, special cell wall with infections protected in tubercles (reason why one of them is called tuberculosis)
Typical mycobacteria infections: Mycobacterium tuberculosis (TB) and Mycobacterium leprae (leprosy)
Atypical: M. scrofulaceum (Scrofula); M. kansaii and M. marinum (skin infections); M. avium-intracellulare in immuno-compromised hosts (AIDS COPD)
2
Q
what is it when a child is infected with TB?
A
TB in community, is a sentinel event
3
Q
how is TB transmitted
A
airborne (lab culture takes weeks so acid-fast stains of sputum and skin testing and image CXR)
4
Q
What are the two types of TB?
A
- Latent: positive skin test, not progressed to illness and is treated due to “sero-conversion”
- Active: esp in immuno, a child, HIV
a) pulmonary: coughing, night sweats, weight loss, hemoptysis
b_ miliary: other parts of body
5
Q
what are the bactericidal drugs to treat TB?
A
- isoniazid (INH): AEs include peripheral neuropathy (prevent with vitamin B6 pyridoxine 5–100 mg/day); hepatotoxic -> monitor LFTs
- rifamycins (Rifampin, RIF and Rifapentin, Priftin): adjunct, AEs include urine/sweat, turning read, hepatotoxic, flu-like symptoms of myalgia headahce n/v
- drug interaction with CYP P450 enzymes may increase clearance clearance of oral contraceptives making them less effective
- rifabutin (Mycobutin): oral drug, synthetic agent better against M.avium
- pyrazinamide (PZA): adjunct when resistance issue; AEs of hepatotoxic, hyperuricemia, and gouty arthritis
- streptomycin: doesn’t penetrate CSF (can’t treat CNS TB) IM drug
- nephrotoxic, ototoxic (vestibular toxic)
- capreomycin: similar to streptomycin; IM drug
6
Q
bacteriostatic drugs to treat TB
A
- static=slow down so typically used in combo
1. para-aminosalicylic acid (PAS, aminosalicylic acid) oral drug; Aes of mono-like syndrome, GI intolerance
2. ethambutol (Myambutol): oral drug, AEs retrobulbar neuritis, loss of central vision; must have baseline opthalmic exam to establish baseline before starting drug
7
Q
Other drugs with anti-TB effects
A
- aminoglycosides: kanamycin, amikacin (renal/ototoxic)
2. fluro-quinolones: levofloxacin, moxifloxacin
8
Q
What’s the treatment protocols for latent TB infections (LTBIs)?
A
INH x 9 months or RIF x 4 months
9
Q
What’s the treatment protocol for resistant infections?
A
- daily treatment no lapses or resistance
- DOT: direct observation of treatment for 1st week
- combo therapy
- at least one bactericidal
- sensitivity testing checks for MDRTB or multi-drug resistant TB
10
Q
if someone has TB, what’s important information for them?
A
referall to health department; provide lab monitoring, xrays, usually free drugs, this is nurse managed
11
Q
Older and newer drugs for leprosy
A
older: many aes, renal, gi, rashes
1. injectable dapsone (IM acedapsone)
2. oral dapsone
3. clofazimine (Lamprene)
newer
1. thalidomide (Thalomid)
- originally anxiolytic, can cause birth defects
AEs: teratogencity, periph neurop, rash, hypothyroid, neutropenia, fever, increased HIV-RNA levels
12
Q
mycobacterium avium overview
A
- in immuno not healthy; sometimes called opportunistic infection
- multi-drug: fluroquinolones, macrolide, and usual mycobacterium drugs
13
Q
antifungal drugs
A
also called anti-mycotic
1. Azoles (imidazoles and triazoles)
- poss heart failure/liver
- lots of drug-drugs
SYSTEMIC: fluconazole (Diflucan), ketoconazole (Nizoral), itraconazole (Sporanox), voriconazole (Vfend), posaconazole (Noxafil)
TOPICAL: clotrimazole (Lotrimin, Mycelex), miconazole (Micatin), ketoconazole (Nizoral shampoo), econazole (Spectazole), oxiconizole (Oxistat), sulconizole (Exelderm solution)
- polyenes: amphotericin B (Fungizone, also a macrolide antibiotic); Nystatin (Mycostatin, Nystatin, Nilstat)
- allylamines: neutropenia, liver, SJS, less drug-drugs
- naftate (Naftin cream), terbinafine (Lamisil, cream/oral/spray) - potassium iodide: older drug, no longer used
- flucytosine (Ancoben): severe mycoses/fungal infections
- griseovulvin (Gris-Peg, Fulvicin)
- older, longterm to work
- take with fatty food
- teratogenic
14
Q
Non-pharmacologic measure in fungal infections
A
- education to prevent recurrence
- fungi keep ventilated/dry
- avoid trauma/lifestyle factors
- use clean, dry white
- manage underlying conditions (ex DM hyperglycemia) - surgical removal of the nail in onychomycosis
- nail hygiene (for onychomycosis):
- nails clean and short
- clip tonails straight, file
- avoid high heels, narrow-toed shoes
- - avoid community nail stuff
- acoid barefoot/clean dry
- discard old shoes, sprary with antifungal sprary periodically
15
Q
which gloves are use for dry manual work and which for wet?
