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Therapeutics 5 Kappa Epsilon > Exam 5 - Opportunistic Infections (Erdman) > Flashcards

Exam 5 - Opportunistic Infections (Erdman) Flashcards

1
Q

Normal CD4 count in adults?

A

500 - 1200 cells/mm3

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2
Q

without ART therapy a patient with HIV will have a ______ decline in CD4 cells per year

A

50 - 100

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3
Q

when CD4 cell counts are < ______ and especially < ______ are associated with development of opportunistic infections

A

< 500 and < 200

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4
Q

When CD4 counts are < 500 pts may develop OIs such as what 5 infections/diseases?

A 
bacterial pneumonia
vaginal candidiasis
thrush
shingles
oral leukoplakia
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5
Q

When CD4 counts are < 200 pts may develop OIs such as what 7 infections/diseases?

A 
PCP
Kaposi Sarcoma
CMV
MAC
Lymphoma
Cryptococcal meningitis
Cryptospordium diarrhea
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6
Q

why avoid starting ART with an acute OI?

A

IRIS!! (immune reconstitution inflammatory syndrome)

worsening clinical manifestations (because body is getting better immune system really starts attacking the infection)

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7
Q

IRIS will typically develop within the first ______ weeks of initiation of ART if it is going to occur

A

4 - 8 weeks

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8
Q

Oropharyngeal cadidiasis/thrush:

use topical therapy when?

A

if INITIAL, mild or moderate episodes only

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9
Q

Oropharyngeal cadidiasis/thrush:

what are the topical options?

A

nystatin susp
Clotrimazole troches
miconazole buccal tab

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10
Q

Oropharyngeal cadidiasis/thrush:

topical or systemic is superior?

A

systemic fo sho

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11
Q

Oropharyngeal cadidiasis/thrush:

when you absolutely must use systemic therapy?

A

if concomitant candida esophagitis

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12
Q

Symptoms of esophageal candidiasis

A

retrosternal burning pain/discomfrot
dysphagia
odynophagia

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13
Q

Treatment of choice for esophageal candidiasis

A

fluconazole 100 mg PO IV or QD x 14 - 21 days

IV when having issues swallowing for sure — at least initially the move to PO!

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14
Q

Options for Vulvovaginitis Cadidia infection:

A

topical azoles if skin involvement
PO fluconazole
(do longer fluconazole treatment regimens if severe/recurrent episodes)

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15
Q

Primary Prophylaxis for candida infections?

A

NOT RECOMMENDED!!

only do daily secondary prophylaxis if severe/frequent esophagitis or vaginitis

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16
Q

Cryptococcous Meningitis:

Sxs?

A

menigitis things: fever, HA, malaise..

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17
Q

Diagnosis of Cryptococcus meningitis done how?

A

lumber punctures/CSF analysis….

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18
Q

Cryptococcus Pneumonia

________ be excluded in AIDS patients

A

concomitant meningitis

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19
Q

Treatment of Cryptococcus Meningitis:

Overall into what different phases?

A

3 phases:

induction –> consolidation –> maintenance

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20
Q

Treatment of Cryptococcus Meningitis:

what does induction phase consist of?

A

IV liposomal amphotericin B + PO flucytosine x 2 weeks

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21
Q

Treatment of Cryptococcus Meningitis:

what does consolidation phase consist of?

A

PO fluconazole x 8 weeks

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22
Q

Treatment of Cryptococcus Meningitis:

what does maintenance phase consist of?

A

fluconazole x 1 yr

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23
Q

Treatment of Cryptococcus Meningitis:

When to do primary or secondary prophylaxis

A

priamary – almost like never

secondary is like maintenance therapy…secondary prophylaxis CAN be stopped at some point..

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24
Q

what is PCP

A

pneumocystis jirovecii/carnii Pneumonia

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25
Q

main symptoms seen with PCP?

A

CHF like symptom of progressive dyspnea on exertion
annnnd
a NON-productive cough

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26
Q

Hypoxemia: deemed as pO2 < ______ mmHg

A

70

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27
Q

DOC regimen for PCP?

A

SMZ-TMP: HIGH DOSE x 21 days

28
Q

possible adjunctive therapy for PCP?

A

prednisone

29
Q

when to add prednisone for PCP?

A

when pO2 < 70 mmHg

also best to start with INITIATION of PCP therapy

30
Q

should you do Primary prophylaxis for PCP?

A

YES! ALL HIV PTs start when CD4 count is less than 200

31
Q

should you do Secondary prophylaxis for PCP?

