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Spring 2015 PNT Exam 5 > OI > Flashcards

OI Flashcards

1
Q

define opportunistic infection

A

illnesses caused by various organisms, some of which do not cause diseases in immunocompetent persons

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2
Q

Define primary prophylaxis

A

initiated to prevent the first episode of OI

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3
Q

define secondary prophylaxis

A

initiated after treatment of an OI to prevent the second or subsequent episode of an OI

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4
Q

CD4 under 500 at risk for which OI

A

bacterial skin infection
herpes simplex, zoster
Oral, skin fungal infections

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5
Q

CD4 under 400 at risk for which OI

A

Kaposi’s sarcoma

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6
Q

CD4 under 300 at risk for which OI

A

Hairy leukopenia

tuberculosis

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7
Q

CD4 under 200 at risk for which OI

A

PCP
Cryptococcus
Toxoplasmosis

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8
Q

CD4 under 50 at risk for which OI

A

MAC
CMV
lymphoma

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9
Q

CD4 under 50 at risk for which OI

A

MAC
CMV
lymphoma

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10
Q

Which OI predominantly attacks the eyes

A

cytomegalovirus

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11
Q

Which OI predominantly attacks the mouth and throat

A

candidiasis

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12
Q

Which OI predominantly attacks the skin

A

Herpes Simplex

shingles

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13
Q

Which OI predominantly attacks the brain

A

toxoplasmosis

cryptococal meningitis

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14
Q

Which OI predominantly attacks the lungs

A

PCP
MAC
Tb
histoplasmosis

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15
Q

Which OI predominantly attacks the gut

A

cytomegalovirus

cryptosporidiosis

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16
Q

Which OI predominantly attacks the genitals

A

herpes simplex
human papillomavirus
candiasis

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17
Q

PCP caused by

A

pneumocystis jiroveci - fungus with protozoal properties

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18
Q

which patients are at greatest risk for PCP

A

CD4

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19
Q

Clinical presentation of PCP

A 
exertional dyspnea
fever
nonproductive cough
chest discomfort
ground glass opacities - x ray/CT
hypoxemia
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20
Q

2 diagnostic tests for PCP

A

bronchoscopy

Silver stain

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21
Q

Prognostic factors for PCP

A 
PaO2  35
abnormal CXR
Severity of pulmonary dysfunction at baseline
Severity of immunosuppression
Large inoculums detected by bronchoscopy
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22
Q

Indications for primary prophylaxis for PCP

A

CD4

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23
Q

preferred regimen for primary prophylaxis for PCP

A

Bactrim DS po daily

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24
Q

alternative regimens for primary prophylaxis for PCP

A 
Bactrim DS 3x weekly
dapsone 100 mg po daily 
atovaquone 15000 mg po daily (high fat food) 
dapsone + pyrimethamine + leucovorin
pentamidine 300 mg via neb monthly
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25
Q

PCP treatment

A

Bactrim
TMP 15-20 mg/kg/day given q 6 or 8 h
SMX 75-100mg/kg/day
dose based on TMP

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26
Q

Bactrim AEs

A 
rash
fever
N/V
crystaluria
myleosuppression
hyperkalemia
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27
Q

Bactrim AEs

A 
rash
fever
N/V
crystaluria
myleosuppression
hyperkalemia
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28
Q

Alternative treatments for severe PCP

A

Pentamidine 3-4 mg/kg IV daily or

Clindamycin 450 mg QID or 600-900 mg IV q6-8h + Primaquine 30 mg base daily

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29
Q

alternative regimens for mild-moderate PCP

A

dapsone 100 mg po daily + TMP 15mg/kd/day in 3-4 divided doses or
atovaquone 750 mg PO q 12 h

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30
Q

duration of therapy for PCP treatment

A

21 days

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31
Q

when to use steroids in PCP treatment

A

PaO2 35

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32
Q

when to start steroids in PCP treatment

A

within 72 hours of initiating treatment

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33
Q

Duration of therapy of steroids in PCP

A

21 days - taper PO steroids

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34
Q

IV methylprednisone to PO prednisone

A

75% of prednisone dose

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35
Q

Regimens used for secondary prophylaxis of PCP

A

same as primary prophylaxis

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36
Q

When to d/c prophylaxis for PCP

A

CD4 > 200 for 3 months on HAART

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37
Q

Mode of transmission for MAC

A

inhalation
ingestion
inoculation of the respiratory or GI tract

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38
Q

Pts at risk for MAC

39
Q

s/s of MAC

A 
fever
night sweats
abdominal pain
diarrhea
weight loss
lymphadenopathy
40
Q

lab abnormalities in MAC

A

anemia
increased LFTs
increased TNF

41
Q

Indications for primary prophylaxis of MAC

42
Q

Preferred primary prophylaxis regimen for MAC

A

Azithromycin 1200 mg PO once weekly
Clarithromycin 500 mg PO BID
azithromycin 600 mg PO twice weekly

43
Q

Preferred primary prophylaxis regimen for MAC

A

Azithromycin 1200 mg PO once weekly

44
Q

Alternative regimens for primary prophylaxis for MAC

A

clarithromycin 500 mg PO BID
rifabutin 300 mg PO daily - rule out active Tb
azithromycin 600 mg po BID

45
Q

diagnosis of MAC based on

A

clinical s/s

positive MAC cultures from blood, bone marrow, liver, spleen, or other sterile sites

46
Q

MAC treatment of choice

A

Clarithromycin 500 mg PO BID + ethambutol 15 mg/kg PO daily or
azithromycin 500-600 mg + ethambutol 15 mg/kg PO daily

47
Q

MAC treatment of choice

A

Clarithromycin 500 mg PO BID + ethambutol 15 mg/kg PO daily or
azithromycin 500-600 mg + ethambutol 15 mg/kg PO daily

