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840 Exam #2 > Opportunistic Infections > Flashcards

Opportunistic Infections Flashcards

(47 cards)

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1
Q

Which infections do we use primary prevention for?

A
  • Pneumocystis pneumonia
  • Toxoplasma encephalitis
  • Disseminated MAC
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2
Q

Oropharyngeal and esophageal candidiasis are common in …. What can help reduce this risk?

A
  • Patients with CD4 < 200

- HAART reduces likelihood of infection

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3
Q

Most common pathogen n Oropharyngeal and esophageal candidiasis

A

-C. albicans

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4
Q

Adverse effects associated with triazoles as a class

A
  • Drug/drug int with Protease Inhibitors
  • GI upset
  • Hepatotoxicity
  • Rash
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5
Q

Itraconazole adverse reactions

A

-Negative inotropic effects

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6
Q

Voriconazole adverse reactions

A
  • Visual disturbances

- Auditory or visual hallucinations

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7
Q

Why is Fluconazole the best?

A
  • Great oral bioavailability
  • Absorption not affected by food or gastric pH
  • Less drug/drug int than other azoles
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8
Q

Preferred Treatment of Oropharyngeal Candidiasis

A
  • Fluconazole 100mg PO daily

- Duration 7 to 14 days

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9
Q

Alternative therapies for mild to moderate Oropharyngeal Candidiasis

A
  • Itraconazole
  • Clotrimazole
  • Posaconazole
  • Nystatin
  • Miconazole
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10
Q

Preferred Treatment of Esophageal Candidiasis

A

-Fluconazole 100 to 400mg PO/IV daily
or
-Itraconazole 200mg PO daily
-Duration 14 to 21 days

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11
Q

Alternative/Refractory treatment of Esophageal Candidiasis

A
  • Voriconazole
  • Isavuconazole
  • Capsofungin
  • Amp B
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12
Q

Risk factor for Pneumocystis Pneumonia (PCP)

A
  • CD4< 200 cells/mm3

- CD4 < 14%

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13
Q

Pneumocystis Pneumonia (PCP) signs and symptoms

A
  • Nonproductive cough
  • Hypoxemia (PaO2 < 70)
  • Dyspnea
  • Fever
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14
Q

When to consider prophylaxis for PCP

A
  • Pts with CD4<200cells/uL
  • CD4<14%
  • CD4 between 200 and 250 with delayed ART therapy
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15
Q

PCP Prophylaxis treatment regimen

A
  • Bactrim DS PO daily
  • Bactrim SS PO daily
  • Also covers toxoplasmosis
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16
Q

Alternatives to PCP prophylaxis treatment

A
  • Bactrim DS PO m/w/f
  • Dapsone plus pyrimethamine plus leucovorin
  • Atovaquone
  • Aerosolized pentamidine
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17
Q

If taking Bactrim and CrCl < 30 mL/min

A
  • Use half of the usual dose
  • If only using for prophylaxis you do NOT need to dose adjust
  • Monitor CBC and K+
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18
Q

What do you need to monitor if using Dapsone for PCP therapy

A
  • G6PD levels BEFORE beginning treatment
  • Can lead to anemia
  • Monitor CBC and LFTs too
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19
Q

Which drug regimens cover PCP and Toxo prophylaxis?

Study These Flashcards
A
  • Bactrim DS/SS
  • Atovaquone (take with food)
  • Dapsone + Pyrimethamine + Leucovorin
20
Q

When to Discontinue prophylaxis of PCP

Study These Flashcards
A
  • CD4 count > 200 for >3mo

- CD4 100 to 200 with undetectable HIV viral load for >3mo

21
Q

PCP treatment

Study These Flashcards
A
  • Bactrim 15 to 20mg/kg/day for 21 days
  • If PaO2 < 70 add on Prednisone (40BID to 40QD to 20QD)
  • Start HAART within 2 wks of PCP diagnosis
22
Q

Alternative PCP treatment(s)