A
- cotton - dry
2. vinyl - wet
16
Q
what are topical anti-fungals used for?
A
- yeast infections (Candidiasis, tinea versicolor) and ringworm
17
Q
what are the topical imidazoles
A
- clotrimazole (Lotrimin, Mycelex), miconazole (Micatin), ketoconazole (Nizoral), econazole (Spectazole), oxiconizole (Oxistat), sulconizole (Exelderm), sertaconazole (Ertaczo)
- combo therapy: corticosteroi + antifungal (ex Lotrisone, + clotrimazole) for fungal and inflammaiton
- OTCs: miconazole 2% (Lotrimin AF), clotrimazole 1% (Lotrimin AF cream) Butenafine 1% (Lotrimin Ultra)
- RX: terbinafine (Lamisil AT)
18
Q
what are the topical anti-fungals for fungal/mucosal skin infections
A
- topic imidazoles
- topical allylamines: naftifine (Naftin, terbinfaine (Lamisil, spray)
- topical polyenes: nystatin (Mycostatin, Nystatin), amphotericin B (Fungizone)
- topical hydroxypiridone: ciclopirox (Loprox cream and Penlac nail lacquer)
- topical naphthiomate: tolnaftate (Tinactin)
19
Q
what is pityriasis
A
tinea versicolor; involves lare SA and treated with terfinadine spray (Lamisil spray of 1% solution)
20
Q
what is seborrhic dermatitis
A
on scalp
- often fungal infection
1. Nizoral (ketoconazole) shampoo to treat underlying Pitysporum
2. Xologel 2% (ketoconazole) get once daily
21
Q
what represents 50% of all nail disorders
A
onychomycosis (Nail fungus)
22
Q
treatments for onychomycosis
A
- Topical: must do filing/clipping so will penetrate nail; Penlac Nail Lacquer (8% cicloprox olamine) daily
- long-term systemic: potentially toxic, older drugs (griseofulvin, Gris-Pet; ketoconazole, Nizoral)
- short-term systemic (commonly used): off-lael fluconazole (Diflucan); label itraconazole (Sporanox); terbinafine (Lamisil)
- time length of drugs varies and if treating toe or fingernail
- Aes: heart failure, liver, rash
23
Q
what do 2/3 of infants gets
A
diaper dermatitis (rash); though diapers with increased absorbency have reduced incidences; breast-fed infants have less diaper rash
24
Q
non-pharm treatment for diaper dermatitis
A
- keep dry/reduce contact time of urine.feces (frequent changes)
- clean are with water or baby wipes w/out perfume
- avoid corn or talcum powders (can be inhaled)
- use dye-free diapers and go “diaper free” if possible to dry skin
25
pharm treatment of diaper dermatitis
1. skin protectants: barrier for skin/lubricate against friction
- A&D ointment, lanolin, zinc oxide, petrolatum
2. antifungal meds: antifungals with nystatin, clotrimazole, miconazole due to Candida infections
- for diaper rash: Vusion combo of zinc oxide, petrolatum, and .25% miconazole (much less than Monistat 4% or OTC Desenex/Micatin reason is to reduce systemic absorption into infant)
- note: could by zinc oxide, petrolatum aka Vaseline and mix into Monistat/Desenex and would cost much less
3. Topical steroids: only for severe cases, use hydrocortisone cream (HC 1%) for up to 2 weeks; check baby in one week otherwise maybe other
26
when do serious systemic mycotic infections occur?
