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IPT: ID > Block 4 - Viral Infections > Flashcards

Block 4 - Viral Infections Flashcards

1
Q

Acyclovir vs Valacyclovir, which is the pro drug?

A

Valacyclovir

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2
Q

Acyclovir and Valacyclovir AE?

A

Neurotoxicity and AKI

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3
Q

Acyclovir and Valacyclovir MOA?

A

Phosphorylated by Thymidine kinase

Competitively inhibits viral DNA polymerase

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4
Q

Bamlanivimab use and counseling point?

A

For mild/moderate COVID-19

Admin within 10 days of symptoms onset

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5
Q

Cidofovir AE/monitoring?

A

Must be administerd w/ probenecid

Must also be prehydrated w/ 1L of NS

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6
Q

Cidofovir counseling points?

A

Sulfa allergy

Use back-up method for 3 months

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7
Q

Foscarnet AE?

A

Weird dosing

Must be admin w/ hydrating fluids

Electrolyte wasting

Nephrotoxic

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8
Q

Valganciclovir/ganciclovir AE?

A

Bone marrow suppression, leukopenia

AKI (BMP at baseline and at least weekly)

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9
Q

Letermovir indication?

A

CMV prophylaxis in bone marrow transplant

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10
Q

Letermovir AE?

A

Inhibits CYP3A4

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11
Q

Remdesivir AE?

A

LFT elevations

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12
Q

Ribavirin AE?

A

BBW: hemolytic anemia, pregnancy

Many toxicities

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13
Q

DOC of HSV?

A

Acyclovir

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14
Q

DOC of CMV?

A

Ganciclovir

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15
Q

How is CMV transmitted?

A

Direct contact of fluids

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16
Q

S/Sx of CMV in immunocompromised pt? HIV? Congenital?

A

Immunocompromised = viremia

HIV = retinitis + colitis

Congenital = mental retardation + deafness

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17
Q

Which Rx is used for resistant CMV? AE?

A

Foscarnet + Cidofovir (give w/ probenecid)

Give fluid replacements

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18
Q

VZV infectious period?

A

48hrs before vesicle formation through 4-5 days after vesicle crust over (so avoid contact until 4-5 days after lesions heal)

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19
Q

Zoster Sx?

A

Unilateral vesicular eruption w/ dermatomal distribution

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20
Q

Tx of chickenpox/shingles?

A

Hygiene

Acyclovir or Valacyclovir

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21
Q

Shingrix vaccine info?

A

0.5ml IM x 2 doses 2-6 months apart, more AE on second dose

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22
Q

Measles infectious period?

A

4 days before to 4 days after rash via droplet and airborne

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23
Q

S/Sx of measles?

A

Maculopapular rash, koplik spots which can cause subacute sclerosing panencephaltitis

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24
Q

Measles Tx?

A

Supportive care

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25
Q

S/Sx of mumps?

A

Parotitis, aseptic meningitis, encephalitis

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26
Q

Mumps Tx?

A

Supportive care

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27
Q

Tx of rabies?

A

PEP within 10 days

Prevent via vaccine IM x days 0, 7, and 21 or 28 days

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28
Q

Common coronavirus is the ___ most common cause of a cold

A

2nd

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29
Q

RF of common coronavirus

A

Sleeping less than 7 hrs per night

30
Q

What are the cell wall inhibitors for antifungal?

A

Echinocandins (-fungin)

Targets Beta-1,3-D glucan synthesis

31
Q

What are the cell membrane inhibitors for antifungals?

A

Azoles, polyenes (amphotericin B), and allylamines (terbinafine)

32
Q

What are the intracellular based antifungals?

A

Flucytosine (thymidylate synthase inhibitor)

33
Q

Amphotericin B
Echinocandins
Flucytosine
Triazoles

AUC:MIC
Peak:MIC
Time:MIC

A

Ampho + Echino = Peak

Flucytosine = Time

Triazoles = AUC

34
Q

Micafungin has good activity against which kind of fungi?

A

Candida (yeast), generally used empirically until we get susceptibility

35
Q

DOC for Candida albicans?

A

Fluconazole

36
Q

DOC for cryptococcus?

A

Either fluconazole or amphotericin

37
Q

DOC for dimorphic fungi (blastomyces, histoplasma, coccidioides)?

