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NAPLEX RxPrep 2023 > Infectious Disease 4: Opportunistic Infections > Flashcards

Infectious Disease 4: Opportunistic Infections Flashcards

1
Q

When do opportunistic infections occur?

A
  • Predisposed immunocompromised patients
  • Immune system is weak & unable to normally respond to bacteria, fungi, viruses, & protozoa

RxPrep p 403

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2
Q

What patient factors are categorized as immunocompromised states?

A
  • Diseases - HIV with CD4 < 200
  • Steroid use for 14+ days at prednisone dose of 20 mg/day or 2 mg/kg/day
  • Asplenia (dysfunctional spleen) - sickle cell disease or splenectomy
  • Immunosuppressant use (TNF-alpha inhibitors)
  • Chemotherapy agents - cause severe neutropenia, ANC < 500

RxPrep p 403

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3
Q

What common OIs require primary chemoprophylaxis?

A
  • Pneumocystis jirovecii pneumonia (PJP, PCP)
  • Toxoplasmosis gondii encephalitis
  • Mycobacterium avium complex (MAC)

RxPrep p 404

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4
Q

True / False

Is chemoprophylaxis recommended for Candida infections, like thrush?

A

False - not usually recommended

RxPrep p 404

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5
Q

Chemoprophylaxis Regimens in HIV

PJP or PCP

Initiation Criteria, Regimens, & Discontinuing Criteria

A
  1. CD4 < 200
  2. Preferred: Bactrim DS daily
  3. Alternatives: Dapsone, or Atovaquone, or Dapsone + Pyrimethamine + Leucovorin (DPL)
  4. D/C when CD4 > 200 for > 3 mo on ART

RxPrep p 404

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6
Q

Chemoprophylaxis Regimens in HIV

Toxoplasma gondii Encephalitis

Initiation Criteria, Regimens, & Discontinuing Criteria

A
  1. CD4 < 100
  2. Preferred: Bactrim DS daily
  3. Alternatives: Atovaquone, or Dapsone + Pyrimethamine + Leucovorin (DPL)
  4. D/C when CD4 > 200 for > 3 mo on ART

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7
Q

Chemoprophylaxis Regimens in HIV

MAC

Initiation Criteria, Regimen, & Discontinuing Criteria

A
  1. NOT on ART & CD4 < 50
  2. Azithromycin 1200mg weekly
  3. D/C when taking full suppressive ART

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8
Q

Chemoprophylaxis Regimens in HIV

Patient has a sulfa allergy.
What alternative regimens should be considered?

Bactrim was the preferred regimen

A

Atovaquone, Dapsone, & Pentamidine

Inhaled Pentamidine is an alternative option for PJP/PCP

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9
Q

Chemoprophylaxis Regimens in HIV

Patient has a G6PD deficiency.
What alternative regimens should be considered?

Bactrim was the preferred regimen

A

Atovaquone & Pentamidine

Inhaled pentamidine is an alternative option for PJP/PCP

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10
Q

Chemoprophylaxis Regimens in HIV

Why is leucovorin added to pyrimethamine containing regimens?

PJP/PCP & Toxoplasma gondii Encephalitis

A

Rescue therapy to reduce the risk of pyrimethamine-induced myelosuppression

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11
Q

Treatment of OIs

After completing initial treatment, is secondary prophylaxis recommended?
Why or why not?

A

Secondary prophylaxis given to prevent recurrence of the infection

RxPrep p 405

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12
Q

Treatment of OIs

Patient with HIV+ has thrush.
Is systemic or localized treatment preferred?
Is secondary prophylaxis recommended after treatment?

A

Systemic treatment w/ NO secondary prophylaxis

Fluconazole&raquo_space;> localized agents (clotrimazole, miconazole, nystatin)

RxPrep p 405

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13
Q

Treatment of OIs

Candidiasis thrush (oropharyngeal/esophageal)

Presentation & Regimens

A
  1. White film in the mouth/throat
  2. Preferred regimen: Fluconazole
  3. Alternative for oropharyngeal: itraconazole or topicals
  4. Alternative for esophageal: voriconazole or caspofungin

Secondary Prophylaxis NOT recommended!

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14
Q

Treatment of OIs

Cryptococcal meningitis

Regimens

A
  1. Preferred: Amphotericin B + Flucytosine
  2. Alternative: Fluconazole substituted for Ampho B or Flucytosine

Fluconazole + Flucytosine or Fluconazole + Amphotericin B

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15
Q

Treatment of OIs

Cytomegalovirus (CMV)

Regimens

A
  1. Valganciclovir or Ganciclovir
  2. Alternative (refractory): Foscarnet or Cidofovir

No secondary prophylaxis if CD4 > 100 maintained

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16
Q

Treatment of OIs

Mycobacterium avium complex (MAC)

Regimen

A

Macrolide (Clarithromycin or Zithromax) + Ethambutol

RxPrep p 405

17
Q

Treatment of OIs

Pneumocystis jirovecii Pneumonia (PJP or PCP)

Regimens

A
  1. Bactrim +/- prednisone or methylprednisolone x 21 days
  2. Alternatives: Atovaquone or Pentamidine IV

Alternatives commonly used in Sulfa allergy or G6PD deficiency

RxPrep p 405

18
Q

Treatment of OIs

Toxoplasmosis gondii Encephalitis

Environmental Risk Factors & Regimens

A
  1. Undercooked/raw meat or cat feces/litter
  2. Preferred: Pyrimethamine + Leucovorin + Sulfadiazine (PLS)
  3. Alternative: Bactrim

RxPrep p 405

NAPLEX RxPrep 2023 (5 decks)

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