48
Q

For treatment of MAC consider adding ___ if CD4

A

rifabutin 300 mg PO daily

49
Q

4th drug for advanced disease for MAC treatment

A

levofloxacin 500 mg PO daily / moxifloxacin 400 mg PO daily or
Amikacin 10-15 mg/kg IV daily or
streptomycin 1 g IV daily

50
Q

AE of macrolides

A

GI intolerance

51
Q

AE of clarithromycin

A

taste disturbances

52
Q

AE of ethambutol

A

dose related optic neuritis

53
Q

AE of rifabutin

A

discolored secretions, rash, leucopenia

54
Q

duration of treatment for MAC

A

at least 12 months

55
Q

Secondary prophylaxis duration for MAC

A

lifetime maintanence unless sustained immune recovery on HAART

56
Q

Secondary prophylaxis for MAC option

A

macrolide + ethambutol +/- rifabutin

57
Q

When to d/c primary prophylaxis for MAC

A

CD4 > 100 x 3 months

58
Q

when to d/c secondary prophylaxis for MAC

A

> 12 months of therapy AND

CD4>100 x 6 months

59
Q

Patients at greatest risk for toxoplasma

60
Q

clinical presentation of toxoplasma

A 
HA
confusion 
motor weakness
fever
seizures
ring enhancing lesions on CT or MRI
61
Q

diagnosis for toxoplasma

A

IgG antibodies

Isolation of parasite from blood or CSF

62
Q

Indication for primary prophylaxis of toxoplasma

63
Q

Preferred primary prophylaxis regimen for toxoplasma

A

Bactrim DS 1 PO daily

64
Q

alternative regimens for primary prophylaxis for toxoplasma

A

dapsone + pyrimethamine + leucovorin

atovaquone

65
Q

alternative regimens for primary prophylaxis for toxoplasma

A

dapsone + pyrimethamine + leucovorin

atovaquone

66
Q

when to d/c primary prophylaxis for toxoplasma

67
Q

Preferred regimen for treatment of toxoplasma

A

pyrimethamine + sulfadiazine + leucovorin

68
Q

Alternative regimens for treatment of toxoplasma

A 
Pyrimethamine+ leucovorin+ clindamycin
Bactrim
Atovaquone +pyrimethamine + leucovorin
Atovaquone + sulfadiazine
Atovaquone
Pyrimethamine + leucovorin+ azithromycin
69
Q

Alternative regimens for treatment of toxoplasma

A 
Pyrimethamine+ leucovorin+ clindamycin
Bactrim
Atovaquone +pyrimethamine + leucovorin
Atovaquone + sulfadiazine
Atovaquone
Pyrimethamine + leucovorin+ azithromycin
70
Q

Duration of treatment for toxoplasma

A

at least 6 weeks

71
Q

when to use corticosteroids for toxoplasma

A

within 24-48 hours of therapy if elevated intracranial pressure or edema

72
Q

Preferred secondary prophylaxis for toxoplasma

A

pyrimethamine 25-50 mg PO daily + sulfadiazine 2000-4000 mg PO daily (2-4 divided doses) + leucovorin 10-25 mg PO daily

73
Q

Alternative secondary prophylaxis for toxoplasma

A

clindamycin + pyrimethamine + leucovorin

atovaquone +/- pyrimethamine/leucovorin

74
Q

when to d/c secondary prophylaxis for toxoplasma

A

CD4>200 for 6 months on HAART

75
Q

when to d/c secondary prophylaxis for toxoplasma

A

CD4>200 for 6 months on HAART

76
Q

presentation of cryptococcus neoformans meningitis

A 
decrease intracranial pressure -> CSF shunt/lumbar puncture
cerebral edema
confusion
severe HA
emesis
fading vision
77
Q

diagnosis of cryptococcus

A

india ink
cultures
serology
radiologic findings

78
Q

primary prophylaxis for cryptococcus

A

not recommended

79
Q

3 phases of cryptococcus treatment

A

induction
consolidation
chronic maintence

80
Q

regimen of choice for induction therapy for cryptococcus

A

liposomal amphotericin B 3-4 mg/kg IV dialy + flucytosine 25 mg/kg PO QID

81
Q

duration of induction phase therapy for cryptococcus

82
Q

alternative regimens for induction therapy for cryptococcus

A

amphotericin B + fluconazole 800 mg PO/IV therapy
Amphotericin + flucytosine
Fluconazole 800 mg PO daily + 5-FC 25 mg/kg po QID

83
Q

duration of consolidation therapy for cryptococcus

84
Q

preferred agent for consolidation therapy for cryptococcus

A

fluconazole 400 mg PO or IV once daily

85
Q

alternative agent for consolidation therapy for cryptococcus

A

itraconazole 200 mg PO BID

86
Q

alternative agent for consolidation therapy for cryptococcus

A

itraconazole 200 mg PO BID

87
Q

duration for chronic maintance therapy for cryptococcus

A

at least 12 months

88
Q

preferred agent for chronic maintance therapy of cryptococcus

A

fluconazole 200 mg PO

89
Q

when to d/c maintance/secondary prophylaxis for cryptococcus

A

at least 1 year of therapy
CD4 100
undetectable viral load

90
Q

clinical presentation of HSV-1 infection

A

sensory prodrome in the affected area

course of illness in untreated patients is 5-10 days

91
Q

clinical presentation of HSV2 infection

A

evolution of stages of papules -> vesicle -> ulcer -> crust

prodrome syndrome: pain and pruritis

92
Q

diagnosis of HSV infection

A

viral culture
HSV DNA PCR
HSV antigen detection

93
Q

Primary prophylaxis for HSV infection

A

not recommended

Spring 2015 PNT Exam 5 (6 decks)

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