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Flashcards in Infectious Diseases III Deck (9)
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1
Q

Which of the following are potential treatment options for the management of vesicular genital lesions caused by a first episode of HSV-2 in a non-HIV positive patient. (Select all that apply)

A. Calcite 900 mg PO BID x 5 days
B. Famvir 250 mg PO TID x 10 days
C. Valtrex 1 g PO daily x 5 days
D. Foscavir 90mg/kg IV Q 12 H x 14 days
E. Zovirax 400 mg PO TID x 7-10 days
A

B and E
Preferred option for first episode of HSV-2 genital lesions include
acyclovir 400 mg PO TID (or 200 mg PO 5x/day) OR
valtrex 1 g PO BID OR
Famvir 250 mg PO TID

Duration of HSV-2 first episode should be 7-10 days

2
Q

Which of the following is/are active against Zygomycetes (Mucor, Rhizopus species)? (Select all that apply)

A. Amphotericin B deoxycholate
B. Amphotericn B liposomal
C. Voriconazole
D. Cresemba
E. Posaconazole
A

A, B, D and E
Voriconazole is active against aspergillus but not zygomycetes
Cresemba = Isavuconazonium (similar spectrum to posaconazole)

3
Q

Which of the following drugs is contraindicated with the use of itraconazole?

A. Cetirizine
B. Quinidine
C. Zafirlukast
D. Azithromycin
E. Amphotericin B
A

B. Quinidine
Itraconazole is a strong 3A4 inhibitor
Use with certain drugs has been associated with QT prolongation and ventricular arrhythmias

4
Q

Which of the following is an important point regarding IV isavuconazonium?

A. This medication requires light protection during administration
B. This medication is not compatible with PVC containers and will be supplied in a glass bottle
C. This medication requires a filter for administration
D. This medication requires PTT monitoring
E. This medication can prolong the QT interval

A

C. requires a filter
Isavuconazonium (Cresemba) is a prodrug of isavuconazole.
It does not contain a solubilizing agent as with voriconazole and posaconazole, so a filter is required to prevent any particulates from entering a patient’s bloodstream.
This agent can shorten QT interval, which is unique within the azalea class (all other agents are associated with a prolonged QT)

5
Q

Patient is getting fluconazole 400 mg IV daily. What is the equivalent PO dose?

A. 800 mg
B. 600 mg
C. 400 mg
D. 200 mg
E. 100 mg
A

C. 400 mg

IV to PO ratio for fluconazole is 1:1

6
Q

Antiviral agents active against cytomegalovirus (CMV) include which of the following:

A. Valganciclovir, valacyclovir, acyclovir
B. Atazanavir, valganciclovir, foscarnet
C. Foscarnet, acyclovir, cidofovir
D. Valganciclovir, foscarnet, cidofovir
E. Acyclovir, valacyclovir, ganciclovir
A

D. Valganciclovir, foscarnet, cidofovir

Ganciclovir, valganciclovir, foscarnet and cidofovir are indicated for CMV

Others listed are indicated for HSV (acyclovir, valacyclovir, famciclovir) or HIV (atazanavir)

7
Q

Which of the following counseling points regarding Vfend are correct? (Select all that apply)

A. This medication should be taken with meals, preferably breakfast and dinner
B. This medication can cause lymphomas with prolonged use
C. This medication can cause visual changes; care is advised when driving and driving at night should be avoided
D. This medication can damage the liver and liver function tests may need to be monitored
E. This medication is associated with many drug interactions

A

C, D and E
Vfend = voriconazole
visual disturbances (abnormal vision, color vision change and/or photophobia) occur in about 20% of voriconazole-treated patients.
Voriconazole is taken on an empty stomach 1 hour before or 1 hour after meals

8
Q

Which of the following statements is incorrect with regard to amphotericin B?

A. Lipid formulations were formulated to reduce the risk for infusion reactions and nephrotoxicity
B. It is a fungicidal agent with broad anti fungal spectrum of activity
C. Liposomal amphotericin B requires lower doses than conventional amphotericin B deoxycholate
D. It is compatible with D5W only
E. It is commonly associated with nephrotoxicity and electrolyte abnormalities

A

C.

Lipid-based amphotericin B doses are higher than conventional, ranging from 3-6 mg/kg/day.
To help prevent dosing errors, amphotericin B deoxycholate (conventional) carries a boxed warning to confirm any dose exceeding 1.5 mg/kg/day

9
Q

Which of the following is/are true regarding posaconazole dosage forms?

A. Posaconazole suspension and tablets should be taken on an empty stomach to improve bioavailability
B. Posaconazole tablets require 25% dose increase when converting from IV therapy
C. Posaconazole injection requires a higher dose than the suspension
D. Posaconazole injection and suspension have nearly identical bioavailability
E. Posaconazole suspension has lower bioavailability than the tablets

A

E. suspension has lower bioavailability than the tablets
Tablets and injection have similar bioavailability and a 1:1 IV to PO ratio
Both oral forms should be taken with food