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Infectious Diseases Module > EXAM FIVE COVERAGE > Flashcards

EXAM FIVE COVERAGE Flashcards

1
Q

What antivirals are used for Herpes Simplex HSV and Varicella Zoster VZV?

A
  1. Acyclovir
  2. Valacyclovir
  3. Penciclovir
  4. Famciclovir
  5. Docosanol (HSV Only)
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2
Q

What antivirals are used for Cytomegalovirus CMV?

A
  1. Ganciclovir
  2. Valganciclovir
  3. Foscarnet
  4. Cidofovir
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3
Q

Acyclovir

A
  1. 10x more potent against HSV than VZV
  2. Requires 3 phosphorylation steps for activation
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4
Q

Valacyclovir

A
  1. Prodrug of Acyclovir
  2. More potent PO valacyclovir = IV acyclovir
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5
Q

Famciclovir

A
  1. Renally eliminated
  2. Inhibits DNA Polymerase
  3. Has 3 OH Groups
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6
Q

Penciclovir

A

Topical Agent
1. Prodrug of Famciclovir

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7
Q

Docosanol

A

Topical Agent
1. Inhibits fusion of HSV

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8
Q

Acyclovir AEs

A
  1. Nausea
  2. HA
  3. Diarrhea
  4. Nephrotoxicity
  5. Neurotoxicity
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9
Q

Famciclovir AEs

A
  1. Nausea
  2. HA
  3. Diarrhea
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10
Q

Valacyclovir AEs

A
  1. Nausea
  2. HA
  3. Neurotoxicity
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11
Q

How to avoid Neurotoxicity for Acyclovir?

A

Infuse slowly, maintain hydration, avoid concomitant nephrotoxic agents

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12
Q

How to avoid Neurotoxicity for Acyclovir and Valacyclovir?

A

Infuse slowly, monitor in high doses of valacyclovir

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13
Q

Ganciclovir

A

Acyclic Guanosine Derivative
1. Same MOA as Acyclovir
2. IV

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14
Q

Valganciclovir

A
  1. Prodrug of Ganciclovir
  2. PO = Take with FOOD
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15
Q

Foscarnet

A

Inorganic pyrophosphate analog
1. Requires NO phosphorylation
2. Blocks pyrophosphate binding site, blocking DNA polymerase binding

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16
Q

Cidofovir

A

Cytosine Analog
1. Does NOT require activation for phosphorylation
2. Inhibits DNA polymerase

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17
Q

What is a MAJOR AE concern for Ganciclovir and Valganciclovir?

A

Myelosuppression

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18
Q

All Anti-CMV drugs are really eliminated causing probable nephrotoxicity, what are the possible forms of nephrotoxicity seen with each drug?

A

Ganciclovir/Valganciclovir: INCREASE SCr
Foscarnet: TUBULAR Damage
Cidofovir: Proximal TUBULE Damage

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19
Q

How do you prevent Nephrotoxicity with Foscarnet?

A
  1. Maintain adequate hydration
  2. Prehydrate with NS
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20
Q

How do you prevent Nephrotoxicity with Cidofovir?

A
  1. Pre and Post Hydration with 1L NS
  2. Probenecid – 3 DOSES on day of cidofovir infusion: it prevents tubule uptake and increase the half life of the drug
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21
Q

What is Letermovir?

A

Random Anti-CMV Agent
MOA: Maturation Inhibitor
Specifically for Prophylaxis

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22
Q

Baloxavir Marboxil = Xofluza

A
  1. Inhibits PA
  2. Approved for adults and adolescents >12
  3. Single weight based dose
  4. CHELATION Interaction
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23
Q

What are the Neuraminidase Inhibitors used in Influenza?

A
  1. Oseltamivir
  2. Zanamivir
  3. Peramivir
    Competitively inhibit neuraminidase activity
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24
Q

Oseltamivir PO = Tamiflu

A

AE: N/V, HA, take with FOOD

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25
Q

Zanamivir INH = Relenza

A

AE: Cough, bronchospasm
AVOID if airway disease or allergy with milk

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26
Q

Peramivir IV = Rapivab

A

AE: Diarrhea, Hyperglycemia, SJS

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27
Q

Influenza Big Picture

A
  1. PA Endonuclease or Neuraminidase Inhibition
  2. MUST initiate within 2 days of symptom onset
  3. Oseltamivir and Peramivir RENALLY dosed
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28
Q

HBsAg

A

HBC surface antigen

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29
Q

HBVDNA

A

Viral Load

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30
Q

Anti-HBc

A

Antibody to HBV core

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31
Q

Anti-HBs

A

Antibody to HBV cell surface

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32
Q

Antigen of Surface HBs present greater than 6 months suggests chronic HBV but antibody to surface HBs present suggests what?

