Week 7 Flashcards by Sophia Timm

First line of treatment for coccidiomycosis

Fluconazole for isolated
Amphotericin B for severe

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A tissue microscopy shows yeast with pseudohyphae, what is the most likely causal pathogen?

Candida
Yeast forms pseudohyphae (can grow hyphae)
Thrush in mouth, endocarditis in IVDU, Vaginal

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A tissue microscopy shows yeast with large capsules, what is the most likely causal pathogen?

Cryptococcus- Meningitis

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A tissue microscopy shows mold with septate hyphate, what is the most likely causal pathogen?

Aspergillus- mold with septate hyphae
Fungus ball in lungs, wound burn infections, indwelling catheter infections, sinusitis

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A tissue microscopy shows mold with nonseptate hyphae, what is the most likely causal pathogen?

Mucor and Rhizopus- mold with nonseptate hyphae
Mucormycosis- necrotic lesion formed when mold invades blood vessels

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Aspergillus treatment

Voriconazole, oral, as prophy
Tx: IV or oral voriconazole or ampho B

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Fluconazole (Diflucan) indications are what

Candidiasis, Candida prophylaxis, cryptococcal meningitis

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What do you need to check before perscribing an antifungal

LFTs- moniter for hepatotoxicity

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What drugs are contradindicated with Antifungals

CYP inhibitors
St. John’s wart

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What are the indications of itraconazole

Coccidiomycosis, blastomycosis, histoplasmosis, aspergillosis (but try voriconazole for aspergillus)

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What is given to treat vaginal candidiasis

Fluconazole 150mg 1x for vaginal candidiasis- preemtive treatment if giving broad spectrum abx

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Do you perscribe ketoconazole po or topically, and what do you perscribe it for?

Perscribe it topically only because of hepatotoxicity
Used for sebhorreic dermaititis

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Describe echinocandins and their indications

Treat all candida infections
IV only
caspofungin, anidulafungin, micafungin.

Go to for serious fungal infections or in immuncompromized patients.
Does not cause drug interactions like fluconazole does

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Amphotericin B is active against what

active fungi- works against most things, but is very toxic (nephrotoxicity and electrolight abnormalities, infusion reactions).
BUT, effective.
Not easily tolerated- must pre-hydrate patients

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Fluconazole works against what bugs

Candida, crypto, cocci (3 c’s)

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Echinocandins (fungins) works against what bugs

Candida

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Itraconazole works against what bugs

Dimoprhic fungi (blasto, cocci, histo)

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Voriconazole works against what bugs

Aspergillus

Ampho B works against what bugs

Effective against most fungals, but only IV and toxic

Metronidazole is indicated where

Protozoa (giardia), H. Pylori, Trichomonas, BV, Bite wounds, rosacea

What two drugs have a disulfram-like reaction?

Metronidazole and tinidazole–> do not drink alcohol with them or take disulfram with them.

Flagyl is best choice if you don’t trust your patient to not drink.

Toxicities of Metronidazole with systemic and long term use

Neurotoxicity, Disulfram-like reaction if mixed with alcohol ( headache, digestive upset)

How do you treat HSV and VZV

Acyclovir/Valacyclovir

CMV prevention drug of choice

valganciclovir
Can use Acyclovir for low risk CMV prevention

Dosing of acyclovir vs valacyclovir or famciclovir

Acyclovir- 5x per day Valacyclovir and famciclovir- 3x per day

Key toxicities of acyclovir and valcyclovir

Interstitial nephritis- even worse with given IV - Nephritis/ Kidney injury Neurotoxicity (especially in elderly)

When do you give antivirals in herpes zoster

Antivirals if <72 hours of onset of lesions Valacyclovir and famciclovir preferred due to less frequent doses

CMV first line of treatment

ganciclovir and valganciclovir

Ganciclovir and Valganciclovir Toxicities BBBws

1. Hematologic- thrombocytopenia, leukopenia, neutropenia 2. Infertility 3. Fetal toxicity, birth defects 4. Carcinogenic

Screening before you start PrEP

1. Negative HIV test before starting, then q3 months 2. Renal function at least yearly 3. HBV

When is HIV considered to be AIDS

When CD4 drops below 200 cells/mm3 Develop an AIDS-defining condition High risk of opportunisitic infection

What are AIDs defining illnesses

Conditions: Kaposka sarcoma, lymphoma Infections: Pneumocystis jirovecci, toxoplasmosis, mycobacterium avium complex (MAC)

Is routine antibiotic prophylaxis recommdended for HIV patients

NO- mostly fungal infections or yeast, not typically bacterial, and can cause resistance

After SOT, what prophylaxes do pts require

Against PJP Anti-fungal against candida and aspergellus Anti-viral against HSV and CMV

Which cancers are the most immunosuppressive

Bone metastases or solid tumors because they involve the bone marrow and disrupt the normal immune response Give very cytotoxic chemo for solid tumors

Neutropenic patients with fevers should be started on what antibiotic

started on anti-pseudomonal antibiotics emperically. Typically gram - organisms or enterobacteria.

Pneumocystis jiroveci treatment first line

TMP-SMX IV or PO 20mg/kg/day divided in 3-4 doses Treatment: 21 days Side effects: nephrotoxicity

pneumocystis jiroveci prophy first line

1 DS or SS tablet PO daily or 1 DS PO TIW (3x/week)

MAC treatment

2-3 antibiotics for at least 12 months Macrolides (Azithro, clarithro) Rifamycins (rifampin, rifabutin) Ethambutol

MAC Prophylaxis

Azithromycin 1200mg po weekly for HIV patients who have CD4 <50.

Most common manifestation of CMV in HIV patients

Retinitis (visual impairments, floaters or flashers)

CMV diagnostics

Histopathology- biopsy of infected tissue- shows enlarged cells with viral inclusion bodies