Pharmacology Of Oppurtunistic Infectiosn Flashcards

1
Q

Most common opportunistic infections

A

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

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2
Q

What 3 opportunistic infections do not decrease in rate of concurrence in AIDS patients who are on proper regiments?

A

TB

Pneumococcal diseases

Dermatomal zoster

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3
Q

Steps to management of OIs

A

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

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4
Q

What are issues with ART therapy mixing with OI therapies?

A

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

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5
Q

Immune reconstitution inflammatory syndrome

A

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*
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6
Q

Bacterial pneumonia pathogens that are seen in HIV patients, but not healthy people

A

S. Aureus and pseudomonas aeruginosa

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7
Q

How does antibiotic therapy of CAP in HIV patients differ?

A

Definitive theraemperic therapy cannot be monotherapy

- must be at least three therapies

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8
Q

What is the most commmon life-threatening OI in AIDS patients?

A

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

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9
Q

Treatment of pneumocystis jirovecii

A

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

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10
Q

How does RIPE therapy for HIV patients change compared to non-HIV patients

A

RIPE therapy is extended for 3 more months (total fo 9 months minimum)

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11
Q

Treatment of MAC in HIV patients

A

Prophylaxis:
- azithromycin or clarithromycin

Treatment of active:
- same as above except add ethambutol

  • use Rifabutin if ADRs/contraindications exist*
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12
Q

Toxoplasma Gondii encephalitis treatment in HIV patients

A

Prophylaxis: TMP-SMX

Treatment: pyrimethamine

  • inhibits dihydrofolate reductase
  • also must COPD minister with leucovorin to prevent high rates of toxicity
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13
Q

Cryptococcosis neoformans treatment in HIV patients

A

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

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14
Q

Candidiasis treatment overall

A

Treatment = fluconazole

  • inhibits egosterol synthesis that is cardinal for candidiasis life
  • VERY POTENT CYP3A4 inhibtor
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15
Q

Cytomegalovirus treatment overall

A

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

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