A

Immunity to HBV

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33
Q

Antibody to Core Particle present suggests what?

A

Past or present infection

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34
Q

What is the disease course for Hepatitis B?

A

Inflammation –> Fibrosis –> Cirrhosis

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35
Q

What are the FOUR major phases of Hepatitis B?

A
  1. Immune Tolerant
  2. Immune Clearance
  3. Non-Replication
  4. Reactivation
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36
Q

What two phases of Hepatitis B are considered active fighting phases and would require treatment?

A

Immune Clearance and Reactivation

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37
Q

Immune Clearance and Reactivation phases both have HIGH ALT and ACTIVE Inflammation, but how do they differ in terms of HBVDNA?

A

Immune Clearance = HIGH
Reactivation = Intermediate-High

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38
Q

What are the 3 main options for HBV Treatment?

A
  1. Tenofovir AF and DF
  2. Entecavir
  3. Peglated Interferon Alfa 2a
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39
Q

Tenofovir Disproxil Fumarate TDF

A
  1. Adenosine nucleotide analog
  2. KNOWN for nephrotoxicity and osteotoxicity (decrease in mineral density)
  3. TDF best data in pregnant women
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40
Q

Tenofovir Alafenamid TAF

A
  1. Adenoside nucleotide analog
  2. NOT nephrotoxic or osteotoxic
  3. TAF is safer and has some data in pregnant women
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41
Q

What are AEs that are seen in TDF and TAF?

A
  1. Lactic acidosis
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42
Q

Entecavir

A
  1. Guanosine Nucleoside Analog
  2. Take on EMPTY STOMACH
  3. Renal dose adjustment
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43
Q

What are the 3 main sites of activity for Entecavir, even thought it does NOT make it more potent that TDF/TAF?

A
  1. Base Priming
  2. Reverse Transcriptase
  3. Synthesis of new HBVDNA
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44
Q

Pegylated Interferon Alfa 2a

A
  1. Inhibits cellular growth, surface antigen expression, etc. multiple MOAs
  2. WEEKLY INJECTION: same day around the same time
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45
Q

What are the AEs of Pegylated Interferon Alfa 2a

A
  1. Fatigue, HA, Insomnia, Depression, Dizziness
  2. Alopecia
  3. N/V/D, Anorexia
  4. Weakness, myalgia
  5. Fever, increased bacterial infections
  6. Cytopenias, hypo/hyperthyroidism, increased LFTs
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46
Q

HBV Big Picture

A
  1. NO cure
  2. Only start therapy in those with active inflammation, high HBVDNA, and high ALT
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47
Q

Monitoring for patient with HBV and NO treatment

A
  1. HBVDNA
  2. ALT
  3. Biopsy every 6-12 months
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48
Q

Monitoring for patient with HBV and ON treatment

A
  1. HBVDNA at 12 and 24 weeks after initiation and can extend to every 3-6 months
  2. Monitor drug toxicities
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49
Q

An increase in HBVDNA can most often be explained by what?

A

Nonadherence to medication

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50
Q

What element of pathophysiology in HCV causes for the requirement of multiple medications for treatment?

A

RNA-Dependent RNA Polymerase that is prone to error leading to mutations

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51
Q

What are the goals of treatment for HCV?

A
  1. Reduce all cause mortality
  2. Reduce liver-related complications
  3. Achieve SVR12 = Cure
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52
Q

What are the NS5A Inhibitors used in HCV?

A
  1. Ledipasvir
  2. Pibrentasvir
  3. Velpatasvir
  4. Elbasvir
    +ASVIR
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53
Q

What are the NS5B Inhibitors used in HCV?

A
  1. Sofosbuvir
    +BUVIR
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54
Q

What are the NS3/4A Inhibitors used in HCV?

