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Lung > HIV and Tb > Flashcards

HIV and Tb Flashcards

1
Q

Single nodule >3cm with central calcification

A

Histoplasmosis = most common (dimorphic fungi)

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2
Q

Single nodule with thick-walled cavetation and/or eccentric calcification?

A

Malignant Nodule

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3
Q

Thin-walled cavetation could be?

A

Abscess
Benign Lesion
Tb

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4
Q

Why do you give TMP-SMX in HIV patients?

A

Prophylaxis against PCP and Toxoplasma Gondi

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5
Q

Gram + lancet shaped bug that infects HIV patients?

A

s. pneumonia

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6
Q

When and why give Azithromycin prophylactically in HIV patients?

A

At CD4 < 50 to prevent M avium

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7
Q

Mycolic acid in Tb does what?

A

Inhibits immune activation/phagocytosis

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8
Q

Cord factor in M tubercolsis does what?

A

Increases TNFa
Inhibits macrophage maturation
Causes IL6 –> AOCD

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9
Q

Sulfatides in M tuberculosis does what?

A

Inhibits phagolysosome formation

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10
Q

Latent Tb treatment and why should we treat?

A

Isonizid for 9 mo
Decreases risk of active disease
Decreases Spread/Prevalence

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11
Q

Latent Tb vs Active Tb?

A 
Latent = Not contageous, asymptomatic
Active = Contageous, Symptomatic
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12
Q

Tuberculin Skin test readings
>5mm?
>10mm?
>15mm?

A 
>5 = positive in immunocomp
>10 = positive in IV drugs, medical staff, immigrants
>15 = positive for normal folks
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13
Q

What if you get a positive reading in someone with a BCG vaccine?

A

STILL TREAT

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14
Q

Positive Predictive Value is?

A

True positive/Total postive

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15
Q

Tb drug that binds to RNA polymerase and blocks mRNA elongation

A

Rifampin

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16
Q

Tb drug that inhibits mycolic acid synthesis?

A

Isoniazid

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17
Q

What does supplementing Isoniazid with Pyridoxine do?

A

Prevents peripheral neuropathy by supplementing the loss of B6 caused by Isoniazid

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18
Q

What Tb drug is a pro-drug that is activated by Mycobacterial catalase-peroxidase?

A

Isoniazid

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19
Q

Major toxicities of Isoniazid?

A

Hepatitis = LIMITING FACTOR due to acetylation

Peripheral neuropathy

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20
Q

What Tb drugs turns fluids red?

A

Rifampin

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21
Q

What Tb drug should NOT be giving with protease inhibitors? Why?

A

Rifampin

Induces cyp450

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22
Q

What Tb drug inhibits mycobacterial cell membrane metabolism and transport by acidification?

A

Pyrazinamide

23
Q

What Tb drug inhibits arabinosyl transferases?

A

Ethambutol

24
Q

Why don’t you give Ethambutol ti kids?

A

Blindness side effecty

25
Q

Streptomycin MOA?

A

Inhibits 30S ribosome function

26
Q

Why would you give Streptomycin along with another Tb drug?

A

Streptomycin kills extracellular organisms

Other drugs kill intracellular organisms

27
Q

What is a risk associated with TNFa inhibitors?

A

Tb reactiviation (Macrophages proliferate)

28
Q

NRTIs? (5)

A

TALEZ (AGCCT)

Tenofovir -----A
Abacavir-------G
Lamivudine---C(dine)
Emtricitabine-C(sine)
Zidovudine----T
29
Q

Zidovvudine MOA?

A

Thymidine anolog

30
Q

Anemia and Granulocytopenia are SE of which NRTI?

A

Zidovodine

31
Q

Abacavir MOA

A

Guanosine analog

32
Q

Lamivudine MOA

A

Cytodine analog

33
Q

Most common Abacavir SE?

A

Hypersensitivity

34
Q

Tenofovir MOA

A

Adenosine analog

35
Q

Tenofovir SE?

A

Renal Tox
Hepatotox
flatulence

36
Q

Emtricitabine MOA?

A

Cytosine analog

37
Q

Raltegravir MOA?

A

Integrase inhibitor

38
Q

Protease Inhibitors?

A

RAD

Ritonavir
Darunavir
Atazanavir

39
Q

Ritonavir used in low doses for what?

A

Inhibits Cyp450, increases other protease inhibitors action

40
Q

Protease Inhibitors metabolism?

A

Cyp450 (also inhibit)

41
Q

Entry/fusion inhibitors?

A

ME
Maraviroc
Enfuviritide

42
Q

When use maraviroc?

A

After genetic testing of HIV to see if it binds to CCR5

43
Q

Maraviroc binds what?

A

gp120

44
Q

Enfuvirtide binds what?

A

gp40

45
Q

Non-NRTIs?

A

Efavirenz

Etravirine

46
Q

Non-NRTI MOA?

A

Directly binds Reverse Transcriptase

47
Q

Streptomycin Toxicities?

A

Vertigo

Permanent Hearing Loss

48
Q

Why don’t you give streptomycin to pregnant patients?

A

Causes neonatal deafness

49
Q

What combination of NRTI and Non-NRTI is most effective?

A

2 NRTI, 1 non-NRT

50
Q

Common side effect of Pyrazinamide?

A

Hyperuricemia

51
Q

Common Infectious in HIV patients with CD4 above 200?

A

S Pneumoniae
H influenzae
Tb
Candida

52
Q

Common infections in HIV patients with CD4 <200

A 
PCP
Coccidiomycosis
Cryptosporidium
Aspergillus
Toxoplasma Gondi
53
Q

Common infections in HIV patients with CD4 <50?

A

M Avium
Cryptococcus
CMV

54
Q

What is the difference in the common location of primary vs. secondary Tb?

A

Primary is usually lower lobe

Secondary is usually upper lobe

Lung (6 decks)

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