1. immuno comp
2. HIV/AIDS, cancer, organ transplant, high-dose steroids
- infections under specialist care, most drugs with serious AEs
1. amphotericin B (Fungizone), amphotericin B lipid complex (Abelcet) -- may be nephrotoxic
2. nystatin: PO use for GI Candida and oral thrush
3. flucytosine (Ancoben) may cause leucopenia, nausea, hepatitis, bone marrow depression
4. azoles: ketoconazole (Nizoral), fluconazole (Diflucan), itraconazole (Sporanox), voriconazole (Vfend), posaconazole (Noxafil)
5. echinocandins: caspofungin (Cancidas IV), anidulafungin (Eraxis IV), micafungin (Mycamine), anidulafungin (Eraxis)
27
management of PCP
PCP = Pneumocystis carinii Pneumonia
- in immuno comp, may need prophylaxis drugs
DOC: TMP/SMZ (trimethoprim/sulfamethoxazole, Bactrim, Septra)
Other drugs: aerosolized pentamidine (NebuPent), sulfone drugs dapsone (AED) alone or with antiparasitic pyrimethamine (Daraprime, adds dapsone); antiparasitic atovaquone (Mepron, anti-malarial), anti-folate drug trimetrexate (Neutrexin), other combos like clindamycin (Cleocin) + primaquine
Adjunct drugL prednisone (glucocorticoid steroid) if patient is hypoxic
28
what causes malaria?
protozoans Plasmodium falciparum; P. vivax and P. ovale
| - mosquito vector in tropical/subtropica; may be fetal; is resistance to ant-malarials; prophylaxis for travellers
29
what are some non-pharm ways to prevent malaria
- mosquito repellant, sleep in screen areas, don't go out after sunset
repellants. ...
1. DEET: higher%, longer but not better (not for infants under 2 months, don't use on face, not on hands)
2. picaridin in OTC Cutter
3. permethrin (Duranon, Permanone): liquid/spray for clothes nets bags etc
30
Prevention drugs of malaria
1. chloroquine (Aralen): DOC if chloroquine-sensitive malaria area
- multiple toxicities -> CNS, retinal damage, hemolysis in G6PD deficiency
2. malarone for chloroquine-resistant: combo atovaquone + proguanil daily; GI AEs, SJS
3. mefloquine (Lariam): no if depression, anxiety, psychosis, schizo, suicidality, seizure, cardiac (long QT)
4. doxycycline: for 8+ and not pregnant
31
Treatment of malaria
1. chloroquine (Aralen)
2. for chlorquine resistant use quinine plus Fansidar (pyrimethamine+sulfadoxine), quinine (Qualaquine), mefloquine (Lariam), halofantrine (Halfan), primaquine, atocaquone+proguanil (Malarone), doxycycline
32
The worm infections
- called helminthic infestations-
PINWORM
- caused by Enterobius vermicularis, called enterobiasis
- most common worm in USA
- diagnosis made at night with tape
- may cause vulvovaginitis
- treat whole family, repeat dose in two weeks (drugs paralyze worms and then pass stoll)
- rx= mebendazole (Vermox), albendazole (Zentel)
* *****REMEMBER repeat dose in 2 weeks
- OTC= pyrantel (Pin-X) liquid
ROUNDWORM
- caused by Ascaris, thus called ascariasis
- abdominal discomfort/pain and anemia (children)
- drugs= mebendazole (Vermox), pyrantel (Pin-X OTC), albendazole (Zentel), nitazoxanide (Alinia)
33
Scabies
- PRURITIC skin infestations
DRUGS
Topical: 5% permethrin (Elimite) cream, 10% crotamiton (Eurax), second-line lindane 1% (G-well), malathion .5% (Ovide), permethrin 1% (Nix), and OTC (piperonyl butoxide 4% or pyethrum .33%)
Systemic: oral drug ivermectin (Mectizan)
34
chiggers
red bug/harvest mite
- VERY PRURITIC
treatment: antipruritic
prevention: avoidance of areas with chiggers, use DEET repellant, let infestation run its course
35
Protozoans
1. trichomoniasis
2. cyclospora: found on unwashed fruit, diarrhea, treat with TMP/SMX
3. cryptosporidiosis+giardiasis: from water protozoans, diarrhea,
- - nitazoxanide (Alinia) for diarrhea; metronidazole (Flagyl) for Giardia/more complicated infections; tinidazole (Tindamax)
36
What are the head lice
Pediculus capitis (head louse, P. corporis (body louse, Phthirus pubis (pubic louse or crabs)
37
non-pharmacologic managemnt of lice
***MUST be combined with drug therapy
1. wet combing: fine touth comb on shampooed hair
2. petroleum jelly/olive oil: cover hair then use shower cap to suffocate mites or for eyelashes
38
what adjunctive therapies are used for lice
1. anti-itch (antihistamines, topical corticosteroids)