A
  1. Glecaprevir
  2. Voxilaprevir
    +PREVIR
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55
Q

In the treatment of HCV, you MUST ALWAYS use >2 agents from different classes, therefore what are the 3 first line regimens for treatment NAIVE?

A
  1. Ledipasvir/Sofosbuvir = HARVONI
  2. Velpatasvir/Sofosbuvir = EPCLUSA
  3. Glecaprevir/Pibrentasvir = MAVYRET
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56
Q

HARVONI is considered what type of coverage?

A

NARROW = covers only GT1

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57
Q

EPCLUSA and MAVYRET are considered what type of coverage?

A

BROAD = covers GT1-GT2-GT3

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58
Q

What is the dose and duration of HARVONI and EPCLUSA for GT1 treatment?

A

1 tablet
Duration 12 weeks no matter if cirrhosis is present or not

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59
Q

What is the dose and duration of MAVYRET for GT1 Treatment?

A

3 tablet
Duration 8 weeks no matter if cirrhosis is present or not

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60
Q

What is the duration of MAVYRET for GT2 and GT3 Treatment?

A

8 weeks

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61
Q

What is the duration of EPCLUSA for GT2 and GT3 Treatment?

A

12 weeks
If cirrhosis =MUST check for resistance prior to starting

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62
Q

Harvoni, Epclusa, and Mavyret are all affected by strong CYP3A4 Inducers but what does Amiodarone do to them?

A

Sofosbuvir + any other direct acting antiviral = BRADYCARDIA
AKA only MAVYRET not affected

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63
Q

What two ingredients and drugs are affected by ACID Suppressants?

A

Velpatasvir = EPCLUSA
Ledipasvir = HARVONI

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64
Q

What DDI affects Harvoni, Epclusa, and Mavyret and must require dose adjustments?

A

Statins

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65
Q

What are the 3 MOST COMMON AEs of DAA?

A
  1. HA
  2. Fatigue
  3. Nausea
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66
Q

What are characteristics that make patients with HCV more difficult to treat?

A
  1. Presence of Cirrhosis
  2. Previous treatment failure
  3. GT1a over GT1b
  4. Presence of resistance mutations
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67
Q

What is Ribavirin?

A

MOA: Inhibit initiation and elongation of viral fragments through RNA polymerase
1. TAKE WITH FOOD
2. ANEMIA AE MAJOR
3. AVOID IN PREGNANCY and 6 MONTHS post
Old Agent

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68
Q

Monitoring for HCV Pre-Treatment HBV Reactivation

A
  1. HCV has suppressive activity against HBV
  2. Pre-Screen before starting HCV treatment
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69
Q

Monitoring for HCV During Treatment

A
  1. LFTs
  2. CBC if on RIBAVIRIN
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70
Q

Monitoring for HCV POST Treatment

A
  1. SVR12 - 12 weeks after treatment completed - sustained virology response 12 weeks after
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71
Q

What are the Replicative Enzymes in HIV?

A
  1. Reverse Transcriptase = replication
  2. Integrase = permanent infection
  3. Protease = cleaves polybprotein making it infectious
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72
Q

HIV binds to 1 or 2 coreceptors on the CD4 cell, what are those 2 sites?

A
  1. CXCR4
  2. CCR5
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73
Q

After binding to the CD4 cell, attachment and fusion occurs how?

A

Attach via gp120 subunit on HIV envelope attaches to CD4
Fusion via HIV envelope subunit gp41 fuses to CD4 cell

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74
Q

After attachment and fusion, reverse transcriptase does what?

A

Convert HIVRNA to HIVDNA

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75
Q

HIVDNA then travels to the nucleus of CD4 where ___ integrates HIVDNA into human DNA

A

Integrase

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76
Q

Replication and Assembly of new HIVRNA move to the cell surface which is non-infectious, however, immature HIV buds off the CD4 cell and HIV releases ____ that cleaves the long protein chains making it mature and infectious?

A

Protease

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77
Q

What are the drug targets in HIV treatment?

A
  1. Entry Inhibition
  2. Reverse Transcriptase and Nucleosides
  3. Integrase
  4. Protease
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78
Q

What are the specific targets that fall under Entry Inhibition targets?

