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3151 finals > dose > Flashcards

dose Flashcards

1
Q

urine culture for

A

complicated UTI
1) Preg
2) Recurrent UTI (relapse within 2wks/ freq)
3) Pyelonephritis
4) Catheter-associated Uti
5) MEN with UTI

NOT: uncomplicated cystitis/ ASB

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2
Q

uncomplicated cystitis first liness

A

fosfomycin 3g (1dose)
nitrofurantoin 50mg QDS (5d)
CMX 960mg BD (3d)

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3
Q

uncom cys 2nd line

A

beta-lactams 5-7d
amox-clav 625mg BD
cefuroxime 250mg BD
cephalexin 250mg QDS

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4
Q

pen allergy uncom cys

A

FQ 3d
ciprofloxacin 250mg BD
levofloxacin 250mg OD

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5
Q

uncomplicated pyelo PO

A

PO CMX 960mg BD (10-14d)
PO cipro 500mg BD (7d)
PO levo 750mg OD (5d)

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6
Q

severely ill pyelo IV

A

IV cipro 400mg BD
IV amoxicillin-clav 1.2g TDS +/- gentamicin 5mg/kg/d
IV cefazolin 1g TDS +/- gentamicin 5mg/kg/d

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7
Q

uncomplicated pyelo beta-lactams

A

10-14d
amox-clav 625mg TDS
cefuroxime500mg BD
cephalexin 500mg QDS

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8
Q

complicated cystitis

A

fosfomycin 3g (EOD 3dose)
nitrofurantoin 50mg QDS (7-14d)
CMX 960mg BD (7-14d)

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9
Q

risk of prostatitis, men with pyelo

A

PO CMX 960mg BD (10-14d)
PO ciprofloxacin 500mg BD (10-14d)

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10
Q

HAI-UTI risk factors

A

UTI after >48hr hospitalisation

Pt hosp last 6mnths

Invasive urological procedure last 6mnths

Indwelling urine catheter

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11
Q

HAI-Pyelo PO

A

PO cipro 500mg BD (7-14d)
PO levo 750mg OD (7-14d)

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12
Q

HAI-Pyelo IV
M4

A

IV meropenem 1g TDS
IV imipenem 500mg QDS
IV cefepime (2g BD) +/- amikacin 15mg/kg/d

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13
Q

Catheter-UTI PO

A

PO CMX 960mg BD (3d)
PO levofloxacin 750mg OD (5d)

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14
Q

PO CMX for CAT UTI when

A

Treat of women PO CMX:

</= 65 y/o CA-UTI

without upper UTI symptoms -

after removal of catheter

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15
Q

cat-UTI IV

ML4

A

IV levo 750mg OD (7d)
IV meropenem 1g TDS (7d)
IV imipenem 500mg QDS (7d)
IV cefepime (2g BD) +/- amikacin 15mg/kg/d (7d)

(7d. defeverse in 72hrs. 10-14d if delayed response)

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16
Q

symptomatic relief UTI

A

Phenazopyridine 100-200mg TDS

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17
Q

impetigo (staph, strep)

A

TOP muciporin BD 5d

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18
Q

ecthyma – strep A

A

(7d)
PO cloxacillin 500mg QDS
PO cephalexin 500mg QDS

MSSA: cloxacillin, cephalexin, clindamycin

S.pyogenes: pen V 500mg BD, amoxicillin 500mg TDS

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19
Q

PURULENT SSTI, MILD, MOD, SEVERE CLASSIFICATION

A

MILD -

MOD - systemic sx

SEVERE - age, immunosupp, more severe systemic, failed I&D

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20
Q

PURULENT SSTI – staph aureus, grp B strep

MILD

A

(5-10d)
MILD: I&D + warm compres

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21
Q

PURULENT SSTI – staph aureus, grp B strep

MODERATE

A

MOD: I&D + PO cloxacillin 500mg QDS, cephalexin 500mg QDS, PO clindamycin 300-450mg QDS

