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Clin Med II > ID Tx > Flashcards

ID Tx Flashcards

1
Q

What pphx should HIV pts be on w/ CD4 <200

A

TMP/SMZ, if allergic → dapsone, atovaquone

for PCP

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2
Q

What pphx should HIV pts be on w/ CD4 <50

A

Azithromycin 2 g qwk or clarithromycin

for MAC

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3
Q

What is the goal of HIV tx?

A

get viral load to undetectable (<20)

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4
Q

If pt has + HLA-b5601 what HIV medication should you AVOID?

A

Do NOT use Abacavir due to hypersensitivity response*

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5
Q

What medication should you avoid in the first 8 wks pregnancy?

A

efavirenz

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6
Q

Tx for HIV w/ + HBV

A

Must use Tenofovir AF or DF and Emtricitabine + fully suppressive ARV tx

Can use entecavir if tenofovir cannot be used

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7
Q

Post-exposure Prophylaxis

A

Raltegravir 400 mg twice daily + tenofovir DF/emtracitabine (Truvada) QD x 4 wks

Within 2 hrs best, MAX 72 hrs

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8
Q

Who gets Pre-exposure Prophylaxis (PrEP)?

A

Inj drug users, sex workers, hx unprotected intercourse esp MSM

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9
Q

What drug is used for Pre-exposure Prophylaxis (PrEP)?

A

Tenofovir DF 300 mg + emtricitabine 200 mg (Truvada) one PO daily

90 day supply

Test q3mo

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10
Q

What are the NRTIs?

A

Abacavir (Ziagen)

Emtricitabine (Emtriva)

Lamivudine (Epivir)

Tenofovir AF or DF

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11
Q

What are the integrase inhibitors?

A

Raltegravir (Isentress)

Elvitegravir (only in combo with cobisistat/tenofovir AF or DF/emtricitabine =

Genvoya/Stribild)

Dolutegravir

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12
Q

What are the protease inhibitors?

A

Darunavir

Ritonavir

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13
Q

Gram + Cocci

A

Staph
Strep
Enterococcus

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14
Q

Gram + Rods

A

Listeria
B. anthrax
Clostridium
B. cereus

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15
Q

G- diplococci

A

Gonorrhea

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16
Q

G- coccobacilli

A

H. flu
Morexilla
Enterobacter

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17
Q

G- rods

A 
E. coli
Salmonella
Klebsiella
Shigella
Pseudomonas
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18
Q

Spirochetes

A

Treponema → Syphilus

Borrelia → Lyme

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19
Q

Molds

A

Dermatophytes → skin

Asperigillus

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20
Q

Yeast

A

Candida

Cryptococcus

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21
Q

GAS tx

A

penicillin x 10 d

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22
Q

UTI rx

A

nirtofuraintoin

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23
Q

complicated otitis media tx

A

amoxicillin + tylenol

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24
Q

CAP tx

A

azithromycin

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25
Q

G+ meningitis

A

ceftriazone + vancomycin

may want to add dexamethasone

if old/immunocompromised also add Ampicillin (to cover listeria)

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26
Q

Infected wound tx

A

Augmentin or IV vanc/linezolid

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27
Q

chlamydia tx

A

azithromycin

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28
Q

gonorrhea tx

A

ceftriazone + azithromycin

29
Q

Hospital acquired pneumo tx

A

Pip/tazo + aminoglycoside or quinilone

30
Q

c diff tx

A

metronidazole (or oral vanc) or await stool studies

31
Q

Hospital acquired infection

A

IVF + meropenem + vancomycin

32
Q

acute sinusitis sx > 10 d

A

augmentin + saline irrigation and decongestants

33
Q

Bronchitis tx

A

Nsaids

if no improvement in 1 wk consider macrolides or doxy

34
Q

Tx for RMSF

A

doxycycline

35
Q

AE of Tenofovir DF (AF better)

A

Renal Disease

Bone loss

36
Q

AE of NRTIs

A

Lipodystrophy

Lipoatrophy

37
Q

AE of Protease inhibitors

A

Lipodystrophy

Lipid changes

Heart disease

38
Q

AE of NNRTIs

A

Lipid changes

39
Q

What should you avoid with PI or boosters (ritonavir/cobisistat)?

A

simvastatin, lovastatin or pitavastatin

40
Q

What should you avoid with PI or NNRTIs?

A

St John’s wort

41
Q

What should you avoid with PI AND boosters combined?

A

fluticasone

42
Q

What meds should you avoid with PIs?

A

benzos

CCB

43
Q

What is effect on viagra (PDE5 inhibitor) if taken with PI orNNRTIs?

A

levels of viagra are INC w/ PI and DEC w/ NNRTIs

44
Q

PPhx for PJP w/ HIV

A

PPhx CD4 <200

Trimethoprim-sulfamethoxazole 160 mg/800 mg one PO daily

Alternatives: dapsone or atovaquone

45
Q

PPhx for M. tuberculosis w/ HIV

A

PPhx for all pts w/ ⊕ PPD or close contacts of TB pts

Isoniazid

46
Q

Pphx for Mycobacterium Avium Complex (MAC) w/ HIV

A

PPhx CD4 <50

Azithromycin 1200 mg weekly

47
Q

TB treatment

A

Initial-
Daily INH, rifampin, PZA & ethambutol* X 8 wks (56 doses* may D/C ethambutol if sensitivities favorable)

Pyradoxine (vit B6) 25 mg PO daily

Continuation- INH and rifampin qd x 18 wk or 2x/wk x 18 wks

48
Q

What is intermittent Preventive Treatment in Pregnancy (IPTp) for malaria?