| 2. for sumperimposed bacterial infection from scratching etc
39
primary drug therapy for lice
1. TOPICAL
- DOC = OTC 1% permethrin (Nix) or prescription 5% permethrin (Elimite)
- others: OTC pyrethrins with peperonyl butoxide (Rid, Clear, Pronto) which are natural extracts from chrysanthemum flowers (needs repeating in one weeks, often fails); malathion (Ovid topical which if flammable so CAN'T use hair dryer); lindane (Kwell 1% shampoo, lotion)
2. SYSTEMIC (for resistant lice)
- oral ivermectin (Mectizan or Stromectol)
40
important infor for anti-viral agents and viral infections
- viruses must live in host cell/take over to replicate
- viruses = nucleic acid (DNA/RNA) covered by protein
- anti-virals try to interrupt specific step in viral life cycle
- MANY/MOST ANTI-VIRALS HAVE TOXIC POTENTIAL
41
life cycles of viruses
1. adsorption (NOT absorption) via fusion to host cell (attaches at receptor sites such as CD4 receptors on T-lymphocytes)
2. penetration of host cell - viral protein coat dissolves and exposes viral DNA/RNA
3. synthesis of enzymes that replicate viral nucleic acid -> synthesis of viral proteins -> assembly of mature viral particles (virions
4. death of cell and release of viral particles
42
some important information on how viruses infect
1. retroviruses like HIV have RNS that has t be copied to DNA to take over cell
2. many viruses co-infect (if you have HIV, more likely to get hepatitis)
3. some viruses like HIV cause other effects like loss of immune system through CD4 T cell destruction
43
viral prevention/treatment
1. Vaccine
2. Chemoprophylaxis: symptoms often appear only when viral load (viremia) in bloodstream is very large; prophylaxis with anti-viral may prevent symptoms
3. admin of antiviral after symptoms appear
4. PEP
- - for HIV or HBV; special chemoprophylaxis; occupational PEP and non-occupational or nPEP
44
some types of antivirals
1. Gamma globulins: block viral penetration into cell; immunoglobulins our body makes in response to viruses
- - "pooled" from people's blood for wide variety
- - hyperimmune concentrated from plasma with high antibody levels against specific viruses
EXAMPLES
a) HBIG (hepatitis-B immune globuline) for hepatitis B
b) VIGIV (vaccinia immune globulin intravenous) for smallpox
c) VZIG (varicella zoster immune globulin) - given with 4 days of chickenpox exposure
d) IVIG (intravenous immune globulin) and SCIG (subcutaneous immune globulin) for primary immune deficiency
- -- effects can be less if other vaccines given w/in 6 months
2. Interferons: made in body to interfere with viral protein synthesis; also useful in cancer/MS
a) Anti-viral Inerferons
- antivirals: interferon alfa-2a (Roferon-A), interferon alfa-2b (Intron-A), PEG-Intron, interfero nalfa-n3 (Alferon N), interferon alfa-n1 (Wellferon), Betaseron, peginterferon alfa-2a (Pegasys)
- for hep B/C: PEG-Intron (pegylated Intron-A, ribavirin + interferon alfa-2a, Pegasys (peginterferon alfa-2a)
- pegylate formulations: links polyethylene glycol to make it stay longer in bloodstream (word peg at beginning of drug name)
other uses for interferons: MS - interferon beta-1b (Betaseron), iterferon beta-1a (Avonex)
AEs: like bad flue (myalgia, fever, headache, n/v); suicidal/depression, endocrine complications
3. Zinc - for rhinovirus (upper resp infection, URI)
- may be safe if used for first few days of URI symptoms but can't be sure of safety
- at effective doses, significant side effects (still birth, neutropenia copper deficiency, anemia, lymphopenia) esp if used long-term
45
HPV
human papilloma virus
- causes anal cancer, cervical cancer, anogenital warts
1) Vaccines for prevention: Gardasil and new Cervarix
2) Drugs: off label -injections of interferons or cidofovir cream (Vistide)
on label: imiquimod (Aldara) topical, podofilox (Condylox) topical, topical tricloroacetic acid (TCA), topical pdophyllin, topical cryotherapy (liquid nitrogen or cryoprobe)
46
Herpes viruses
includes: colds sores (Herpes labialis), chingles and chickenpox (Varicella zoster virus, VZV), genital herpes (Herpes simplex virus, HSV type 2)
1. shingles (Varicella Zoster Virus, VZV)
- painful rash on one side of body