A
  1. CCR5 on CD4 cell
  2. gp120 on HIV cell
  3. Domain 2 on the CD4 cell
  4. gp41 on the HIV cell
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79
Q

List the drugs that are classified as Entry Inhibitors

A
  1. Maraviroc
  2. Fostemsavir
  3. Ibalizumab
  4. Enfuirtide
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80
Q

Maraviroc

A

CCR5 Antagonist
1. ONLY drug to work on CD4 Cell
2. Salvage Therapy
3.BID
AE: Orthostatic Hypotension

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81
Q

Fostemsavir

A

Attachment Inhibitor
1. Hydrolyzed to Temsavir - Prodrug
2. PO BID
AE: QT Prolongation

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82
Q

Ibalizumab

A

Post Attachment Inhibitor
1. Causes conformational change prevents HIV binding to CD4
2. Salvage Therapy
3. IV
AE: Infusion Related

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83
Q

Enfuvirtide

A

Infusion Inhibitor
1. Prevents the fusion of HIV envelope and the CD4 cell
2. SQ BID
AE: Nodules at Injection Site

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84
Q

Would you use entry inhibitors as initiation therapy for HIV?

A

NO they are SALVAGE therapy and ALL can be taken without regard to food

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85
Q

List the drugs that are classified as Nucleoside Reverse Transcriptase

A
  1. Abacavir
  2. Emtricitabine
  3. Lamivudine
  4. Tenofovir AF
  5. Tenofovir DF
  6. Zidovudine
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86
Q

What is the class adverse effect for Nucleoside Reverse Transcriptase NRT?

A

MITOCHONDRIAL toxicity
Lactic Acidosis most common

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87
Q

What is the AE of Abacavir and what should be tested before initiating therapy?

A

AE: Hypersensitivity, fever
TEST HLAB5701 REQUIRED

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88
Q

What are the AEs of Emtricitabine and Lamivudine?

A

NONE, well tolerated

89
Q

What are the AEs of Tenofovir AF and Zidovudine?

A

TAF: Increased LDL
Zidovudine: Anemia, neutropenia

90
Q

How often should NRTs be dosed?

A

QD or BID
TAF/TDF are QD
Zidovudine is BID
the rest are either

91
Q

List the drugs that are Non-Nucleoside Reverse Transcriptase

A
  1. Doravirine
  2. Ertavirine
  3. Efavirenz
  4. Rilpivirine
92
Q

NNRTs work by causing conformational change and inactivating RT, but how do NRTs differ?

A

NRTs stops chain elongation and blocking HIVDNA creation

93
Q

What is the class adverse effect of NNRTs?

A

RASH

94
Q

What is the AE and dosing of Doravirine?

A

PO QD
Sleep Disturbance

95
Q

What is the AE and dosing of Efavirenz?

A

PO QD HS
Sleep disturbance, vivid dreams, hungover feeling

96
Q

What is the AE and dosing of Ertavirine?

A

PO BID
Severe Rash

97
Q

What is the AE and dosing of Rilpivirine?

A

PO QD with 400 CALORIES
Sleep disturbance, vivid dreams

98
Q

List the drugs that are Integrase Inhibitors

A
  1. Bictegravir
  2. Cabotegravir
  3. Dolutegravir
  4. Elvitegravir
  5. Raltegravir
99
Q

What is the MOA of Integrase Inhibitors?

A

Bind to Mg or Mn cofactor on integrase enzyme and inhibits the activity of the enzyme

100
Q

Bictegravir

A

PO QD
AE: False Increase in SCr
FIRST LINE

101
Q

Cabotegravir

A

IM q4wks
AE: Injection site

102
Q

Dolutegravir

A

PO QD
AE: HA, insomnia, false increase in SCr

103
Q

Elvitegravir

A

PO QD with FOOD
HIGHEST risk of resistance, least used

104
Q

Raltegravir

A

PO QD or BID
AE: myopathy

105
Q

List the drugs that are Protease Inhibitors

A
  1. Atazanavir
  2. Darunavir
106
Q

What is the MOA of Protease Inhibitors?

A

Bind near active site of protease enzyme and inhibits cleavage of proteins aka inhibits maturation and infective quality

107
Q

Protease Inhibitors as a class cause N/V/D but how should the drugs be administered?