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22
Q

PURULENT SSTI – staph aureus, grp B strep

SEVERE

A

SEVERE: I&D + IV cloxacillin 500mg-1g QDS, IV cefazolin 1-2g TDS, IV clindamycin 600mg TDS, IV vancomycin 15mg/kg Q8-12H

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23
Q

PURULENT SSTI ADD-ONS COVER FOR___

A

CA MRSA: doxy (100mg BD), clindamycin (300-450mg QDS), CMX 960mg BD

HA MRSA: IV vancomycin 15mg/kg Q8-12H, daptomycin 4-6mg/kg/d, linezolid 600mg BD

ANAEROBE: amox-clav 625mg TDS

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24
Q

CA MRSA

A

Contact (sports, military, IV drug abuse, prison)

Overcrowded facilities, close contact, lack sanitation

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25
Q

HA MRSA

A

MRSA infection/colonization in last 12 months

prolonged/repeated hospital stay in the last 12 months,

hemodialysis.

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26
Q

anaerobe, GN bacilli

A

skin abscess in perioral/ perirectal/ vulvovag area

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27
Q

risk factors for less common pathogen in non purulent

A

Aeromonas, vibrio vulnificus, pseudomonas with water exposure

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28
Q

what classify as MILD, MOD, SEVERE NON-PURULENT SSTI

A

mild: no systemic sign

mod: systemic signs + purulence
*MSSA cover

severe: systemic sign of infeciton, failed PO, immunocompromised.
* broader coverage, necrotising infection

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29
Q

NON-PURULENT SSTI MILD

A

(5-10d, 14d for immunocomp)

MILD (strep pyogenes)

PO pen V 250mg QDS
PO cephalexin 500mg QDS
Po cloxacillin 500mg QDS
Po amoxicillin 500mg TDS
PO clindamycin 300-450mg QDS

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30
Q

NON-PURULENT SSTI
MOD (MSSA)

A

(MSSA cover):
IV cefazolin 1-2g TDS
IV clindamycin (600mg TDS)

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31
Q

NON-PURULENT SSTI SEVERE

(necrotising, anaerobe cover): MP4

A

IV meropenem 1g TDS
IV imipenem 500mg QDS
IV pip-tazo 4.5mg IV TDS
IV cefepime 2g TDS

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32
Q

ADD-ONS FOR NON-PURULENT SSTI

A

+/- MRSA:

IV vancomycin 15mg/kg Q8-12H
daptomycin 4-6mg/kg/d,
linezolid 600mg BD

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33
Q

common DFI bact

A

staphylococcus aureus

streptococcus spp

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34
Q

GN bacilli eg and when to tx

A

e.coli, kleb spp, proteus spp, pseudo less common

Gram neg bacilli (chronic wounds, previous tx with AB)

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35
Q

anerobes in DFI when

A

peptostreptococcus spp, veilonella spp, bacteriodes spp

Anaerobes (ischemia, necrotising wound)

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36
Q

pseudo cover in DFI

A

Warm climate, exposure to water

Empiric cover
( for severe infection// failure of Abx)

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37
Q

DFI/ PU (staph aures, strep spp)

MILD

A

1-2wks if no bone involved
PO cloxacillin 500mg QDS,
POcephalexin 500mg QDS
PO clindamycin (300-450mg QDS)

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38
Q

MILD DFI MRSA

A

if MRSA USE INSTEAD: PO doxy (100mg BD), clindamycin (300-450mg QDS), CMX 960mg BD

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39
Q

DFI MOD (AXONE)

strep, staph aureus, GN (+/- pseudo) , anaerobes

A

1-3wks if no bone involved
IV ampicillin-clav 1.2g TDS
IV ceftriaxone (1-2g OD-BD)+ metronidazole (500mg TDS)
IV cefazolin (1-2g TDS) + metronidazole (500mg TDS)