- antivirals: acyclovir (Zovirax), valacyclovir (Valtrex), famcyclovir (Famvir)
- adjuncts for pain
- after infection, PHN or long-term neuralgia pain may develop, treated with chronic drugs like ADs, AEDs, corticosteroids
- Zostavax: vaccine for prevention of shingles/PHN
2. Genital herpes (HSV type 2)
- for initial episodic treatment: acyclovir (Zovirax), valacyclovir (Valtrex), famciclovir (Famvir); chronic higher doses
3. herpes labialis (HSV type 1) cold sore
- rx: penciclovir cream 1% (Denavir), acyclovir cream 5% (Zovirax cream)
- OTC: sinecatechins (Veregen) from green tea, docusanol 10% cream (Abreva)
- OTC CAM: honey
- acyclovir, famciclovir, valacyclovir
- in serious neonatal invections: IV acyclovir
47
RSV in children
respiratory syncytial virus
1. prevention: premies
- respigam: older drug, monthly IV hyperimmune globulin
- palivizumab (Synagis): newer, IM qmonthly
2. treatment: ribavirin as aerosol (Virazole) can be toxic; oral ribasphere (for hep C)
48
CMV treatment
cytomegalovirus
- somtimes seen in immunocompromised
- ganciclovir (Cytovene) and newer foscarnet (Foscavir, parenteral), valganciclovir (Valcyte, oral), cidofovir (Vistide, IV for CMV retinitis in AIDS patients
49
influenza treatment
1. can be influenza A or B
- can change from year to year (swine flue was H1N1)
PREVENTION: vaccination, new each year
TREATMENT
- neuraminidase inhibitors for influenza A/B: zanamivir (Relenza), oral oseltamivir (Tamiflu) -> AE of inhaled is lungs, AE of oral is neuropsychiatric symptoms like seizures
- adamantamines for influenza A: amantidine (Symmetrel), rimantidine (Flumadine) -> prob with resistance
50
what can you use to treat bird flu
neuraminidase ihibitors
51
Hepatitis B
HBV
- main concern: don't progress to chronic (liver cancer/death)
- usually needlestick or con-infection, transfusion contamination
TREATMENT: injectable interferons like interferon alfa-2a (intron-A) and Pegasys and oral antivirals like lamivudine (Epivir-HBV), adefovir dipivoxil (Hepsera), entecavir (Baraclude), telbivudine (Tyzeka) - highrate of relapse
52
Hepatitis C
HCV
- chronic form, liver failure
- treatment for chronic HCV: SC peginterferon alfa-2b (Peg-Inton) plus ribavirin oral, SC peginterferon alfa-2a (Pegasys) plus ribavirin oral
- treatment for acute HCV: interferon alfa-2b (Intron-A)
53
what are the type of drugs used to treat HIV?
call antiretrovirals
1. NNRTIs (non-nucleoside reverse transcriptase inhibitors)
2. NRTs or NtRTIs (nucleoside/nucleotide analogs)
3. protease inhibitors (PI)
4. fusion inhibitors (enfuvirtide, Fuzeon injectable)
5. CCR5 co-receptor antagonists (maraviroc, Selzentry)
6. HIV-integrase strand enzyme inhibitor (ratelgravir, Isentress)
54
what are the drug-drugs of antiretrovirals?
methadone, TB antibiotics, macrolide antibiotics, cholesterol drugs, BP meds (almost every class of drugs)
55
Therapy protocols for HIB
```
ARV = antiretroviral therapy
HAART = highly active antiretroviral therapy
```
- clinical guidlines like viral load or CD4 count or con-infections dictate choice of drug
- must NOT have lapse in therapy
56
what are the NNRTIs for HIV therapy
- block viral enzyme
- nevirapine (Viramune), delavirdine (Rescriptor), efavirenz (Sustiva)
AEs: teratogenic, drug-drugs
57
NRTs/NtRTIs for HIV therapy
- used to raise CD4 counts and also for needlestick prophylaxis
- adefovir dipivoxil (Hepsera), ribavirin (Virazole, Rebetol) acyclovir (Zovirax) valacyclovir (Valtrex), famciclovir (Famvir), pencyclovir (Denavir) topical, ganciclovir (Cytovee) etc etc
some are used more for HIV: zidovudine (ZDV, AZT, Retrovir), lamivudine (Epivir), zalcitabine (Hivid), stavudine (Zerit), adefovir (Hepsera, Preveon), abacavir (Ziagen), emtricitabine (Emtriva), tenofovir (Viread)
- look up fixed combos
AEs: anemia, hepatitis, myopathy, kidney damage, metabolic problems acidosis, genetic hypersensitivities
DRUG-DRUG= acetaminophen
58
protease inhibitors for HIV
interfere with an enzyme needed by HIB
- indinavir (Crixivan), saquinavir (Invirase), etc
AEs: hyperglycemia (DM2 development), dyslipidemia, liver toxicity, retinitis from CMV infection, bleeding, osteoporosis
CAM interaction = St. John's wort cna inactivate PI drugs
