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Clin Med II > ID Tx > Flashcards

ID Tx Flashcards

1
Q

What pphx should HIV pts be on w/ CD4 <200

A

TMP/SMZ, if allergic → dapsone, atovaquone

for PCP

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2
Q

What pphx should HIV pts be on w/ CD4 <50

A

Azithromycin 2 g qwk or clarithromycin

for MAC

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3
Q

What is the goal of HIV tx?

A

get viral load to undetectable (<20)

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4
Q

If pt has + HLA-b5601 what HIV medication should you AVOID?

A

Do NOT use Abacavir due to hypersensitivity response*

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5
Q

What medication should you avoid in the first 8 wks pregnancy?

A

efavirenz

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6
Q

Tx for HIV w/ + HBV

A

Must use Tenofovir AF or DF and Emtricitabine + fully suppressive ARV tx

Can use entecavir if tenofovir cannot be used

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7
Q

Post-exposure Prophylaxis

A

Raltegravir 400 mg twice daily + tenofovir DF/emtracitabine (Truvada) QD x 4 wks

Within 2 hrs best, MAX 72 hrs

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8
Q

Who gets Pre-exposure Prophylaxis (PrEP)?

A

Inj drug users, sex workers, hx unprotected intercourse esp MSM

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9
Q

What drug is used for Pre-exposure Prophylaxis (PrEP)?

A

Tenofovir DF 300 mg + emtricitabine 200 mg (Truvada) one PO daily

90 day supply

Test q3mo

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10
Q

What are the NRTIs?

A

Abacavir (Ziagen)

Emtricitabine (Emtriva)

Lamivudine (Epivir)

Tenofovir AF or DF

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11
Q

What are the integrase inhibitors?

A

Raltegravir (Isentress)

Elvitegravir (only in combo with cobisistat/tenofovir AF or DF/emtricitabine =

Genvoya/Stribild)

Dolutegravir

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12
Q

What are the protease inhibitors?

A

Darunavir

Ritonavir

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13
Q

Gram + Cocci

A

Staph
Strep
Enterococcus

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14
Q

Gram + Rods

A

Listeria
B. anthrax
Clostridium
B. cereus

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15
Q

G- diplococci

A

Gonorrhea

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16
Q

G- coccobacilli

A

H. flu
Morexilla
Enterobacter

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17
Q

G- rods

A 
E. coli
Salmonella
Klebsiella
Shigella
Pseudomonas
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18
Q