A

give > 2 times during pregnancy

Protects against maternal anemia & low birth weight but less effective if HIV+

also recommended in infants

49
Q

Tx for Plasmodium falciparum

A

Medical emergency*

IV quinidine or IV artesunate

ICU
IV fluids, ± blood transfusion
Anti-convulsants if seizure
Glucose if hypoglycemic

50
Q

Tx for P vivax, P ovale and P malariae

A

Chloroquine

Primaquine x 14 days

Must treat liver hypnozoites to prevent
relapse (chloroquine doesn’t kill in liver) → screen for G6PD deficiency first

51
Q

Babesiosis tx

A

Mostly self-limited

Treat severe and sx dz

Atovaquone + azithromycin (fewer side effects)

or Clindamycin + quinine

52
Q

Tx for Giardia Intestinalis

A

Metronidazole

Tinidazole – single dose

Nitazoxanide

May need to treat multiple times before its gone due to relapse

53
Q

Amoebiasis tx

A

If colitis or liver abscess→ Metronidazole (kills trophozoites) then luminal agent (to act on cysts)

If asymptomatic → luminal agent only

54
Q

Cryptosporidiosis tx

A

If immunocompetent will recover in 1-2 wks

HIV (CD4 <200) → chronic diarrhea

↓ e immunosuppression (e.g., ARVs in HIV+)

Nitazoxanide (efficacy isn’t great)

55
Q

Chagas Disease tx

A

Antiparasitic drugs not very effective

Long duration of treatment (months)

Cure in only ~50%

Pacemaker

Cardiac transplantation

56
Q

Kala-azar

Visceral Leishmaniasis (VL) tx

A

Majority of infections self-resolving

Pentavalent Antimony (SbV) = 1st line

Liposomal amphotericin B= tx of choice in US

57
Q

Mucocutaneous Leishmaniasis (ML) tx

A

Tx of cutaneous lesion may not prevent future mucosal lesion

Mild: topical paromycin, heat therapy, intralesional antimony

Moderate: pentavalent antimony, fluconazole/ketoconazole x4-6 wks, oral miltefosine

58
Q

When is surgery indicated for infective endocarditis

A 
CHF
Recurrent systemic embolization
Uncontrolled sepsis
Conduction disturbances, myocardial abscess
Fungal endocarditis
Large vegetation size
59
Q

What pphx would you give pt prior to dental procedure that involves perf of mucosa?

A

Amoxicillin 2 gm po
or
Cephalexin 2 gm po (if PCN allergic)

60
Q

Pt w/ fever and neutropenia

A

Rapid initiation of empiric antimicrobial therapy is mandatory (treat even if fever is only sx in immunocomp pts)

61
Q

Therapy goals for Infections in Neutropenic Host

A

Initial antimicrobial therapy is empiric

Gram negative coverage is mandatory

Recovery of the neutrophil count * major prognostic factor

62
Q

What should you do if f patients remains febrile despite adequate antibacterial coverage?

A

consider beginning antifungal therapy

63
Q

What preventive measures should you take for neutropenic pts to try to prevent infection?

A

Isolation

Consider prophylactic antimicrobials

Granulocyte colony stimulating factor (G‐
CSF)

64
Q

PPhx for PJP w/ HIV +

A

Begin at CD4 <200

Trimethoprim‐sulfamethoxazole (Bactrim) which also protects against toxoplasma infections

Alt: dapsone, atovaquone

65
Q

PPhx for MAI and TB w/ HIV +

A

Azithromycin for MAC at CD4 <50

PPhx for TB w/ isoniazid for all pts w/ + PPD or quantiferon (or close contacts of TB pt)

66
Q

Sepsis tx

A

Medical emergency

Abx + supportive care

Delay in effective antibiotics → ↑ mortality

ARDS→ ventilate w/ low tidal vol (6mL/kg), control inflam and prevent vol overload that will ↑ lung congestion

67
Q

Septic Shock tx

A

Stabilize resp and establish IV access

Empiric broad-spectrum abx (Vancomycin + carbapenem +/- fluoroquinolone or aminoglycoside)

IV bolus crystaloid (LR, 0.9% NS)→ want to maintain MAP ≥ 65 mmHg

Once euvolemic → add pressors (NE 1st line)

Stress steroids for shock refractory to vasopressor therapy

Admit to ICU

Drain spaces, surg control

If pt unable to clear lactate to <2 → poor prognosis*

Supportive meas: mech vent, renal replacement therapy, nutrition, blood glucose control, prevent DVT and stress ulcers

68
Q

DIC management

A

Serial labs to monitor

If pt is bleeding → bleeding by giving coag support (FFP, cryo)

If pt clotting → give antigoagulation (heparin drip)

PRBC to replace lose blood vol

Support: vasopressors, O2, ventilator

Clin Med II (19 decks)

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