Pharmacology Of Oppurtunistic Infectiosn Flashcards
Most common opportunistic infections
Varicella zoster
Kaposi sarcoma
Candidasis
TB
Pneumocystis jiroveci pneumonia
Non-Hodgkin’s lymphoma
Cryptococcal meningitis
Toxoplasmosis
Herpes simplex virus / cytomegalovirus infections
mycobacterium Avium complex (MAC) infections
Pneumococcal respiratory diseases
What 3 opportunistic infections do not decrease in rate of concurrence in AIDS patients who are on proper regiments?
TB
Pneumococcal diseases
Dermatomal zoster
Steps to management of OIs
1) Prevent exposure
2) Vaccinate to dangerous ones
3) Primary chemoprophylaxis agents
4) Treat any emergent OI
5) Use secondary chemo prophylaxis to prevent OI recurrence
6) Discontinue prophylaxis and switch to ART-associated therapy
What are issues with ART therapy mixing with OI therapies?
While it is almost always recommended to begin both if a patient has HIV and an opportunistic infection, the following can occur due to the overload of drugs
1) drug-drug interactions
2) ADRs/drug toxicities
3) treatment failures altogether
4) immune reconstitution inflammatory syndrome
Immune reconstitution inflammatory syndrome
When rebuilding the immune system of someone who is immunosuprresed, inflammatory reactions can appear
- especially if rapid increases in CD4 is seen
General Symptoms:
- fever
- sweats
- malaise
Specific symptoms:
- TB present = mass severity increases in general symptoms
- MAC present = suppurative lymphadenitis
- meningitis = increased intracranial presssure
Treatment:
- NSAIDs: if symptoms are mild
- corticosteroids: if symptoms are severe
- Note: unless symptoms are life-threatening, ART therapy should be continued in HIV patients*
- this is very common in TB, HHV-8 and CMV infections patients getting ART therapy*
Bacterial pneumonia pathogens that are seen in HIV patients, but not healthy people
S. Aureus and pseudomonas aeruginosa
How does antibiotic therapy of CAP in HIV patients differ?
Definitive theraemperic therapy cannot be monotherapy
- must be at least three therapies
What is the most commmon life-threatening OI in AIDS patients?
Pneumocystis jirovecii infections
- everyone runs into this at some point, however the chances of it taking hold and actually infecting someone is zero unless the CD count is <200 cells/mm3
Treatment of pneumocystis jirovecii
Sulfamethoxazole and trimethoprim combo therapy (TMP-SMX)
- both work to synergistically antagonize fungal folate synthesis
Can be treatment of prophylaxis
Dapsone is the 2nd line if a rash ADR develops with use
How does RIPE therapy for HIV patients change compared to non-HIV patients
RIPE therapy is extended for 3 more months (total fo 9 months minimum)
Treatment of MAC in HIV patients
Prophylaxis:
- azithromycin or clarithromycin
Treatment of active:
- same as above except add ethambutol
- use Rifabutin if ADRs/contraindications exist*
Toxoplasma Gondii encephalitis treatment in HIV patients
Prophylaxis: TMP-SMX
Treatment: pyrimethamine
- inhibits dihydrofolate reductase
- also must COPD minister with leucovorin to prevent high rates of toxicity
Cryptococcosis neoformans treatment in HIV patients
Treatment: liposomal amphtercin B and flucytosine
- Amp B = forms pores in fungus
- flucytosine = inhibits fungal DNA synthesis
Amp B is highly nephrotoxic ANS must be give IV with liposomal suspension
Candidiasis treatment overall
Treatment = fluconazole
- inhibits egosterol synthesis that is cardinal for candidiasis life
- VERY POTENT CYP3A4 inhibtor
Cytomegalovirus treatment overall
Ganciclovir (IV)
- activated by viral thymidine kinase and causes DNA chin-termination
- valganciclovir is the PO form
Foscarnet (IV)
- directly inhibt is DNA polymerases by blocking pyrophosphate binding sites