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40
Q

DFI SEVERE MPC3,4

strep, staph aures, GN (pseudo), anaerobe

A

SA, strep, GNB, anaerobe
2-4wks if no bone involved
IV meropenem (1g TDS)
IV imipenem (500mg QDS)
IV pip-tazo (4.5g TDS)
IV Ciprofloxacin (400mg BD)+ IV clindamycin (600mg TDS)
IV cefepime (2g TDS)+ IV metronidazole (500mg TDS)

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41
Q

DFI MOD / SEVERE + MRSA

A

IV vancomycin 15mg/kg Q8-12H
daptomycin 4-6mg/kg/d
linezolid 600mg BD

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42
Q

bone involvement duration

A

amputate 2-5 days
residual soft tissue 1-3wk
residual viable bone 4-6wk

no surgery/ residual dead bone > 3mnths

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43
Q

common cold

A

self-limiting 7-10 days

post-nasal drip 2-3wks.
feel better in 3-4d, but sx linger

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44
Q

influenza risk of complications in

A

Child <5// elderly >65
Preg/ 2wks post-partum
Nursing homes/ LT care
Obese BMI > 40kg/m2
Chronic medical conditions

Asthma, COPD, HF, DM, CKD, immunocompromised

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45
Q

influenza

A

PO oseltamivir 75mg BD (5d)

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46
Q

pharyngitis - strep pyogenes PAZI 1

A

(10d, sx 1-2d)
pen V 250mg QDS
amox 500mg BD
cephalexin 500mg BD
azithromycin 500mg OD (5d)
clarithromycin 250mg BD
clindamycin 300mg TDS

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47
Q

modified centor criteria

A

FLECA
fever, swollen lymph, exudate tonsils, no cough, 3-14 yrs

> 2 pts throat test for Grp A strep

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48
Q

prevent what with Abx tx in pharyngitis

A

Acute rheumatic fever
Prevented with early initiation of effective AB

Acute glomerulonephritis
Not prevented by AB

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49
Q

when to treat rhinosinusitis

A

=/>1

1) Symptoms persists > 10 days w/o clinical improvement

2) Symptoms severe
- Fever > 38*C
- Purulent nasal discharge
- Facial pain > 3 days consecutive

3) Symptoms worsen after initial improvement
*double sickness! (improve for 3 days or worsen (5-6 days)
-New-onset fever
-Headache
-Incr nasal discharge

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50
Q

rhinosinusitis - strep pneumo, h influ

MALA2

A

(5-7d course, but 7-10d to improve)

cefuroxime 500mg BD
amox 500mg TDS
amox-clav (h.influ) 625mg TDS
moxi 400mg OD (5-7d)
levo 500mg OD (5-7d)

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51
Q

incr strep pneumo resistance (change in PBP)

cannot use which Abx

A

CMX
MACROLIDES
TETRACYCLINES

use amox high dose

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52
Q

bronchitis

A

self limit in 3wks, Abx does not resolve cough

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53
Q

LRTI duration

A

CAP: 5d min, 48-72hr for clinical stability
elderly take longer, do not escalate in 72hrs

7d: risk MRSA, PSEUDO

3-6wk: burk

6mn TB

HAP/VAP: 7 day min
48-72hr clinical stability, delay 4-5d if comorbidities

54
Q

CAP outpt, no comrbities – strep pneumo

A

PO amoxicillin 1g TDS
PO levo 750mg OD (5d)

55
Q

comorbities

A

Chronic heart, lung, liver, renal disease
DM
Alcoholism
Malignancy
Asplenia

56
Q

CAP outpt, comorbities – strep pneumo, H influ, atypicals

3 classes

A

beta-lactams
PO amoxicillin 1g TDS
PO cefuroxime 500mg BD

+

macrolides
clarithromycin 500mg BD
azithromycin 500mg OD
DOXYCYCLINE 100mg BD

OR: PO levofloxacin 750mg OD

57
Q

Pre-treatment blood and resp gram-stain and culture for pt in hosp:

