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Infection Flashcards

1
Q

Recommended pre-txp serologic testing

A
  1. HIV
  2. HBV (HBsAg, HBsAb, HBcAB)
  3. HCV Ab
  4. CMV IgG
  5. EBV IgG
  6. Toxo IgG
  7. Syphilis
  8. TB
    If Endemic region: Strongyloides IgG, Trypanosoma cruzi serology, Coccidioides serology
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2
Q

HBV: Immune due to natural infection

A

HBsAb +
HBcAb +
HBsAg -

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3
Q

HBV: Immune due to vaccination

A

HBsAb +
HBcAb -
HBsAg -

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4
Q

HBV: Active infection (acute or chronic)

A

HBsAb -
HBcAb +
HBsAg +

IgM will determine if acute (+) or chronic (-)

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5
Q

Recommended HBV prevention in liver txp with donor HBcAb+

A

Antiviral ppx for recipient: indefinite vs 1 year

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6
Q

Recommended HBV prevention in non-liver txp with donor HBcAb+

A

Antiviral ppx IF no vaccine or natural immunity; if non-immune consider prophylaxis for up to 1-year

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7
Q

Toxoplasma gondii prophylaxis strategies if donor+ or recipient +

A
  1. Bactrim

2. Atovaquone +/- pyrimethamine + leucovorin

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8
Q

Strongyloides prophylaxis strategies if donor+

A

Ivermectin 200 mcg/kg daily x2 doses

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9
Q

Trypanosoma prophylaxis strategies if donor+ for heart txp

A

Heart –> avoid dt risk of reactivation

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10
Q

Coccidioidomycosis prophylaxis strategies

A

Endemic area: Fluc 200 mg daily

Seropositive: Fluc 400 mg daily x6-12 months

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11
Q

Recipient post-txp recommended serologic testing

A
  1. HIV
  2. HBV
  3. HCV
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12
Q

CMV Preemptive monitoring is appropriate to consider for which groups/organs?

A

High risk: liver, pancreas, kidney

Mod risk: Kidney, liver, pancreas, heart

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13
Q

Kidney txp peri-operative abx recommendations

A

Cefazolin

24 hr

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14
Q

Liver txp peri-operative abx recommendations

A

Zosyn | Unasyn | CTR + amp +/- fluc/mica

24-48 hours

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15
Q

Panc txp peri-operative abx recommendations

A

Some discrepancies - cefazolin vs Unasyn +/- fluc/mica

24-48 hours

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16
Q

Small bowel txp peri-operative abx recommendations

A

Vanc + Zosyn + Fluc/Mica

72hr-7d

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17
Q

Heart txp peri-operative abx recommendations

A

Some discrepancies - cefazolin vs Vanco + CTR/Cefepime
24-48 hours
Delayed chest closure: MRSA, PSA, fungi coverage through chest closure

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18
Q

Lung txp peri-operative abx recommendations

A

Some discrepancies - cefazolin vs Vanco + anti-PSA beta lactam
48-72 hours (or based on donor pathogens)
If CF: target colonizing organisms
Delayed chest closure: MRSA, PSA, fungi coverage through chest closure

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19
Q

Kidney Txp Candida Ppx

A

Not routinely recommended

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20
Q

Liver Txp Candida Ppx

A

Fluc x2-4 weeks for those at risk

Re-op, Re-txp, HD, choledoJ, candida colonization, >40u blood products

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21
Q

Intestine Txp Candida Ppx

A

Fluc/Mica x4 weeks or until anastomosis has healed

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22
Q

Heart Txp Candida Ppx

A

Not routinely recommended

Some populations may quality for anti-aspergillus ppx: re-operaion, CMV disease, post txp HD, recent IA

23
Q

Lung Txp Candida Ppx

A

Anti-aspergillus (vori/itra) x3–6 months

24
Q

Pancreas Txp Candida Ppx

A

Fluc for those at risk

Enteric drainage, thrombosis, pancreatitis

25
Q

PJP Prophylaxis Strategies

A
  1. Bactrim: SS QD or MWF, DS MWF
  2. Dapsone 50 - 100 mg daily
  3. Atovaquone 1500 mg daily
  4. Pentamidine 300 mg monthly
  5. Clinda + pyrimethamine
26
Q

Donor Bacteremia or Meningitis Strategies

A

Tx donor x24-48 hr; recip 7-14d with targeted therapy

27
Q

HIV: Usual HAART combination consists of:

A

3 drug regimen:

  1. NRTI (abacavir, emtricitabine, lamivudine, TAF, TDF, zidovudine)
  2. NRTI
  3. INSTI (“-tegravir”) or NNRTI (“virine”) or PI/booster (“-navir”
28
Q

Which HIV meds have interactions with common txp meds?