Spirochetes

A

Treponema → Syphilus

Borrelia → Lyme

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19
Q

Molds

A

Dermatophytes → skin

Asperigillus

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20
Q

Yeast

A

Candida

Cryptococcus

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21
Q

GAS tx

A

penicillin x 10 d

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22
Q

UTI rx

A

nirtofuraintoin

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23
Q

complicated otitis media tx

A

amoxicillin + tylenol

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24
Q

CAP tx

A

azithromycin

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25
G+ meningitis
ceftriazone + vancomycin may want to add dexamethasone if old/immunocompromised also add Ampicillin (to cover listeria)
26
Infected wound tx
Augmentin or IV vanc/linezolid
27
chlamydia tx
azithromycin
28
gonorrhea tx
ceftriazone + azithromycin
29
Hospital acquired pneumo tx
Pip/tazo + aminoglycoside or quinilone
30
c diff tx
metronidazole (or oral vanc) or await stool studies
31
Hospital acquired infection
IVF + meropenem + vancomycin
32
acute sinusitis sx > 10 d
augmentin + saline irrigation and decongestants
33
Bronchitis tx
Nsaids if no improvement in 1 wk consider macrolides or doxy
34
Tx for RMSF
doxycycline
35
AE of Tenofovir DF (AF better)
Renal Disease Bone loss
36
AE of NRTIs
Lipodystrophy | Lipoatrophy
37
AE of Protease inhibitors
Lipodystrophy Lipid changes Heart disease
38
AE of NNRTIs
Lipid changes
39
What should you avoid with PI or boosters (ritonavir/cobisistat)?
simvastatin, lovastatin or pitavastatin
40
What should you avoid with PI or NNRTIs?
St John’s wort
41
What should you avoid with PI AND boosters combined?
fluticasone
42
What meds should you avoid with PIs?
benzos CCB
43
What is effect on viagra (PDE5 inhibitor) if taken with PI orNNRTIs?
levels of viagra are INC w/ PI and DEC w/ NNRTIs
44
PPhx for PJP w/ HIV
PPhx CD4 <200 Trimethoprim-sulfamethoxazole 160 mg/800 mg one PO daily Alternatives: dapsone or atovaquone
45
PPhx for M. tuberculosis w/ HIV
PPhx for all pts w/ ⊕ PPD or close contacts of TB pts Isoniazid
46
Pphx for Mycobacterium Avium Complex (MAC) w/ HIV
PPhx CD4 <50 Azithromycin 1200 mg weekly
47
TB treatment
Initial- Daily INH, rifampin, PZA & ethambutol* X 8 wks (56 doses* may D/C ethambutol if sensitivities favorable) Pyradoxine (vit B6) 25 mg PO daily Continuation- INH and rifampin qd x 18 wk or 2x/wk x 18 wks
48
What is intermittent Preventive Treatment in Pregnancy (IPTp) for malaria?
give > 2 times during pregnancy Protects against maternal anemia & low birth weight but less effective if HIV+ also recommended in infants
49
Tx for Plasmodium falciparum
Medical emergency* IV quinidine or IV artesunate ICU IV fluids, ± blood transfusion Anti-convulsants if seizure Glucose if hypoglycemic
50
Tx for P vivax, P ovale and P malariae
Chloroquine Primaquine x 14 days Must treat liver hypnozoites to prevent relapse (chloroquine doesn't kill in liver) → screen for G6PD deficiency first
51
Babesiosis tx
Mostly self-limited Treat severe and sx dz Atovaquone + azithromycin (fewer side effects) or Clindamycin + quinine
52
Tx for Giardia Intestinalis
Metronidazole Tinidazole – single dose Nitazoxanide May need to treat multiple times before its gone due to relapse
53
Amoebiasis tx
If colitis or liver abscess→ Metronidazole (kills trophozoites) then luminal agent (to act on cysts) If asymptomatic → luminal agent only
54
Cryptosporidiosis tx
If immunocompetent will recover in 1-2 wks HIV (CD4 <200) → chronic diarrhea ↓ e immunosuppression (e.g., ARVs in HIV+) Nitazoxanide (efficacy isn't great)
55
Chagas Disease tx
Antiparasitic drugs not very effective Long duration of treatment (months) Cure in only ~50% Pacemaker Cardiac transplantation
56
Kala-azar Visceral Leishmaniasis (VL) tx
Majority of infections self-resolving Pentavalent Antimony (SbV) = 1st line Liposomal amphotericin B= tx of choice in US
57
Mucocutaneous Leishmaniasis (ML) tx
Tx of cutaneous lesion may not prevent future mucosal lesion Mild: topical paromycin, heat therapy, intralesional antimony Moderate: pentavalent antimony, fluconazole/ketoconazole x4-6 wks, oral miltefosine
58
When is surgery indicated for infective endocarditis
``` CHF Recurrent systemic embolization Uncontrolled sepsis Conduction disturbances, myocardial abscess Fungal endocarditis Large vegetation size ```
59
What pphx would you give pt prior to dental procedure that involves perf of mucosa?
Amoxicillin 2 gm po or Cephalexin 2 gm po (if PCN allergic)
60
Pt w/ fever and neutropenia
Rapid initiation of empiric antimicrobial therapy is mandatory (treat even if fever is only sx in immunocomp pts)
61
Therapy goals for Infections in Neutropenic Host
Initial antimicrobial therapy is empiric Gram negative coverage is mandatory Recovery of the neutrophil count * major prognostic factor
62
What should you do if f patients remains febrile despite adequate antibacterial coverage?
consider beginning antifungal therapy
63
What preventive measures should you take for neutropenic pts to try to prevent infection?
Isolation Consider prophylactic antimicrobials Granulocyte colony stimulating factor (G‐ CSF)
64
PPhx for PJP w/ HIV +
Begin at CD4 <200 Trimethoprim‐sulfamethoxazole (Bactrim) which also protects against toxoplasma infections Alt: dapsone, atovaquone
65
PPhx for MAI and TB w/ HIV +
Azithromycin for MAC at CD4 <50 PPhx for TB w/ isoniazid for all pts w/ + PPD or quantiferon (or close contacts of TB pt)
66
Sepsis tx
Medical emergency Abx + supportive care Delay in effective antibiotics → ↑ mortality ARDS→ ventilate w/ low tidal vol (6mL/kg), control inflam and prevent vol overload that will ↑ lung congestion
67
Septic Shock tx
Stabilize resp and establish IV access Empiric broad-spectrum abx (Vancomycin + carbapenem +/- fluoroquinolone or aminoglycoside) IV bolus crystaloid (LR, 0.9% NS)→ want to maintain MAP ≥ 65 mmHg Once euvolemic → add pressors (NE 1st line) Stress steroids for shock refractory to vasopressor therapy Admit to ICU Drain spaces, surg control If pt unable to clear lactate to <2 → poor prognosis* Supportive meas: mech vent, renal replacement therapy, nutrition, blood glucose control, prevent DVT and stress ulcers
68
DIC management
Serial labs to monitor If pt is bleeding → bleeding by giving coag support (FFP, cryo) If pt clotting → give antigoagulation (heparin drip) PRBC to replace lose blood vol Support: vasopressors, O2, ventilator

Clin Med II (19 decks)

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