A
  • Severe CAP
  • Risk factors for drug-resistant pathogens (MRSA, pseudo)

1) Being empirically tx for MRSA, pseudo
(VAP/ HAP)

2) Previously infected with MRSA or Pseudo in last 1 year

3) Hosp or IV Abx in last 90d

58
Q

CAP non severe inpt – strep pneumo, H influ, atypicals, INFLUENZA

A

beta-lactams
PO/IV amox-clav 625mg TDS/ 1.2g TDS
PO cefuroxime 500mg BD
IV ceftriaxone 1-2g OD

+

macrolides
clarithromycin 500mg BD
azithromycin 500mg OD
DOXYCYLCINE 100mg BD

OR: levofloxacin 750mg OD

59
Q

CAP non severe inpt ADD-ONS

A

+/- MRSA:
vanco (25-30mg/kg LD, 15mg/kg Q8-12H),
linezolid 600mg BD

+/- PSEUDO: MPL3,4
PO/ IV levo 750mg OD
IV meropenem 1g TDS
IV imipenem 500mg QDS
IV pip-tazo 4.5g TDS
IV ceftazidime 2g TDS
IV cefepime 2g TDS

influenza: Oseltamivir 75mg BD 5d

60
Q

CAP non severe inpt MRSA cover when

A

Resp isolation of MRSA in last 1 yr

hospitalisation/ IV Abx use in last 90d + MRSA PCR screen +ve

61
Q

CAP non severe inpt pseudo cover when

A

Pseudo risk factors

Resp isolation of pseudo in last 1 yr
(MPL3,4)

62
Q

CAP non severe anaerobic cover when

A

Radiology investigation (CXR, CT scan for lung abscess, empyema)

63
Q

severe CAP IDSA

A

Major criteria (any 1)
- Mechanical ventilation
- Septic shock require vasoactive medications (haemodynamic instability)

Minor criteria (>3)
- RR >30breath/min
- PaO2/ FiO2 < 250
- Multilobar infiltrate (extensive infection)
- Confusion/ disorientation (Elderly tho..)
- Uremia (urea>7 mmol/L)
- Leukopenia (WBC <4/L), Must not be from other causes, chemo etc
- Hypothermia (<36*C)
- Hypotension, aggressive fluid resuscitation

64
Q

CAP severe
strep pneumo, H influ, atypicals, staph aureus, GNB (kleb, e.coli, pseudo), burkholderia, INFLUENZA

A

beta-lactams
IV amox-clav 1.2g TDS
IV pen G 1-3g Q4-6H ***

+ CEFTAZIDIME 2g TDS

+ macrolides

azithromycin 500mg OD
clarithromycin 500mg BD

OR: IV levofloxacin 750mg OD + IV ceftazidime 2g TDS

65
Q

CAP severe inpt add ons

A

+/- MRSA: vanco, linezolid

psuedo covered by ceftazidime, levo

influenza: Oseltamivir 75mg BD 5d

Adjunct corticosteroid therapy

66
Q

when cover burkholderia pseudomallei

A

Severe CAP in tropical countries – ceftazidime

67
Q

severe CAP inpt MRSA risk factors

A

Resp isolation of MRSA in last 1 yr

hospitalisation/ IV Abx use in last 90d

68
Q

severe CAP pseudo risk factors

A

Resp isolation of pseudo in last 1yr

Hosp or IV Abx use in last 90d

69
Q

CAP abscess found when

A

Radiology investigation (CXR, CT scan for lung abscess, empyema)

70
Q

CAP anerobe tx

A

PO/IV metronidazole 500mg QDS-BD/ PO 400mg TDS)

CLINDAMYCIN (PO 300-450mg QDS) (IV 600mg TDS)

71
Q

Adjunct corticosteroid therapy added when

A

Shock refractory to fluid resuscitation and vasopressor support

No benefit in non-severe CAP

Prednisolone (PO), dextromethorphan, hydrocortisone (IV)

