Clinical Questions Flashcards
What is the preferred treatment for mild candida albicans oropharyngeal infection?
Topical miconazole or clotrimazole
Alternative: nystatin
What is the preferred treatment for an HIV patient with oropharygeal candida infection?
Fluconazole
What is the preferred treatment for Candida albicans esophageal infection?
Fluconazole
Alternative: Echinocandins
Candida krusei or glabrata preferred treatment
Echinocandin
Alternative: Amp B, HIGH dose fluconazole (need susceptibility)
Aspergillus infection preferred treatment
Voriconazole (Vfend)
Treatment for cryptococcus neoformins
Amp B + Flucytosine
Dermatophytes treatment
Terbinafine or itraconazole
Patient was started on an antifungal treatment 2 days ago. He/she starting having visual changes. What medication is it MOST likely to have started?
Voriconazole
Patient presents to ER with peripheral edema and shortness of breath. Her BNP is extremely elevated. Patient was start an antifungal 5 days ago. Which antifungals could be th cause of this new onset of symptoms?
Itraconazole or Ketoconazole (Nizoral)
Candida krusei is considered resistant to which antifungal?
fluconazole
A patient is receiving 200 mg daily of fluconazole IV for an infection. She can now be converted to PO. What should her dose be?
200 mg PO daily
A hospitalized patient is on ibuprofen, enoxaparin, omeprazole, vancomycin, and fluconazole. Her CrCl declined from 60 mL/min to 45 mL/min. What could have been the cause? What dose adjustments should you recommend?
Ibuprofen or Vancomycin
Fluconazole dose shoulde decrease by 50%
**vanco dose should probably decrease too
A 67 year old patient presents with fever, chills, and fatigue for the last 36 hours. The patient tests positive for Influenza. What is the preferred treatment? Any counseling points?
Since it is within 48 hours, we can start Tamiflu 75 mg BID x 5 days
Has a risk of neuropsychiatric events especially at risk for elderly
What are all the different types of herpes virus?
Herpes Simplex Viruses (HSV-1 - ororpharyngeal disease, HSV-2 - genital disease)
Varcilla zoster virus (VZV)
Cytomegalovirus (CMV)
Epstein Barr Virus (EBV)
Human herpes virus (HHV)
Kaposi sarcoma (HHV-8)
Patient presents with a bump on the lip and complains of tingling and itching in the area. This is the second time this has happened this year. She was recommended an OTC option and wants to do that treatment again. What would be your recommendation? What would be a Rx alternative?
Docosanol (Abreva) topical treatment 5x daily
Rx: Acyclovir (Zovirax) topical 5x daily x 4 days
**oral options also could have been options
A patient comes into your clinical with her 5th cold sore most likely due to herpes simplex labialis. What would you recommend for treatment?
Topical would no longer be appropriate
Systemic antivirals for chronic suppression:
acyclovir 400 mg BID
valacyclovir 500-1000mg QD
A patient tests positive for HSV-2. What is the most likely cause of this viral infection? Is it curable?
sexually transmitted
life-long virus :/
When is the most optimal time to start treatment for genital herpes?
within 1 day of lesion onset
What are treatment options for genital herpes (HSV-2)?
Acyclovir (Zorvirax) 400 mg TID or 200 mg x5 for 7 - 10 days
***treat until the lesion heals = most contagious!
What are the vaccinations to prevent varicella zoster and herpes zoster?
Varicella (Zostavax)
Herpes Zoster (Shingrix)
A patient presents with a painful rash up her arm and leg on the left side 2 days ago. The rash is painful and itchy. What is the preferred treatment regimen?
Acyclovir 800 mg 5x daily x 7 days
Valacyclovir 1 g PO TIC x 7 days
What is the preferred regimen for patients with gential herpes that is resistant to fluconazole?
Foscarnet
What is the preferred treatment for CMV infection?
Ganciclovir (Cytovene) or Valganciclovir (Valcyte)
What is the preferred treatment for Epstein-Barr Virus?
This is mono. There is no treatment besides symptom management
What can cause hepatitis?
Hepatitis viruses
Alcohol
Drugs
Autoimmune diseases
How is Hepatitis A transmitted?
Through fecal to oral route
- contaminated food or water
-improper handwashing
How is Hepatitis B transmitted?
Blood or body fluids
How is Hepatitis C transmitted?
Blood or body fluids
Which hepatitis infections have vaccines?
Hepatitis A + B
A patient presents with hepatitis from a virus caught from contaiminated food. She was diagnosed with hepatitis A. What is the best treatment option?
Supportive care
–there are no treatments for this acute infections
A patient comes in with a hepatitis B infection. What is the best treatment option?
NRTI monotherapy
preffered: Viread (TDF), Vemlidy (TAF), Baraclude (Entecavir)
or Pegalyated interferon alfa
Which regimens for HCV is approved for ALL 6 genotypes in treatment Naive Patients?
Mavyret (Glecaprevir/Pibrentasvir)
Epclusa (Sofobuvir/Velpatasvir)
Which HCV medications should be taken with FOOD?
Protease inhibitors:
Glecaprevir
Grazoprevir
Paritaprevir
Voxilaprevir
What 8-week course can be used to treat HCV?
Mayvret (glecaprevir/pibrentasvir)
A patient with newly diagnosised hepatis C is 31 yo male. He has history of alcohol abuse and severe hepatic impairment. Which preferred therapy is contraindicated?
Mayvret (glecaprevir/pibrentasvir)
Which initial HCV preferred treatment is not recommended with PPIs?
Epclusa (Velpatasvir/Sofosbuvir)
Which interferon is approved for HCV and HBV?
Interferon ALFA
A patient with a newly diagnosised HCV infection is a 25 yo male with history of depression and seizures. He is currently on Trileptal and Remeron. What is the best option for him for treatment of HCV?
Ribavirin + interferon alfa
or
interferon alfa monotherapy
DAA use is contraindicated with strong CYP3A4 inhibitors like Oxcarbamazepine (Trileptal)
Which HCV treatment is absolutely contraindicated in pregnancy due to its boxed warning of teratogenicity?
Ribavirin
What testing should be done before starting any HCV DAA therapy?
Test for HBV due to the risk of reactivation