A

WITH FOOD

108
Q

Atazanavir

A

PO W/MEAL w/ or w/o PKN booster
AE: HYPERbilirubinemia, lipid sparing if unboosted

109
Q

Darunavir

A

PO QD/BID W/FOOD and MUST BE BOOSTED
AE: Sulfa rash

110
Q

List the drugs that are PKN Boosters

A
  1. Cobicistat
  2. Ritonavir
    Both are strong CYP450 inhibitors
111
Q

Cobicistat

A

With Protease Inhibitor or Elvitegravir
AE: false increase in SCr

112
Q

Ritonavir

A

PO with FOOD and Protease Inhibitor
AE: GI, dyslipidemia

113
Q

Atazanavir DDI Acid Suppressants

A

Protease Inhibitor
Antacids: take them 2hrs before or 1 hr after
H2RAs: take at the same time or 10hrs after
PPIs: AVOID

114
Q

Rilpivirine DDI Acid Suppressants

A

NNRT
Antacids: take 2 hrs before or 4 hrs after
H2RAs: take 12hrs before or 4 hrs after
PPIs: AVOID

115
Q

What drug class interactions via Chelation and should be separates with Mg, Al, Fe, Ca, Zn 2 hrs before or 6 hrs after administration?

A

INSTs = Integrase Inhibitors

116
Q

NNRTs interact with what type of CYP3A4?

A

ALL of them interact with 3A4 substrates
Efavirenz and Etravirine interact with 3A4 inducers

117
Q

INSTIs interact with what type of CYP3A4?

A

Bictegravir, Folutegravir, and Elvitegravir interact with 3A4 substrates

118
Q

Protease Inhibitors interact with what type of CYP3A4?

A

ALL of them interact with 3A4 Substrates and Inhibitors

119
Q

Entry Inhibitors interact with what type of CYP3A4?

A

Maraviroc and Fostemsavir interact with 3A4 substrates

120
Q

PKN Boosters interact with what type of CYP3A4?

A

Cobicistat and Ritonavir interact with 3A4 inhibitors

121
Q

What are 3A4 inducers that we worry about?

A

Rifamycins, carbamezepine, oxcarbazepine, anti-epileptics, and St. Johns wort

122
Q

Statin metabolism is inhibited by Protease Inhibitors and PKN Boosters, what statins can be used in and which ones are CI’d?

A

Atorvastatin and Rosuvastatin = Preferred
Lovastatin and Simvastatin = CI

123
Q

Corticosteroid metabolism is inhibited by Protease Inhibitors and PKN Boosters, which ones can be used while the rest should be avoided?

A

Beclomethasone and Flunisolide

124
Q

Warfarin has interactions with what two drugs?

A

Efavirenz and Ritonavir

125
Q

In terms of Cobicstat and Ritonavir, what DOACs should be AVOIDED and NEVER used with them?

A

Dabigatran = AVOID w/ Cobicstat
NEVER USE RIVAROXABAN

126
Q

For NRTs when should you renally dose adjust?

A

TDF = CrCl <50
Others = CrCl <15

127
Q

PDE5 Inhibitor metabolism is inhibited by Protease Inhibitors and PKN Boosters, what is the max dose that can be used?

A

Sildenafil = 25 mg q48hrs
Tadalafil = 10 mg q72hrs
Vardenafil = 2.5 mg q72hrs

128
Q

What is the Gold Standard Test for HIV?

A

Antigen/Antibody Test

129
Q

HIV Pathophysiology is infected CD4 cells resulting in a decline in immune function, what amount of CD4 is indicative of AIDS?

A

<200

130
Q

Anti-Retroviral Therapy ART is consisted of what?

A

2 NRT backbone + 3rd agent from a different class (NNRT/PI/INSTI)

131
Q

What are the first line regimens of ART for HIV?

A
  1. Biktarvy =TAF+Emtricitabine+Bictegravir
  2. Descovy + (Trivicay) = TAF+Emtricitabine + (Dolutegravir)
  3. Triumeq = Abacavir+Lamivudine+Dolutegravir
  4. Dovato = Lamivudine+Dolutegravir
132
Q

Biktarvy Considerations

A

Single Tablet Regimen
MOST USED

133
Q

Descovy + Tivicay Considerations

A

2 TINY tablets
MUST be taken TOGETHER

134
Q

Triumeq Considerations

A

Very large single tablet regimen
MUST ASSESS HLA before

135
Q

Dovato Consideration

A

DUAL THERAPY
Single tablet regimen
Do NOT USE if HIVRNA >500,000 copies/mL

136
Q

What are the APPROVED DUAL therapy options for HIV?