72
Q

when double pseudo cover

A

Antimicrobial resistance

1) Prior IV abx use within 90d
2) Acute renal replacement therapy prior to VAP onset
3) Isolation of Pseudo in last 1 year

Hosp in a unit where >10% of pseudo are resistant to an agent being considered for monotherapy

Prevalence of pseudo no known
* But pt high risk of mortality
* Need for ventilatory support due to HAP & septic shock

73
Q

when VAP/HAP need MRSA cover

A

1) Prior IV Abx use in last 90d

2) Isolation of MRSA in last 1yr

3) Hosp in unit where >20% of SA is MRSA

4) Prevalence of MRSA in hosp unknown

  • But pt high risk for mortality
  • Need for ventilatory support due to HAP and septic shock
74
Q

VAP/HAP tx

A

pseudo cover
beta-lactamas MPL3,4 (meropenem, imipenem, piptazo, ceftazidime, cefepime)
FQ (cipro, levo)
AG (amikcain, gentamicin)

MRSA cover
linezolid
vancomycin

75
Q

Listeria monocytogenes found where?

A

Gram +ve, intracellular rod bact
○ found in moist environ, soil, water
○ Food borne (replicates in refrigerator temp – cold deli meats, unpasteurized dairy pdt)

* Infect young, old!
76
Q

bacterial meningitis neonates covers what pathogen using which Abx?

A

strep B, listeria, e.coli

ceftriaxone 2g BD
ampicillin 2g Q4H

77
Q

child 1mn-23mn

A

strep B, e.coli, strep pneumo, neisseria

ceftriaxone 2g BD
vancomycin 25-30mg/kg (KD), 15mg/kg/h (Q8-12H)

78
Q

2-50yo:

A

strep pneumo, neisseria

ceftriaxone 2g BD
vancomycin 25-30mg/kg (KD), 15mg/kg/h (Q8-12H)

79
Q

> 50yo

A

strep pneumo, neisseria, listeria, e.coli

ceftriaxone 2g BD
vancomycin 25-30mg/kg (KD), 15mg/kg/h (Q8-12H)
ampicillin 2g Q4H

80
Q

culture-directed
Neisseria meningiditis

A

5-7d
pen G IV 4 MU, Q4H, ampicillin 2g Q4H
ceftriaxone 2g BD

81
Q

culture-directed for Strep pneumo (meningitis)

A

10-14d
pen V IV 4 MU, Q4H
ampicillin 2g Q4H
ceftriaxone 2g BD

VANCOMYCIN (25-30mg/kg LD, 15mg/kg Q8-12H)+ RIFAMPICIN IV 300mg BD

82
Q

culture directed for strep B

A

14-21d

pen V IV 4 MU, Q4H, ampicillin 2g Q4H
ceftriaxone 2g BD

83
Q

culture directed for Listeria monocytogenes

A

< 21d
pen V IV 4 MU, Q4H, ampicillin 2g Q4H
CMX 5mg/kg TDS
MEROPENEM 2g TDS

84
Q

add-on for bacterial meningitis

A

dexamethasone 10mg QDS (4d)

H.Influenzae & strep pneumoniae meningitis
1) prevent Abx inflammation
2) Less hearing loss and other neurological sequelae
3) Decr mortality in strep pneumoniae meningitis

85
Q

when admin dexamethasone

A

Administer 10-20mins before/ same time as 1st dose of Abx

beyond neonatal age (>6wks)

86
Q

Chemoprophylaxis using 3

A

rifampicin PO
Ciprofloxacin PO
ceftriaxone IM

87
Q

rifampicin PO

A

adult 600mg/kg bd (4 dose)
child 10mg/kg bd (4 dose)
neonate 5mg/kg bd (4 dose)

88
Q

ciprofloxacin PO (meningitis prophylaxis)

A

adult 500mg (1dose)

89
Q

ciprofloxacin PO

A

adult 500mg (1dose)

