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Infection Flashcards

(53 cards)

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1
Q

Recommended pre-txp serologic testing

A
  1. HIV
  2. HBV (HBsAg, HBsAb, HBcAB)
  3. HCV Ab
  4. CMV IgG
  5. EBV IgG
  6. Toxo IgG
  7. Syphilis
  8. TB
    If Endemic region: Strongyloides IgG, Trypanosoma cruzi serology, Coccidioides serology
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2
Q

HBV: Immune due to natural infection

A

HBsAb +
HBcAb +
HBsAg -

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3
Q

HBV: Immune due to vaccination

A

HBsAb +
HBcAb -
HBsAg -

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4
Q

HBV: Active infection (acute or chronic)

A

HBsAb -
HBcAb +
HBsAg +

IgM will determine if acute (+) or chronic (-)

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5
Q

Recommended HBV prevention in liver txp with donor HBcAb+

A

Antiviral ppx for recipient: indefinite vs 1 year

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6
Q

Recommended HBV prevention in non-liver txp with donor HBcAb+

A

Antiviral ppx IF no vaccine or natural immunity; if non-immune consider prophylaxis for up to 1-year

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7
Q

Toxoplasma gondii prophylaxis strategies if donor+ or recipient +

A
  1. Bactrim

2. Atovaquone +/- pyrimethamine + leucovorin

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8
Q

Strongyloides prophylaxis strategies if donor+

A

Ivermectin 200 mcg/kg daily x2 doses

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9
Q

Trypanosoma prophylaxis strategies if donor+ for heart txp

A

Heart –> avoid dt risk of reactivation

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10
Q

Coccidioidomycosis prophylaxis strategies

A

Endemic area: Fluc 200 mg daily

Seropositive: Fluc 400 mg daily x6-12 months

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11
Q

Recipient post-txp recommended serologic testing

A
  1. HIV
  2. HBV
  3. HCV
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12
Q

CMV Preemptive monitoring is appropriate to consider for which groups/organs?

A

High risk: liver, pancreas, kidney

Mod risk: Kidney, liver, pancreas, heart

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13
Q

Kidney txp peri-operative abx recommendations

A

Cefazolin

24 hr

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14
Q

Liver txp peri-operative abx recommendations

A

Zosyn | Unasyn | CTR + amp +/- fluc/mica

24-48 hours

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15
Q

Panc txp peri-operative abx recommendations

A

Some discrepancies - cefazolin vs Unasyn +/- fluc/mica

24-48 hours

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16
Q

Small bowel txp peri-operative abx recommendations

A

Vanc + Zosyn + Fluc/Mica

72hr-7d

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17
Q

Heart txp peri-operative abx recommendations

A

Some discrepancies - cefazolin vs Vanco + CTR/Cefepime
24-48 hours
Delayed chest closure: MRSA, PSA, fungi coverage through chest closure

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18
Q

Lung txp peri-operative abx recommendations

A

Some discrepancies - cefazolin vs Vanco + anti-PSA beta lactam
48-72 hours (or based on donor pathogens)
If CF: target colonizing organisms
Delayed chest closure: MRSA, PSA, fungi coverage through chest closure

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19
Q

Kidney Txp Candida Ppx

A

Not routinely recommended

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20
Q

Liver Txp Candida Ppx

A

Fluc x2-4 weeks for those at risk

Re-op, Re-txp, HD, choledoJ, candida colonization, >40u blood products

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21
Q

Intestine Txp Candida Ppx

A

Fluc/Mica x4 weeks or until anastomosis has healed

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22
Q

Heart Txp Candida Ppx

Study These Flashcards
A

Not routinely recommended

Some populations may quality for anti-aspergillus ppx: re-operaion, CMV disease, post txp HD, recent IA