A
  1. Dovato = approved for naive patients only
  2. Juluca (Dolutegravir/Rilpivirine) = approved for experienced patients only
  3. Cabreuva (Cabotegravir/Rilpivirine) = IM
137
Q

What is the most important factor in maintain suppression?

A

ADHERENCE

138
Q

What should you AVOID for HIV THERAPY?

A
  1. Two agents from classes that is not NRT
  2. Dual therapy that is not approved
  3. 3 NRTs = resistance
  4. 2 PKN boosters = ONLY need ONE
  5. Lamivudine + Emtricitabine = both are cytosine analogs aka antagonistic
139
Q

What are monitoring considerations for HIV therapy?

A

HIV RNA
CD4
CMP
CBC
STIs

140
Q

Pre-Exposure Prophylaxis PrEP Regimen Options

A
  1. Truvada = at risk through sex or IV drug use
  2. Descovy = at risk through sex excluding receptive vaginal sex
    1 TAB PO QD
    Adults and Adolescents >35 kg
141
Q

How often do you have to re-test for HIV?

A

EVERY 3 MONTHS

142
Q

Post Exposure Prophylaxis PEP

A

Best if initiated within 72 hrs of exposure
TDF/Emtricitabine + Either Raltegravir or Dolutegravir x 28 days

143
Q

What are the recommended regimens for infants born to mothers with HIV?

A

PAIR 2 NRTs + 3rd Agent

2 NRT:
1. TDF + Emtricitabine - nephrotoxicity possible
2. Abacavir + Lamivudine - test HLA

3rd Agent:
1. Raltegravir = BID
2. Dolutegravir = CNS AE, teratogen?
3. Atazanavir + Ritonavir =interaction with acid suppressant
4. Darunavir + Ritonavir = BID

144
Q

When is Intrapartum Zidovudine recommended?

A

HIVRNA>1,000 C-Section delivery

145
Q

Postpartum, must start ART ASAP what are the two regimens?

A
  1. HIVRNA <50 copies/mL = Zidovudine PO BID x 4 WEEKS
  2. HIVRNA >50 copies/mL = Zidovudine + Lamivudine + Raltegravir or Neirapine BID x 6 WEEKS
146
Q

How many tests can safely exclude HIV for infants?

A

2 Negative Tests

147
Q

Mycobacterim Avium Complex MAC Manifestations

A

Fever, night sweats, weight loss
Greatest risk CD4 <50

148
Q

MAC Primary Prophylaxis

A
  1. Initiate ART
  2. If unable to start ART =
    Azithromycin 1200 mg weekly = preferred
    Clarithromycin 500 mg BID
149
Q

MAC Treatment

A
  1. Macrolide (Azithro or Clarithro) + Ethambutol
  2. Rifamycin considered as 3rd agent is needed
    Duration = 12 months
150
Q

Toxoplasmic Encephalitis Manifestation

A

Toxoplasma Gondii - Protozoan Parasite
Encephalitis most common
Most Common with CD4 <100

151
Q

Toxoplasmic Encephalitis Primary Prophylaxis

A

Indicated in those with positive IgG and CD4 <100
1. Bactrim PO Daily - DC once CD4 >200

152
Q

Toxoplasmic Encephalitis Treatment

A

Acute 6 WEEKS = Sulfadiazine + Pyrimethamine + Leucovorin
Chronic >6 Months = LOW dose Sulfadiazine + Pyrimethamine + Leucovorin
- DC when CD4 >200 and asymptomatic for 6 MONTHS

153
Q

What is the AE of Dapsone?

A

Hemolytic Anemia
Check G6PD FIRST

154
Q

What is the AE of Atovaquone?

A

GI, disgusting flavor

155
Q

What is the AE of Sulfadiazine?

A

Rash, sulfa

156
Q

What is the AE of Pyrimethamine?

A

Pantocytopenia

157
Q

Cytomegalovirus Manifestations

A

Retinitis most common followed by colitis
Highest risk in CD4 <50

158
Q

What is the primary prophylaxis for Cytomegalovirus?

A

ART

159
Q

What is the treatment of Cytomegalovirus Retinitis?