90
Q

ceftriaxone IM

A

adult: 125-250mg (1dose)

91
Q

CDI non severe labs

A

WBC <15 x10*9
& SCr <133umol/L

92
Q

CDI non-severe

first ep

A

PO vancomycin 125mg QDS
PO metronidazole 400mg TDS

10-14d

93
Q

CDI severe

first ep

A

PO vancomycin 125mg QDS

10-14d

94
Q

CDI fulminant

first ep

A

IV metronidazole 500mg TDS

+/- PO vancomycin 500mg QDS
+/- PR vancomycin 500mg QDS

95
Q

CDAD recurrence risk factors

A

Resolution of CDI sx, subsequent reappearance of sx after tx discontinued

1) other Abx during/ after initial Tx of CDI

2) defective humoral immune response
- Age
- underlying disease

3) Continued use of PPI

96
Q

recurrent
use fidoxacin, vancomycin first

A

PO vancomycin tapered/ pulsed (6-12wks)

125mg QDS 10-14d
125mg BD 7d
125mg OD 7d
125mg every 2-3daysx 2-8wks

97
Q

recurrent CDI use metronidazole first

A

PO vancomycin 125mg QDS 10-14d

98
Q

STI:

gonorrhea

GONE AH

A

ceftriaxone 500mg IM (1 dose) — 1g IF >150KG

gentamicin 240mg IM + azithromycin 2g PO

99
Q

add on for gonorrhea

A

chalmydia cover: PO doxycycline 100mg BD 7d

100
Q

chalmydia DAL

A

doxy 100mgadd-on for g BD 7d
azithromycin 1g PO
levofloxacin 500mg OD 7d

101
Q

syphilis
1,2, early latent <1yr

A

IM pen G 2.4 MU 1dose (benzathine)

PO doxycycline 100mg BD 14d

102
Q

syphilis
3*, late latent >1yr, unknown

A

IM pen G 2.4 MU 3dose (benzathine )
PO doxycycline BD 28d

103
Q

neurosyphilis

A

IV crystalline pen G 3-4 MU (18-24 Q4H) 10-14d

IM procaine pen G 2.4 MU + PO probecenid 500mg QDS 10-14d

IV/IM Ceftriaxone 2g OD (10-14d) —- Desensitise if penicillin allergy

104
Q

herpes
1st epi

A

acyclovir
400mg TDS 7-10d
IV 5-10mg/kg TDS 2-7d then PO for 10d

valacyclovir
PO 1g BD 7-10d

105
Q

CST herpes

A

acyclovir 400mg BD

valacyclovir 1g OD
or 500mg OD (if less freq >10/yr)

106
Q

episoidic herpes

A

Acyclovir 800mg PO BD 5d
800mg TDS 2d

Valacyclovir 500mg BD 3d
1g OD 5d

107
Q

STI diagnosis

A

Gonorrhea:
1) Gram stain of genital discharge
2) Culture – Get AST for resistance strains
3) NAAT

Chlamydia:
1) NAAT

Syphilis:
1) Darkfield microscopy
2) Serological test

Herpes
1) Virologica test (viral cell culture, NAAT)
2) Type specific serologic test
—- 6-8wks ltr HSV 1/ 2

108
Q

HIV diagnosis

A

1) Serum Ab detection
- HIV enzyme immunoassay Ab test
HIV EIA tests
- Western blot

2) HIV RNA detection/ quantification (viral load)
- Nucleic acid amplification (PCR)

109
Q

HIV response monitored through

A

1) CD4
Incr 50-150 in 1st year of therapy

2) Viral load (HIV RNA)

110
Q

Nucleoside reverse transcriptase inhibitors (NRTIs)

A

Tenofovir
Emtricitabine
Abacavir
Lamivudine
Zidovudine

111
Q

HIV NRTI DISADV

A

ADR related to mitochondrial toxicity (Z>T>A> L)
* Rare but serious
* Lactic acidosis
* Hepatic steatosis (fatty infiltrate)
* Lipoatrophy (Loss of fat)