A

Itraconazole

38
Q

DOC for aspergillus?

A

Voriconazole

39
Q

DOC for mucormycosis?

A

Posaconazole, Isavuconazole, or amphotericin

40
Q

Amphotericin dosing?

A

3-5mg/kg IV daily

41
Q

Amphotericin AE?

A

Rigors (tx w/ meperidine PRN)

Nephrotoxic

K/Mg wasting
Hepatotoxicity

42
Q

Itraconazole caveats and monitoring?

A

Capsule taken w/ food

Solution taken w/o food

Not interchangeable^^

Monitor TDM

43
Q

Voriconazole caveats and monitoring?

A

Requires LD

Visual and auditory issues, skin cancer, prolongs QTc

Monitor TDM and eye exam

44
Q

Posaconazole caveats and monitoring?

A

Suspension requires food for acidic environment, DDI w/ acid suppressants

Monitor TDM

45
Q

Isavuconazole caveats and monitoring?

A

Requires LD

Shortens QTc

46
Q

TDM levels of Voriconazole, Posaconazole, and Itraconazole

A

Voriconazole >1-1.5 to <5-6

Posaconazole >0.5 to 1.5

Itraconazole >0.5 to 1-3

47
Q

Flucytosine BBW and AE

A

BBW = hematologic, renal and hepatic issues

Bone marrow suppression

48
Q

Flucytosine TDM levels?

49
Q

Which antifungals cause the most DDI?

A

Triazoles (esp posaconazole), ketoconazole, and clotrimazole = inhibitors

50
Q

Yeast w/ “feet” is indicative of what?

A

Candida albicans

51
Q

Oropharyngeal Candidiasis (Thrush) Tx?

A

Mild = Clotrimazole

Moderate-Severe = Fluconazole

52
Q

Esophageal Candidiasis Tx?

A

Fluconazole

53
Q

RF for fungal infections?

A

Neutropenia (ANC<500

Exposure to broad spectrum Abx

Parenteral nutrition

CVC

54
Q

Candidemia Tx?

A

Empiric = Micafungin

Definitive = Fluconazole 12mg/kg LD then 6mg/kg daily

x2 wks from first negaitive culture

55
Q

Candida endocarditis Tx?

A

Source control

Valve replacement

56
Q

IAI candidiasis?

A

Source control

Empiric Echinocandin

57
Q

Just know that follow up blood cultures are required daily until negative

Dilated ophthalmologic exam within 1st week of diagnosis

58
Q

What kind of yeast is cryptococcus?

A

Encapsulated yeast

59
Q

Cryptococcal meningoencephalitis Tx?

A

Induction - AmB + Flucytosine

Consolidation - Fluconazole

If with HIV, wait to initiate ART for 2-10wks

60
Q

Pulmonary cryptococcosis Tx?

A

Mild/Moderate - fluconazole for 6-12 months

Severe - AmB + Flucytosine

61
Q

Blastomycosis
Histoplasmosis
Coccidioidomycosis

A

Blastomycosis - east coast

Histoplasmosis - middle of US

Coccidioidomycosis - south

Texas has both histo and cocci

62
Q

Blastomycoses pathogenesis and localization?

A

Incubation period of 30-45 days

Asymptomatic and presents similar to CAP or chronic PNA

63
Q

Sx of Coccidiodomycosis?

A

Extreme fatigue

Tx with Itra or fluconazole

Only one that isnt treated with AmB in severe cases

64
Q

Aspergillus RF

A

Prolonged neutropenia, waiting for transplant, hematologic malignancy

65
Q

Diagnosis + Aspergillus

A

Halo signs specific to aspergillosis

Galactomannan

66
Q

Mucormycosis RF

A

DM poorly controlled

Persistent neutropenia

67
Q

Mucormycosis presentation

A

Necrosis

Orbital and cerebral invasion

68
Q

Mucormycosis diagnosis

A

Reverse halo signs on CT

69
Q

Besides Rx, what else is required to treat mucormycosis?

A

Surgical debridement

70
Q

What are the pathogens that are considered urgent threats to CDC?

A

Candida auris

DR N. gonorrhoeae

C. diff

Carbapenem resistant Acinetobacter

Carbapenem resistant Enterobacteriaceae

IPT: ID (11 decks)

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