A
  1. PI/boosters (“-navir”) = CYP inhibitors

2. NNRTIs = CYP3A4 inducer

29
Q

HCV Pan-genotypic regimens

A
  1. Velpatasvir + Sofosbuvir (Epclusa)

2. Glecaprevir/pibrentasvir (Mavyret)

30
Q

Recommended regimens for kidney or liver txp recipients with HCV-infected grafts (HCV viremic donors)

A
  1. Velpatasvir + Sofosbuvir (Epclusa) x12 wk
  2. Glecaprevir/pibrentasvir (Mavyret) x12 wk

Kidney only: Ledipasvir + sofosbuvir (Harvoni) x12 weeks if genotype 1, 4, 5, 6

31
Q

Epclusa DDI with common txp meds, PPI, DOAC

Velpatasvir + Sofosbuvir

A
  1. Mild P-gp inhibition; minimal DDI with ISN
  2. PPI: separate by 4 hr bc PPI may reduce HCV DAA exposure
  3. DOACs: Potential inc exposure of DOAC, monitor
32
Q

Mavyret DDI with common txp meds, PPI, DOAC

Glecaprevir/pibrentasvir

A
  1. Inhibits CYP3A4/P-gp = inc FK levels
  2. CsA inc glecaprevir levels due to OATB inhibition
    [AVOID IN PATIENTS ON CSA >100 MG/D]
  3. PPI: may reduce HCV DAA exposure; limit to omep 20 daily due to lack of data with higher dosages
  4. DOACS: NO DABIGATRAN [Stupid high AUC}; potential inc in exposure of all other DOACS; monitor
33
Q

Empiric regimens for nocardia

A

Imipenem + Bactrim OR amikacin

Other abx with activity: linezolid, minocycline, cipro/moxi, augmentin, macrlides

34
Q

When to suspect CMV resistane

A

Persistent viremia or symptoms after 2 weeks of appropriate therapy and total exposure >6 weeks

35
Q

CMV UL97 Mutation

A

GCV resistance dt changes in drug phosphorylation

36
Q

CMV UL54 Mutation

A

GCV resistance +/- CDV and FOS resistance dt change in DNA polymerase

37
Q

Itraconazole capsule & liquid: Absorption & administration

A

Capsule: take with meal or acidic beverage if on acid-reducing tx (requires low gastric pH)
Oral solution: better absorption vs capsule; take on empty stomach

38
Q

Itraconazole TDM Goals

A

Prophy: >0.5
Tx: >1-2 mcg/mL (parent + metabolite)

39
Q

Voriconazole tablet & liquid: Absorption & administration

A

Take on empty stomach; good BA & not dependent on gastric pH

40
Q

Voriconazole TDM Goals

41
Q

Voriconazole: How much dose reduce CNI

A

FK: dec 66%
CsA: dec 50%

42
Q

Itraconazole : How much dose reduce CNI

A

FK: dec 50%
CsA: dec 50%

43
Q

Posaconazole : How much dose reduce CNI

A

FK: dec 66%
CsA: dec 25%

44
Q

Posaconazole TDM Goals

45
Q

Posaconazole tablet & liquid: Absorption & administration

A

Tablet: take with meal; not dependent on gastric pH

Oral solution: take with food & acidic beverage; divide doses to optimize absorption

46
Q

Recommended BKV screening after KTxp

A

Monthly x9 mo, then Q3 month until 2 years

47
Q

Recommended treatment of asymptomatic bacteriuria

A

If two consecutive urine samples yield >105of the same uropathogen in the first two months post-transplant, can consider treatment for 5 days

48
Q

Which respiratory viruses can be treated with ribavirin?

A

RSV, hMPV, PIV

49
Q

First line treatment options for latent TB

A
  1. INH x9 months
  2. RIF x4 months
  3. Weekly INH/Rifapentine x12 doses
50
Q

When to consider steroids for PJP

A

Corticosteroids are best administered within 72 h of patient presentation in the setting of hypoxia (pAO2 < 70 mm Hg)

51
Q

Soliris REMS requirements for providers

A
  1. Read HCP materials
  2. Enroll in the REMS program
  3. Patient counseling & provide patient safety card
  4. Report ADEs
52
Q

OPOs should determine if any of the following occurred within past 30 days to determine risk of HIV, HBV, HCV:

A
  • sex w/ infected person
  • men who has sex with men
  • sex in exchange for $$$ or drugzzzzz
  • drug injection for nonmedical reasons
  • sex with a person who has inject drugs for nonmedical reasons
  • incarceration for 72+ consecutive hours
  • child breastfed by HIV mother
  • child born to HIV HBV HCV mother
  • unknown medical or social hx
53
Q

Recommended recipient testing for HIV HBV HCV post-txp

A

4 - 6 weeks test all recipients using NAT

If OLT: test for HBV NAT at 1 year

BCTXP (11 decks)

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