A

Induction: 2 wks IV ganciclovir or PO valganciclovir BID
Maintenance: PO valganciclovir QD
Duration = 3 MONTHS until CD4 <100

160
Q

What is the treatment of Cytomegalovirus Colitis?

A

IV ganciclovir
3-6 weeks

161
Q

Pneumocystis Pneumonia Manifestation

A

Pneumocystic Jiroveci PJP
Highest Risk CD4 <200
Pneumonia symptoms

162
Q

What is the primary/secondary prophylaxis for Pneumocystis Pneumonia?

A

Bactrim PO QD - continue until CD4 >200 for 3 months

163
Q

What is the treatment for Pneumocystis Pneumonia?

A

Mild-Mod = Bactrim PO TID
Severe = Bactrim IV TID + CORTICOSTEROIDS
Duration 21 DAYS REGARDLESS OF SEVERITY

164
Q

Oropharyngeal/Esophageal Candidiasis Manifestation

A

C. Albicans
Creamy white plaques

165
Q

What is the primary prophylaxis of Oropharyngeal/Esophageal Candidiasis?

A

NOT recommended

166
Q

What is the treatment of Oropharyngeal/Esophageal Candidiasis?

A

PO FLUCONAZOLE
Oropharyngeal = 1-2 weeks
Esophageal = 2-3 weeks

167
Q

Cryptococcal Meningitis Manifestations

A

Cryptococcus Neoformans or C.Gatti
Highest risk CD4 <100

168
Q

What is the primary prophylaxis for Cryptococcal Meningitis?

A

NOT recommended

169
Q

What is the treatment for Cryptococcal Meningitis?

A

Induction = 2 weeks IV Liposomal Amphotericin B + Flucytosine
Consolidation = 8 weeks Fluconazole 800 PO QD
Maintenance = 1 year Fluconazole 200 PO QD

170
Q

When can you DC Cryptococcal Meningitis therapy?

A

> 1 yr since anti fungal infection
Asymptomatic
CD4 >100
On effective ART

171
Q

Disseminated Histoplasmosis Manifestations

A

Histoplasma Capsultaum
Greatest Risk CD4 <150

172
Q

What is primary prophylaxis of Disseminated Histoplasmosis?

A

None

173
Q

What is the treatment of Disseminated Histoplasmosis?

A

Induction: Liposomal Amphotericin B >2 weeks
Maintenance: Itraconazole for <12 months

174
Q

When can you DC Disseminated Histoplasmosis therapy?

A

Azoles x 1 year
Negative fungal blood culture
Absent serum or urine histo antigen
Not Detectable HIVRNA
CD4 >150

175
Q

Immune Reconstitution Inflammatory Syndrome IRIS

A

Hyper-Inflammatory Response to Infection
Can occur with rapid change from high HIVRNA/low CD4 to lowHIVRNA/high CD4

176
Q

IRIS is most often seen with what and what therapy is recommended?

A

MAC and supportive care

177
Q

In Fungal infections, drugs that target cell wall synthesis have what specific target?

A

(B1,3)-D-Glucan synthase

178
Q

In Fungal infections, drugs that target cell membrane synthesis have what specific target?

A

Squalene Epoxidase or Lanosterol Demethylase

179
Q

Squalene –> ___ –> Erogsterol

A

Lanosterol

180
Q

List the drugs that are Cell Wall Inhibitors in Fungal Infections

A
  1. Caspofungin
  2. Micafungin
  3. Anidulafungin
181
Q

What is the MOA of Cell Wall Inhibitors in Fungal infections?

A

Inhibition of B(1,3)-D-Glucan Synthase
Weakens cell wall, prevents growth

182
Q

List the drugs that are Allylamine/Benzylamines

A
  1. Terbinafine
  2. Butenadine
  3. Naftifine
183
Q

What is the MOA of Allylamine/Benzylamines?

A

Squalene Epoxidase Inhibitor
Call membrane cannot be maintained, buildup of squalene is toxic to fungal organism

184
Q

Allylamine/Benzylamines are administered how?

A

ONLY Systemically/Superficially to treat dermatophytosis

185
Q

List the drugs that are Imidazole Azoles

A
  1. Ketoconazole
  2. Miconazole
  3. Clotrimazole
    SUPERFICIAL ONLY
186
Q

List the drugs that are Triazole Azoles

A
  1. Fluconazole
  2. Voriconazole
  3. Itraconazole
  4. Posaconazole
  5. Isavuconazonium
187
Q

What is the MOA of Azoles?