23
Q

Lung Txp Candida Ppx

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A

Anti-aspergillus (vori/itra) x3–6 months

24
Q

Pancreas Txp Candida Ppx

Study These Flashcards
A

Fluc for those at risk

Enteric drainage, thrombosis, pancreatitis

25
PJP Prophylaxis Strategies
1. Bactrim: SS QD or MWF, DS MWF 2. Dapsone 50 - 100 mg daily 3. Atovaquone 1500 mg daily 4. Pentamidine 300 mg monthly 5. Clinda + pyrimethamine
26
Donor Bacteremia or Meningitis Strategies
Tx donor x24-48 hr; recip 7-14d with targeted therapy
27
HIV: Usual HAART combination consists of:
3 drug regimen: 1. NRTI (abacavir, emtricitabine, lamivudine, TAF, TDF, zidovudine) 2. NRTI 3. INSTI ("-tegravir") or NNRTI ("virine") or PI/booster ("-navir"
28
Which HIV meds have interactions with common txp meds?
1. PI/boosters ("-navir") = CYP inhibitors | 2. NNRTIs = CYP3A4 inducer
29
HCV Pan-genotypic regimens
1. Velpatasvir + Sofosbuvir (Epclusa) | 2. Glecaprevir/pibrentasvir (Mavyret)
30
Recommended regimens for kidney or liver txp recipients with HCV-infected grafts (HCV viremic donors)
1. Velpatasvir + Sofosbuvir (Epclusa) x12 wk 2. Glecaprevir/pibrentasvir (Mavyret) x12 wk Kidney only: Ledipasvir + sofosbuvir (Harvoni) x12 weeks if genotype 1, 4, 5, 6
31
Epclusa DDI with common txp meds, PPI, DOAC Velpatasvir + Sofosbuvir
1. Mild P-gp inhibition; minimal DDI with ISN 2. PPI: separate by 4 hr bc PPI may reduce HCV DAA exposure 3. DOACs: Potential inc exposure of DOAC, monitor
32
Mavyret DDI with common txp meds, PPI, DOAC Glecaprevir/pibrentasvir
1. Inhibits CYP3A4/P-gp = inc FK levels 2. CsA inc glecaprevir levels due to OATB inhibition [AVOID IN PATIENTS ON CSA >100 MG/D] 3. PPI: may reduce HCV DAA exposure; limit to omep 20 daily due to lack of data with higher dosages 4. DOACS: NO DABIGATRAN [Stupid high AUC}; potential inc in exposure of all other DOACS; monitor
33
Empiric regimens for nocardia
Imipenem + Bactrim OR amikacin Other abx with activity: linezolid, minocycline, cipro/moxi, augmentin, macrlides
34
When to suspect CMV resistane
Persistent viremia or symptoms after 2 weeks of appropriate therapy and total exposure >6 weeks
35
CMV UL97 Mutation
GCV resistance dt changes in drug phosphorylation
36
CMV UL54 Mutation
GCV resistance +/- CDV and FOS resistance dt change in DNA polymerase
37
Itraconazole capsule & liquid: Absorption & administration
Capsule: take with meal or acidic beverage if on acid-reducing tx (requires low gastric pH) Oral solution: better absorption vs capsule; take on empty stomach
38
Itraconazole TDM Goals
Prophy: >0.5 Tx: >1-2 mcg/mL (parent + metabolite)
39
Voriconazole tablet & liquid: Absorption & administration
Take on empty stomach; good BA & not dependent on gastric pH
40
Voriconazole TDM Goals
1-5.5
41
Voriconazole: How much dose reduce CNI
FK: dec 66% CsA: dec 50%
42
Itraconazole : How much dose reduce CNI
FK: dec 50% CsA: dec 50%
43
Posaconazole : How much dose reduce CNI
FK: dec 66% CsA: dec 25%
44
Posaconazole TDM Goals
>1250
45
Posaconazole tablet & liquid: Absorption & administration
Tablet: take with meal; not dependent on gastric pH | Oral solution: take with food & acidic beverage; divide doses to optimize absorption
46
Recommended BKV screening after KTxp
Monthly x9 mo, then Q3 month until 2 years
47
Recommended treatment of asymptomatic bacteriuria
If two consecutive urine samples yield >105of the same uropathogen in the first two months post-transplant, can consider treatment for 5 days
48
Which respiratory viruses can be treated with ribavirin?
RSV, hMPV, PIV
49
First line treatment options for latent TB
1. INH x9 months 2. RIF x4 months 3. Weekly INH/Rifapentine x12 doses
50
When to consider steroids for PJP
Corticosteroids are best administered within 72 h of patient presentation in the setting of hypoxia (pAO2 < 70 mm Hg)
51
Soliris REMS requirements for providers
1. Read HCP materials 2. Enroll in the REMS program 3. Patient counseling & provide patient safety card 4. Report ADEs
52
OPOs should determine if any of the following occurred within past 30 days to determine risk of HIV, HBV, HCV:
- sex w/ infected person - men who has sex with men - sex in exchange for $$$ or drugzzzzz - drug injection for nonmedical reasons - sex with a person who has inject drugs for nonmedical reasons - incarceration for 72+ consecutive hours - child breastfed by HIV mother - child born to HIV HBV HCV mother - unknown medical or social hx
53
Recommended recipient testing for HIV HBV HCV post-txp
4 - 6 weeks test all recipients using NAT | If OLT: test for HBV NAT at 1 year

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