A

must do it!

32
Q

can you ever stop prophylaxis for PCP?

A

yes only when CD4 count has been above 200 for 3 consistent months

33
Q

what infection can be affected by lifestyle choices a lot (can come from shell fish, raw/undercooked meat or soil or cat feces exposure)

A

toxoplasma gondii

34
Q

main treatment for Toxoplasma?

A

pyrimethamine and sulfadiazine x 6 weeks and leucovorin

35
Q

what is leucovorins role in toxoplasma treatment

A

it help minimize bone marrow suppression from pyrimethamine

36
Q

what are the adjunctive therapy options for toxoplasma treatment and when to use them?

A

steroids - use for patients with mass effect from focal lesions or assoc. edema and
anticonvulsants - if history of of seizures (only to use during acute treatment)

37
Q

when to do primary prophylaxis for toxoplasma?

A

when pt is seroPOSITIVE and do it when CD4 is < 100

38
Q

Washing hands (after soil or cat liter handling) and fruits is important what type of patient?

A

Toxo IgG seroNEGATIVE toxoplasma

39
Q

what does MAC stand for

A

mycobacterium avium complex

40
Q

MAC occurs most when CD4 count is below what?

A

50!

41
Q

MAC Symptoms:

Gradual onset or hit them like a train?

A

gradual onsest

42
Q

Treatment of MAC should involve at least 2 or more __________ drugs

A

antimycobacterial

43
Q

what are the main drugs used for treating MAC

A

Clarithromycin and Ethambutol

maybe rifabutin

44
Q

treat disseminated MAC for how long?

A

> 12 months

45
Q

If pt with disseminated MAC is not on ART..when do you start ART?

A

preferably as soon as ART is started

46
Q

when treating MAC: watch out for drug interactions b/w rifabutin or clarithromycin and the use of what 2 specific ARTs mainly?

A

Protease inhibitors

and NNRTIs

47
Q

when to do primary prophlaxis for MAC?

A

only do it it pts are NOT on fully suppressive ART and have CD4 count < 50

48
Q

do secondary prophylaxis for who and how long after MAC?

A

everyone gets it for a year

49
Q

DOC for oropharyngeal cadidiasis

A

fluconazole PO QD 7 - 14 days

50
Q

Monitor ________ periodically during prolonged azole therapy

A

LFTs

51
Q

Azoles can cause ______ or ______ as side effects

A

GI upset

hepatoxicity

52
Q

Side effects of IV amphotericicin?

A

NEPHROtoxicity (BUN/SCr monitoring)
Hypokalema (electrolyte monitoring)
hypomagnesemia (electrolyte monitoring)
Infusion related reactions

53
Q

Side effects of Flucytosine/monitor what?

A

Bone marrow suppression (CBC once or twice weekly)

54
Q

T or F: you do not need to renal adjust flucytosine

A

false you hella do need to adjust

55
Q

Alt. Therapy options for PCP?

A

Atovaquone
Primaquine
DAPSONE + TMP

56
Q

SMX-TMP:

Side effects?

A

some reason a lot higher in pts with AIDS

Rash, fever, leukopenia/thrombocytopenia/ hepatitis, HYPERKALEMIA

57
Q

Monitor what when giving SMX-TMP?

A

CBC/SCr and K (2 - 3 times per week)

58
Q

what two drugs do you need to test for G6PD deficiency (because risk of methemoglobinemia/hemolysis)

A

Dapsone and Primaquine

relevant to PCP

59
Q

ADEs of ethambutol?

A

optic neuritis

hepatoxicity

60
Q

ADEs of rifabutin?

A

red/orange colored body fluids
hepatoxicity
uveitis

61
Q

DOC for PCP prophylaxis?

A

BACTRIM DS PO QD

62
Q

DOC for Toxoplasma primary prophylaxis?

A

BACTRIM DS PO QD

63
Q

For Primary prophylaxis:

Dapsone alone is ok to cover PCP or Toxoplasma?

A

Dapsone is only ok alone for PCP;

Dapsone needs to be given with pyrimethamine if want to cover Toxoplasma

64
Q

For secondary prophylaxis for Toxoplasma:

do what drugs?

A

(same as treatment)

pyrimethamine and sulfadiazine and leucovorin

65
Q

drug of choice for MAC primary prophylaxis

A

Azithromycin once WEEKLY

66
Q

drug of choice for MAC secondary prophylaxis

A

Clarithromycin/Ethambutol +/- rifabutin

Therapeutics 5 Kappa Epsilon (27 decks)

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