A

Inhibit lanosterol demethylase, stopping progression to ergosterol
Cell Dies

188
Q

Lanosterol Demethylase is a CYP450 enzyme and therefore,

A

Imidazole affect human CYP450 more than triazoles and are only used topically

189
Q

List the drugs that are Polyenes

A
  1. Amphotericin B
  2. Nystatin
190
Q

What is the MOA of Polyenes?

A

Binds to ergosterol and forms pores causing intracellular contents to leak out
CAN also bind to human cholesterol cells

191
Q

Flucytosine

A

Activity in fungal cell nucleus
Competes with RNA synthesis

192
Q

Griseofulvin

A

Inhibits mitotic spindle formation and cell division

193
Q

Echinocandins AE

A

Infusion Related Reactions

194
Q

Ibrexafungerp is a Major 3A4 substrate

A

AVOID inducers

195
Q

Allylamines/Benxylamine Systemic Terbinafine can cause increased what?

A

Increased LFTs Monitor at 4 weeks

196
Q

Triazoles are teratogenic and have what AE as a class?

A

QT Interval Changes

197
Q

Fluconazole Pearls/AEs

A

100mg for oropharyngeal candidasis
800 mg for cryptococcal meningitis
QT PROLONGATION
Good diffusion into CNS

198
Q

Voriconazole AEs

A
  1. VISUAL DISTURBANCES
  2. Photoxicity, rash
  3. QT Prolongation
199
Q

Itraconazole Capsule vs Solution

A

Capsule = ADMIN WITH FOOD
Solution = ADMIN ON EMPTY STOMACH

200
Q

What are the AEs of Itraconazole?

A
  1. CHF
  2. QT PROLONGATION
201
Q

Posaconazole AEs/PEARLS

A

ADMINISTER W/HIGH FAT meal
1. Hyperaldosteronism
2. QT PROLONGATOIN

202
Q

Isavuconazonium AE MUST KNOW

A

QT SHORTENING

203
Q

Amphotericin AEs

A
  1. INFUSION REACTION
  2. RENAL IMPAIRMENT: irreversible tubular damage
204
Q

Dose and Nephrotoxicity of CONVENTIONAL Amphotericin

A

1 mg/kg/day
MOST SEVERE

205
Q

Dose and Nephrotoxicity of LIPOSOMAL Amphotericin

A

3-5 mg/kg/day
Less severe

206
Q

Dose and Nephrotoxicity of LIPID COMPLEX Amphotericin

A

5 mg/kg/day
Less severe

207
Q

Flucytosine AE/Pearl

A

BONE MARROW TOXICITY
PO, Q6hr, weight based
NEVER use as monotherapy

208
Q

Griseofulvin AE

A

HEPTATOXICITY

209
Q

Echinocandins do not have coverage on what organisms?

A
  1. Histo. capsulatum
  2. Crypto. neoformans
  3. Coccidioides
  4. Blastomyces
210
Q

Itraconazole does not have coverage on what organisms?

A

Candidas glabrata

211
Q

Fluconazole does not have coverage on what organisms?

A
  1. Candidas glabrata
  2. Aspergillus fumigatus
212
Q

Flucytosine does not have coverage on what organisms?

A
  1. Aspergillus fumigatus
  2. Histo. capsulatum
  3. Coccidioides
  4. Blastomyces
213
Q

Candida Species most common site of infection?

A

BLOOD

214
Q

What is the first line treatment for Candida Species?

A

Echinocandins

215
Q

What is the first line treatment for Aspergillus Species?

A

Voriconazole for 6-12 weeks

216
Q

What is first line treatment for Blastomyces?

A

Pulmonary: Itraconazole and Amphotericin B
CNS: Fluconazole

217
Q

What is first line treatment for Coccidiodomycoses?

A

Pulmonary: Itraconzole or Fluconazole
CNS: Fluconazole

218
Q

What is first line treatment for Cryptococcus?

A

CNS: Amphotericin B + Flucytosine followed by Fluconazole
Pulmonary: Fluconazole

219
Q

What is first line treatment for Histoplasmosis?

A

Pulmonary: Itraconazole or Amphotericin B

Infectious Diseases Module (5 decks)

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