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840 Exam #2 > Opportunistic Infections > Flashcards

Opportunistic Infections Flashcards

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?

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

When to Discontinue prophylaxis of PCP

A
  • CD4 count > 200 for >3mo

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

21
Q

PCP treatment

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)

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

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

Preventing Recurrence of PCP

A
  • Secondary prophylaxis regimen = primary prophylaxis

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

25
Q

Toxoplasma gondii risk factors

A
  • CD4 < 100
  • Raw meats
  • Cat droppings
26
Q

Signs and symptoms of Toxoplasma gondii

A
  • Headache
  • Confusion
  • Motor weakness
  • Seizure
  • Coma
  • IgG +
27
Q

Toxoplasma Primary Prevention

A
  • Bactrim DS PO daily
  • Dapsone + pyrimethamine + leucovorin
  • Atovaquone
28
Q

When to discontinue Toxoplasma prophylaxis

A
  • CD4 count > 200cells for >3mo

- Pt on ART with CD4 between 100 and 200 with undetectable HIV viral load for 3 to 6mo

29
Q

Things to know about Pyrimethamine

A
  • Penetrates CSF
  • Coadminister with leucovorin
  • Monitor CBC
30
Q

Toxoplasma Encephalitis treatment

A 
-Pyramethamine 200mg PO x1 then 75mg PO daily 
PLUS 
-Sufladiazine 1.5g PO Q6H
PLUS
-Leucovorin 25mg PO daily 
-Duration >/= 6weeks
31
Q

Adverse effects of Sulfadiazine

A
  • Cyrstalluria
  • Bone marrow suppression
  • N/V
  • Advise patient to maintain adequate hydration!
32
Q

Alternative treatments for Toxoplasma Encephalitis

A
  • 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
Q

Toxoplasma secondary prophylaxis

A 
-Pyrimethamine 50mg PO daily 
PLUS
-Sulfadiazine 2g PO BID
PLUS
-Leucovorin 10mg PO daily 
-Discontinue if CD4 > 200 for 6mo or greater
34
Q

Risk factors for MAC

A

-CD4 <50

35
Q

Signs and symptoms of MAC

A
  • Weight loss
  • Fever
  • Night sweats
  • Diarrhea/ abdominal pain
36
Q

MAC prophylaxis regimen

A
  • Azithromycin 1200mg PO qweek

- Clarithromycin 500mg PO BID

37
Q

When to discontinue MAC prophylaxis

A

-CD4 count > 100cells for > 3mo

38
Q

MAC treatment

A 
-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
Q

Ethambutol side effects

A
  • Visual disturbances
  • Adjust dose if CrCl<50mL/min
  • Monitor: Baseline eye exam (then q1mo after that), and Renal function
40
Q

Rifabutin

A
  • Dose adjustments
    a) CYP inducers (Efavirenz) = 450mg PO daily
    b) CYP inhibitors (Ritonavir-boosted PIs) = 150mg daily
41
Q

IRIS

A
  • Happens with initiation of HAART

- Rapid increase in CD4/immune response leads to pt getting worse before he/she gets better!

42
Q

When to give flu vaccine

A

-Annually

43
Q

When to give HPV vaccince

A

-Ages 9 to 26 that meet criteria

44
Q

When to give VZV vaccine

A
  • CD4 count > 200

- VZV seronegative

45
Q

When to give Zostavax vaccine

A
  • Pt > 50yrs

- CD4 count >200

46
Q

When to give Tdap/Td

A
  • To all adults

- Booster q 10 years

47
Q

When to give Men-ACWY vaccine

A
  • If not previously vaccinated give 2 dose primary series

- Then Booster q5yr

840 Exam #2 (6 decks)

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