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CDM 3 Exam 1 > Lecture 7 - Respiratory 2 > Flashcards

Lecture 7 - Respiratory 2 Flashcards

1
Q

MDR resistance is resistance to…

A

both 1st line options

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2
Q

XDR tb is resistance to…

A

both 1st line, fluoroquinolone, and aminoglycosides

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3
Q

TB have to stained with…

A

Ziehl-Neelsen stain

keep red color after acid alcohol wash = acid fast bacilli

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4
Q

Most common TB spread

A

cough, sneezing, talking

infection risk inc in small, poorly vent room…cavitary disease and duration of exposure

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5
Q

disseminated TB

A

spread through blood/lymph if bacterial rep not controlled

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6
Q

PPD test result interpretation

A

5m = HIV, recent contact, immunosuppressive, organ transplant
10 mm = recent immigrant, pts w/ comorbidites, < 5 yrs old, HCWs, IV drug use
15 mm = no TB risk factors

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7
Q

How to diagnose TB?

A

AFB smear + culture = 3 samples in 8hrs
NAAT tests, 24-48hrs + rifampin resistance genes
Stain w/ Ziehl, Neelsen

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8
Q

how long after starting therapy are you infectious with TB?

A

2 weeks + have long course to prevent relapse

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9
Q

1st line TB therapy?

A

Rifamycins - Rifampin
Isoniazide
Pyrazinamide
Ethambutol

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10
Q

2nd line TB agents

A

Aminoglycosides
Fluoroquinolones
Cycloserine
Ethionamide
P-aminosalicylic acid

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11
Q

Alternative TB agents, XDR

A

Bedaquiline
Clofazimine
Delamanid = not FDA approved
Linezolid

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12
Q

Intensive phase for TB

A

RIPE, 1st 2 months

If RIF/INH susceptible then EMB can be D/c

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13
Q

Continuation phase

A

RIF + INH for 4 to 7 months
Daily>3X week > 2 X week

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14
Q

If pt has a cavitary lesion or positive AFB smear at end of intensive phase, they should do therapy for….

A

7 months

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15
Q

Rifamycin MOA

A

Bind to DNA-dependent RNA polymerase, blocking RNA synthesis

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16
Q

Common/significant ADE Rifamycin

A

Red/orange discoloration of all body fluids
Itching
Hepatotoxicity + minor LFT elevation so monitor monthly

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17
Q

Rifapentine is used….

A

in once weekly treatment in continuation phase or LTBI treatment in select patients

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18
Q

Isoniazid MOA

A

inhibit mycolic acid synthesis, resulting in disruption of bacterial cell wall

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19
Q

Isoniazid ADE

A

Peripheral neuropathy**, pyridoxine added on

Hepatitis
Lupus-like symptoms

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20
Q

Monitoring Isoniazide

A

LFT monthly & baseline

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21
Q

Adverse effects pyrazinamide

A

Nongouty polyarthralgia
potential hyperuriemia

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22
Q

Pyrazinamide monitoring

A

Baseline + Periodic LFTs
Joint pain

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23
Q

Ethambutol MOA

A

inhibits synthesis of metabolites, mostly there to prevent emergence of RIF resistance

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24
Q

Ethambutol Side effects

A

Retrobulbar neuritis = red/green color discirmination

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25
Q

Ethambutol monitoring

A

Visual acuity tests + color discrimination tests…BL & Monthly

26
Q

Ethambutol DI

A

lowest risk, least interactions

some with Al containing antacids

27
Q

Management of Hepatotoxicity

A

ALT > 3X ULN w/ symptoms or ALT > 5X ULN w/o symptoms

stop therapy until < 2 X ULN

Then restart rifampin/ethambutol…recheck ALT and add isoniazid after 3-7 days, then can possibly reintroduce pyrazinamide

if symptoms recur or ALT inc then d/x last added med

28
Q

LTBI options

A
  1. ISN + RIF QW for 3 months
  2. RIF QD for 4 months
  3. ISN + RIF QD for 3 months
  4. Isoniazid for 6/9 months, QD or Twice weekly
29
Q

Targets for antifungal agents?

A

Gluons and Sterols

30
Q

Which drugs work by inhibiting ergosterol synthesis?

A

Azoles

31
Q

Which Azole won’t prolong QTc?

