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Spring 2015 PNT Exam 5 > OI > Flashcards

OI Flashcards

1
Q

define opportunistic infection

A

illnesses caused by various organisms, some of which do not cause diseases in immunocompetent persons

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2
Q

Define primary prophylaxis

A

initiated to prevent the first episode of OI

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3
Q

define secondary prophylaxis

A

initiated after treatment of an OI to prevent the second or subsequent episode of an OI

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4
Q

CD4 under 500 at risk for which OI

A

bacterial skin infection
herpes simplex, zoster
Oral, skin fungal infections

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5
Q

CD4 under 400 at risk for which OI

A

Kaposi’s sarcoma

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6
Q

CD4 under 300 at risk for which OI

A

Hairy leukopenia

tuberculosis

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7
Q

CD4 under 200 at risk for which OI

A

PCP
Cryptococcus
Toxoplasmosis

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8
Q

CD4 under 50 at risk for which OI

A

MAC
CMV
lymphoma

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9
Q

CD4 under 50 at risk for which OI

A

MAC
CMV
lymphoma

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10
Q

Which OI predominantly attacks the eyes

A

cytomegalovirus

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11
Q

Which OI predominantly attacks the mouth and throat

A

candidiasis

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12
Q

Which OI predominantly attacks the skin

A

Herpes Simplex

shingles

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13
Q

Which OI predominantly attacks the brain

A

toxoplasmosis

cryptococal meningitis

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14
Q

Which OI predominantly attacks the lungs

A

PCP
MAC
Tb
histoplasmosis

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15
Q

Which OI predominantly attacks the gut

A

cytomegalovirus

cryptosporidiosis

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16
Q

Which OI predominantly attacks the genitals

A

herpes simplex
human papillomavirus
candiasis

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17
Q

PCP caused by

A

pneumocystis jiroveci - fungus with protozoal properties

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18
Q

which patients are at greatest risk for PCP

A

CD4

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19
Q

Clinical presentation of PCP

A 
exertional dyspnea
fever
nonproductive cough
chest discomfort
ground glass opacities - x ray/CT
hypoxemia
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20
Q

2 diagnostic tests for PCP

A

bronchoscopy

Silver stain

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21
Q

Prognostic factors for PCP

A 
PaO2  35
abnormal CXR
Severity of pulmonary dysfunction at baseline
Severity of immunosuppression
Large inoculums detected by bronchoscopy
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22
Q