Study These Flashcards
A
  • IV Pentamidine (Inpatient ONLY)
  • PO Atovaquone
  • PO Dapsone + PO TMP
  • PO Primaquine + PO/IV Clindamycin
  • Treatment duration = 21days
23
Q

Possible adverse rxns with Pentamidine

Study These Flashcards
A
  • Hypotension
  • Hypoglycemia
  • Monitor: Blood pressure, glucose, renal function, electrolytes, CBC
24
Q

Preventing Recurrence of PCP

Study These Flashcards
A
  • Secondary prophylaxis regimen = primary prophylaxis

- Keep therapy going until CD4 > 200 and HAART has been initiated

25
Toxoplasma gondii risk factors
- CD4 < 100 - Raw meats - Cat droppings
26
Signs and symptoms of Toxoplasma gondii
- Headache - Confusion - Motor weakness - Seizure - Coma - IgG +
27
Toxoplasma Primary Prevention
- Bactrim DS PO daily - Dapsone + pyrimethamine + leucovorin - Atovaquone
28
When to discontinue Toxoplasma prophylaxis
- CD4 count > 200cells for >3mo | - Pt on ART with CD4 between 100 and 200 with undetectable HIV viral load for 3 to 6mo
29
Things to know about Pyrimethamine
- Penetrates CSF - Coadminister with leucovorin - Monitor CBC
30
Toxoplasma Encephalitis treatment
``` -Pyramethamine 200mg PO x1 then 75mg PO daily PLUS -Sufladiazine 1.5g PO Q6H PLUS -Leucovorin 25mg PO daily -Duration >/= 6weeks ```
31
Adverse effects of Sulfadiazine
- Cyrstalluria - Bone marrow suppression - N/V - Advise patient to maintain adequate hydration!
32
Alternative treatments for Toxoplasma Encephalitis
- Bactrim 5mg/kg IV/PO BID - For sulfa allergy sub out sulfadiazine for EITHER a) Clindamycin 600mg IV/PO q6h b) Atovaquone 1500 PO BID
33
Toxoplasma secondary prophylaxis
``` -Pyrimethamine 50mg PO daily PLUS -Sulfadiazine 2g PO BID PLUS -Leucovorin 10mg PO daily -Discontinue if CD4 > 200 for 6mo or greater ```
34
Risk factors for MAC
-CD4 <50
35
Signs and symptoms of MAC
- Weight loss - Fever - Night sweats - Diarrhea/ abdominal pain
36
MAC prophylaxis regimen
- Azithromycin 1200mg PO qweek | - Clarithromycin 500mg PO BID
37
When to discontinue MAC prophylaxis
-CD4 count > 100cells for > 3mo
38
MAC treatment
``` -Clarithromycin 500mg PO BID PLUS -Ethambutol 15mg/kg/day (400mg tabs) PLUS -Rifabutin 300mg PO daily -ALTERNATIVE = sub azithromycin 600mg daily instead of clarithro -Duration > 12mo ```
39
Ethambutol side effects
- Visual disturbances - Adjust dose if CrCl<50mL/min - Monitor: Baseline eye exam (then q1mo after that), and Renal function
40
Rifabutin
- Dose adjustments a) CYP inducers (Efavirenz) = 450mg PO daily b) CYP inhibitors (Ritonavir-boosted PIs) = 150mg daily
41
IRIS
- Happens with initiation of HAART | - Rapid increase in CD4/immune response leads to pt getting worse before he/she gets better!
42
When to give flu vaccine
-Annually
43
When to give HPV vaccince
-Ages 9 to 26 that meet criteria
44
When to give VZV vaccine
- CD4 count > 200 | - VZV seronegative
45
When to give Zostavax vaccine
- Pt > 50yrs | - CD4 count >200
46
When to give Tdap/Td
- To all adults | - Booster q 10 years
47
When to give Men-ACWY vaccine
- If not previously vaccinated give 2 dose primary series | - Then Booster q5yr

840 Exam #2 (6 decks)

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