Require dose adjustment in renal impaired pt
* Except abacavir

112
Q

HIV NRTI ADV

A
  • Established dual backbone of combi ART (2NRTI)
  • Renal elimination, less DDI concerns
113
Q

TEZLA SE

A
  • Tenofovir (NVD, renal. BMD)
  • Emtricitabine (Hyperpigmentation, ND)
  • Zidovudine (Myopathy, Bone marrow supp)
  • Lamivudine (Minimal toxicity, NVD)
  • Abacavir (NVD, Hypersensitivity reaction HLAB*5701)
114
Q

INSTI

A

Bictegravir
Dolutegravir
Raltegravir
Elvitegravir

115
Q

INSTI ADVANTAGE

A

1) Bictegravir & Dolutegravir
* Good virologic effectiveness

2) High genetic barrier to resistance
* B/D > R/E
3) Well tolerated

116
Q

INSTI DISADV

A

Bioavailability lowered by concurrent ad of polyvalent cations (Ca, Fe)

B,D,E are CYP3A4 substrates

Weight gain, ND, headache, depression, suicidality

117
Q

INSTI BRED SE

A

Bictegravir (Scr)

Raltegravir (CK, rhabdo)
* Pyrexia (fever)

Dolutegravir (Scr)

118
Q

NNRTI

A

Efavirenz
Rilpivirine

119
Q

NNRTI ADVANTAGE

A
  • Long half life (daily dosing)
  • Less metabolic toxicity <PI
120
Q

NNRTI DISADV

A
  • Low genetic barrier to resistance
  • Cross resistance among approved NNRTIs
  • Skin rash, SJS (E>R)
  • Potential for CYP450 drug interactions

QTc prolongation

121
Q

RILFAV SE

A
  • Rilpivirine (Depression, headache, SJS)
  • Efavirenz (hepatotox, hyperLDL, neuropsy)
122
Q

Mixed CYP inducer/ inhibitor in RILFAV (NNRTI)

A

E: CYP3A4 sub
○ CYP2B6, 2C19 inducer

R: CYP3A4 sub
○PO ab reduced when incr pH (no PPI)

123
Q

PI

A

Ritonavir
Lopinavir
Atazanavir
Darunavir
Fosamprenavir

(ritonavir/ cobicistat)

124
Q

PI ADVANTAGE
FARDL

A

High genetic barrier to resistance
* Esp those with high viral load, risk mutation

PI resistance is less common

125
Q

PI DISADV

A
  • Liver toxicity (if hep B,C)
  • DDI: CYP3A4 inhibitors, substrates
  • Metabolic complications (LDL, insulin)
  • GIT (NVD)
  • Lipohypertrophy, fat maldistribution
  • Incr risk of osteopenia/ osteoporosis
126
Q

FARDL SE

A

Atazanavir (less GI, lipid effect, need LOW ab, skin rash, hyperbilirubin, QT)

Ritonavir (CYP3A4, 2D6i)
* Freq combined with other PI, boost lvl (Lopinavir/ ritonavir)
SE: paresthesia (numb in extremities), taste perversion

Darunavir (less lipid, SJS)
(sulphonamide)

127
Q

Fusion inhibitors

A

Enfuvirtide

128
Q

Enfuvirtide ADVANTAGE AND DISADV

A
  • No appreciable DDI
  • Inj site reaction
  • Rare hypersensitivity reaction
    (Fever, chill, decr BP)
  • Incr bacterial pneumonia
129
Q

CCR5 antagonist

A

Maraviroc

130
Q

Maraviroc DISADVANTAGE

A

CYP3A4 substrate

  • Abdominal pain
  • Cough
  • Dizziness
  • Musculoskeletal sx
  • Pyrexia
  • Rash
  • Upper resp tract infections
  • Hepatotoxicity
  • Orthostatic hypotension

3151 finals (9 decks)

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