Indications for primary prophylaxis for PCP

A

CD4

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23
Q

preferred regimen for primary prophylaxis for PCP

A

Bactrim DS po daily

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24
Q

alternative regimens for primary prophylaxis for PCP

A 
Bactrim DS 3x weekly
dapsone 100 mg po daily 
atovaquone 15000 mg po daily (high fat food) 
dapsone + pyrimethamine + leucovorin
pentamidine 300 mg via neb monthly
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25
PCP treatment
Bactrim TMP 15-20 mg/kg/day given q 6 or 8 h SMX 75-100mg/kg/day dose based on TMP
26
Bactrim AEs
``` rash fever N/V crystaluria myleosuppression hyperkalemia ```
27
Bactrim AEs
``` rash fever N/V crystaluria myleosuppression hyperkalemia ```
28
Alternative treatments for severe PCP
Pentamidine 3-4 mg/kg IV daily or | Clindamycin 450 mg QID or 600-900 mg IV q6-8h + Primaquine 30 mg base daily
29
alternative regimens for mild-moderate PCP
dapsone 100 mg po daily + TMP 15mg/kd/day in 3-4 divided doses or atovaquone 750 mg PO q 12 h
30
duration of therapy for PCP treatment
21 days
31
when to use steroids in PCP treatment
PaO2 35
32
when to start steroids in PCP treatment
within 72 hours of initiating treatment
33
Duration of therapy of steroids in PCP
21 days - taper PO steroids
34
IV methylprednisone to PO prednisone
75% of prednisone dose
35
Regimens used for secondary prophylaxis of PCP
same as primary prophylaxis
36
When to d/c prophylaxis for PCP
CD4 > 200 for 3 months on HAART
37
Mode of transmission for MAC
inhalation ingestion inoculation of the respiratory or GI tract
38
Pts at risk for MAC
CD4
39
s/s of MAC
``` fever night sweats abdominal pain diarrhea weight loss lymphadenopathy ```
40
lab abnormalities in MAC
anemia increased LFTs increased TNF
41
Indications for primary prophylaxis of MAC
CD4
42
Preferred primary prophylaxis regimen for MAC
Azithromycin 1200 mg PO once weekly Clarithromycin 500 mg PO BID azithromycin 600 mg PO twice weekly
43
Preferred primary prophylaxis regimen for MAC
Azithromycin 1200 mg PO once weekly
44
Alternative regimens for primary prophylaxis for MAC
clarithromycin 500 mg PO BID rifabutin 300 mg PO daily - rule out active Tb azithromycin 600 mg po BID
45
diagnosis of MAC based on
clinical s/s | positive MAC cultures from blood, bone marrow, liver, spleen, or other sterile sites
46
MAC treatment of choice
Clarithromycin 500 mg PO BID + ethambutol 15 mg/kg PO daily or azithromycin 500-600 mg + ethambutol 15 mg/kg PO daily
47
MAC treatment of choice
Clarithromycin 500 mg PO BID + ethambutol 15 mg/kg PO daily or azithromycin 500-600 mg + ethambutol 15 mg/kg PO daily
48
For treatment of MAC consider adding ___ if CD4
rifabutin 300 mg PO daily
49
4th drug for advanced disease for MAC treatment
levofloxacin 500 mg PO daily / moxifloxacin 400 mg PO daily or Amikacin 10-15 mg/kg IV daily or streptomycin 1 g IV daily
50
AE of macrolides
GI intolerance
51
AE of clarithromycin
taste disturbances
52
AE of ethambutol
dose related optic neuritis
53
AE of rifabutin
discolored secretions, rash, leucopenia
54
duration of treatment for MAC
at least 12 months
55
Secondary prophylaxis duration for MAC
lifetime maintanence unless sustained immune recovery on HAART
56
Secondary prophylaxis for MAC option
macrolide + ethambutol +/- rifabutin
57
When to d/c primary prophylaxis for MAC
CD4 > 100 x 3 months
58
when to d/c secondary prophylaxis for MAC
> 12 months of therapy AND | CD4>100 x 6 months
59
Patients at greatest risk for toxoplasma
CD4
60
clinical presentation of toxoplasma
``` HA confusion motor weakness fever seizures ring enhancing lesions on CT or MRI ```
61
diagnosis for toxoplasma
IgG antibodies | Isolation of parasite from blood or CSF
62
Indication for primary prophylaxis of toxoplasma
CD4
63
Preferred primary prophylaxis regimen for toxoplasma
Bactrim DS 1 PO daily
64
alternative regimens for primary prophylaxis for toxoplasma
dapsone + pyrimethamine + leucovorin | atovaquone
65
alternative regimens for primary prophylaxis for toxoplasma
dapsone + pyrimethamine + leucovorin | atovaquone
66
when to d/c primary prophylaxis for toxoplasma
CD4
67
Preferred regimen for treatment of toxoplasma
pyrimethamine + sulfadiazine + leucovorin
68
Alternative regimens for treatment of toxoplasma
``` Pyrimethamine+ leucovorin+ clindamycin Bactrim Atovaquone +pyrimethamine + leucovorin Atovaquone + sulfadiazine Atovaquone Pyrimethamine + leucovorin+ azithromycin ```
69
Alternative regimens for treatment of toxoplasma
``` Pyrimethamine+ leucovorin+ clindamycin Bactrim Atovaquone +pyrimethamine + leucovorin Atovaquone + sulfadiazine Atovaquone Pyrimethamine + leucovorin+ azithromycin ```
70
Duration of treatment for toxoplasma
at least 6 weeks
71
when to use corticosteroids for toxoplasma
within 24-48 hours of therapy if elevated intracranial pressure or edema
72
Preferred secondary prophylaxis for toxoplasma
pyrimethamine 25-50 mg PO daily + sulfadiazine 2000-4000 mg PO daily (2-4 divided doses) + leucovorin 10-25 mg PO daily
73
Alternative secondary prophylaxis for toxoplasma
clindamycin + pyrimethamine + leucovorin | atovaquone +/- pyrimethamine/leucovorin
74
when to d/c secondary prophylaxis for toxoplasma
CD4>200 for 6 months on HAART
75
when to d/c secondary prophylaxis for toxoplasma
CD4>200 for 6 months on HAART
76
presentation of cryptococcus neoformans meningitis
``` decrease intracranial pressure -> CSF shunt/lumbar puncture cerebral edema confusion severe HA emesis fading vision ```
77
diagnosis of cryptococcus
india ink cultures serology radiologic findings
78
primary prophylaxis for cryptococcus
not recommended
79
3 phases of cryptococcus treatment
induction consolidation chronic maintence
80
regimen of choice for induction therapy for cryptococcus
liposomal amphotericin B 3-4 mg/kg IV dialy + flucytosine 25 mg/kg PO QID
81
duration of induction phase therapy for cryptococcus
2 weeks
82
alternative regimens for induction therapy for cryptococcus
amphotericin B + fluconazole 800 mg PO/IV therapy Amphotericin + flucytosine Fluconazole 800 mg PO daily + 5-FC 25 mg/kg po QID
83
duration of consolidation therapy for cryptococcus
8 weeks
84
preferred agent for consolidation therapy for cryptococcus
fluconazole 400 mg PO or IV once daily
85
alternative agent for consolidation therapy for cryptococcus
itraconazole 200 mg PO BID
86
alternative agent for consolidation therapy for cryptococcus
itraconazole 200 mg PO BID
87
duration for chronic maintance therapy for cryptococcus
at least 12 months
88
preferred agent for chronic maintance therapy of cryptococcus
fluconazole 200 mg PO
89
when to d/c maintance/secondary prophylaxis for cryptococcus
at least 1 year of therapy CD4 100 undetectable viral load
90
clinical presentation of HSV-1 infection
sensory prodrome in the affected area | course of illness in untreated patients is 5-10 days
91
clinical presentation of HSV2 infection
evolution of stages of papules -> vesicle -> ulcer -> crust | prodrome syndrome: pain and pruritis
92
diagnosis of HSV infection
viral culture HSV DNA PCR HSV antigen detection
93
Primary prophylaxis for HSV infection
not recommended

Spring 2015 PNT Exam 5 (6 decks)

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