A

isavuconazole

they can also all cause hepatotoxicity, inc LFTs

32
Q

Fluconazole (FLU, Diflucan) info

A

Good CNS pen
1:1 IV to PO

33
Q

Itraconazole (ITR, Sporanox) info

A

no more than 200mg/dose
Better absorption w/ suspension
new super-bioavail form

34
Q

Voriconazole (VOR, Vfend) info

A

Good CNS pen
1:1 IV to PO
IV form contains cyclodextrin
can also cause visual disturbances

35
Q

Posaconazole (POS, Noxafil) info

A

Suspension limited absorption, give 200mg QID w/ fatty meals
DR tab better absorption
IV for contains cyclodextrin

36
Q

Isavuconazole (ISV, Cresemba)

A

Prodrug
1:1 IV to PO
Shortens QTc

37
Q

Drugs that Inhibit 1,3-B-D-Glucan Synthase

A

Echinocandins

38
Q

Echinocandins info

A

End in - Fungin

Only come as IV
All cause hepatotoxicity (Monitor LFTs)
Poor pen into CNS, Vitreous humor and Urine

39
Q

Ibrexafungerp info

A

only comes in Oral formulation

Currently only approved for vulvovaginal candidiasis

40
Q

Drugs that bind to ergosterol that create pores in membrane

A

Amphotericin B

41
Q

Amphotericin B Toxicity

A

Nephrotoxicity = give 500ml before/after dose
Hypokalemia
Hypomagnesemia

42
Q

Amphotericin B Infusion related reactions

A

Premed with Acetaminophen/Diphenydramine

can give meperidine, hydrocortisone, ibuprofen

43
Q

Fungal that inhibits Fungal RNA synthesis

A

Flucytosine (5-FC, Ancobon)
Pyrimidine analog

44
Q

Flucytosine info

A

good CNS pen
Resistance can develop quickly
can cause bone marrow suppression (monitor CBC) and hepatotoxicity (LFTs)

45
Q

Key dosing info about azoles

A

All azoles get loading dose, always pick answer with loading dose

46
Q

Fluconazole spectrum tips and tricks

A

Good for things that start with C (Candida, Cryptococcus, Coccilioides)

47
Q

Itraconazole spectrum tips and tricks

A

Similar to Fluconazole

Aspergillus slight activity

Main role is endemic (dimorphic) fungi**

48
Q

Voriconazole spectrum tips and tricks

A

1st line for Aspergillus

still works against Candida & Dimorphic

49
Q

Posaconazole & Isavuconazole spectrum tips and tricks

A

Posa = prophylaxis of Mucor
Isa = treatment of Mucor

50
Q

Echinocandin spectrum tips and tricks

A

Candida mostly

51
Q

Amphotericin spectrum tips and tricks

A

Aspergillius terreus = not active against

overall broad spectrum

52
Q

Therapeutic drug monitoring in Itraconazole and Voriconazole?

A

Troughs

53
Q

Aspergillosis treatment

A

6-12weeks

1st line = Voriconazole
Liposomal Amphotericin B/ Isavuconazole alternatives

salvage: Posa-, Itraconazole, Echinocandins

54
Q

Aspergillious prophylaxis, during high risk immunosuppression

A

Posaconazole = 1st line

55
Q

Histoplasmosis traditionally in….

A

Ohio River valley, spread into eastern US tho

56
Q

Blastomycosis traditionally in…

A

Mississippi River delta, spread into eastern US tho

57
Q

Coccidioidomycosis traditionally in….

A

southwestern US

58
Q

Mild Histoplasmosis, Chronic pulmonary, Mild Disseminated treatment is….

A

itraconazole 200mg QD or BID for 6-12weeks

** 12 months for Chronic pulmonary, disseminated ***

59
Q

Severe Histoplasmosis or CNS or severe Disseminated treatment is…

A

L-AMB for 1-2 weeks then itraconazole 200mg BID for 12 weeks

** 12 months CNS, Disseminated **

60
Q

Mild to moderate Blastomycosis treatment

A

itraconazole 200mg TID X 3 days, then BID 6-12 months

61
Q

Severe or CNS Blastomycosis treatment

A

L-AMB 1-2 weeks (severe)
L - AMB 4-6 weeks (CNS)

Then switch to Itraconazole 6 to 12 months

62
Q

Coccidioidomycosis treatment pneumonia

A

Not really treated unless severe disease

if treated use fluconazole > 400mg QD for 3-6 months

CDM 3 Exam 1 (10 decks)

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