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7451 ID Block 4 > Treatments > Flashcards

Treatments Flashcards

1
Q

Which two types of hepatitis are fecal?

A

A, E

No chronic infection

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2
Q

How to prevent hep E?

A

ensure safe drinking water

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3
Q

Which types of hepatitis have percutaneous/mucosal transmission?

A

B, C, D

blood/body fluids

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4
Q

Which types of hepatitis are prevented with pre/post exposure immunization?

A

A, B, D

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5
Q

Which type of hepatitis is prevented with blood donor screening/risk behavior modification?

A

C

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6
Q

Hep A vaccine:

What is the Havrix vaccine schedule?

A

0, 6-12 months

Age 1-18: 0.5 mL
Age >=19: 1mL

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7
Q

Hep A vaccine:

What is the Vaqta vaccine schedule?

A

0, 6-18 months

Age 1-18: 0.5mL
Age > 19: 1mL

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8
Q

Hep A vaccine:

What is the Twinrix vaccine schedule?

A

0, 1, 6 months

Age >=18: 1mL

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9
Q

Which Hep B antigen is found on surface of HBV and denotes chronic infection if present for > 6 months?

A

HBsAG

hepatitis B surface antigen

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10
Q

Which hepatitis antigen is present in active infection?

A

HBeAG

hepatitis B envelope antigen

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11
Q

Which antigen indicates acute hep B infection (within 6 months)?

A

IgM anti-HBc

immunoglobulin antibody to hepatitis B core antigen

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12
Q

How is HBV DNA measured?

A

as visual load (IU/mL); amount of DNA per mL of plasma

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13
Q

Which hep B antibody is formed in response to HBsAG, and is a predictor of long-term suppression?

A

HBeAb

hepatitis B envelope antibody

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14
Q

Which hep B antibody indicates previous or ongoing infection?

A

Anti-HBc

total hepatitis B core antibody

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15
Q

Which hep B antibody indicates immunity, and is produced after recovery of HBV infection of vaccination?

A

Anti-HBs

hepatitis B surface antibody

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16
Q

Which hep B antigens/antibodies are positive if immune due to natural infection?

HBsAG
anti-HBc
anti-HBs

A

anti-HBc

anti-HBs

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17
Q

Which hep B antigens/antibodies are positive if immune due to HBV vaccination?

HBsAG
anti-HBc
anti-HBs

A

anti-HBs

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18
Q

Which hep B antigens/antibodies are positive is acutely infected?

HBsAg
anti-HBc
IgM anti-HBc
anti-HBs

A

HBsAg
anti-HBc
IgM anti-HBc

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19
Q

Which hep B antigens/antibodies are positive if chronically infected?

HBsAg
anti-HBc
IgM anti-HBc
anti-HBs

A

HBsAg

anti-HBc

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20
Q

Which antigens/antibodies are positive with hep B resolved infection (most common), false positive (susceptible), low level chronic infection, resolving acute infection?

HBsAg
anti-HBc
anti-HBs

A

anti-HBc

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21
Q

Hep B vaccine:

What is the Engerix vaccine schedule?

A

0, 1, 6 months

all ages

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22
Q

Hep B vaccine:

What is the recombivax schedule?

A

0, 1, 6 months

Ages >= 1 year

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23
Q

Hep B vaccine:

What is the Heplisav-B vaccine schedule?

A

0, 1 months

Ages >= 18 years

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24
Q

HBV chronic Tx:

Which is contraindicated with CrCl < 15?

A

tenofovir alafenamide

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25
Q

Tenofovir alafenamide dose for chronic HBV?

A

25mg QD with food

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26
Q

Tenofovir disoproxil fumarate dose for chronic HBV?

A

300mg QD

with CrCl > 50

can cause nephropathy

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27
Q

entecavir dose for chronic HBV?

A

0.5mg tab QD

1mg tab QD if lamivudine experience

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28
Q

pegylated interferon dose for chronic HBV?

A

180mcg SQ weekly

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29
Q

3 non-preferred HBV Tx:

A
  • lamivudine (Epivir)
  • adefovir (Hepsera)
  • telbivudine (Tyzeka)
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30
Q

Which HBV Tx is recommended if finite treatment is desired?

A

pegylated interferone

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31
Q

Which HBV Tx should be avoided if concerns for tolerability and presence of co-morbidities?

A

pegylated interferone

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32
Q

Which HBV Tx should be avoided if Hs of lamivudine resistance?

A

entecavir

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33
Q

Which HBV Tx is recommended for family planning?

A

pegylated interferon pre-pregnancy

tenofovir disoproxil fumarate

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34
Q

What is drug of choice for HBV treatment with concurrent HDV co-infection?

A

pegylated interferon

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35
Q

2 treatments for HBV in pts with decompensated cirrhosis?

A
  • entecavir
  • tenofovir disoproxil fumarate (TDF)

continued indefinitely

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36
Q

Is entecavir reliable for HBV Tx with HIV co-infection?

A

no

need 2 agents:
- tenofovir + emtricitabine/lamivudine

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37
Q

How long should HBV pts immunosuppressive/cytotoxic therapy be treated?

A

> = 6 months post completion of Tx

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38
Q

Hep C:

Which suffix indicates NS3/4A protease inhibitors?

A

-previr

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39
Q

Hep C:

Which suffix indicates NS5B inhibitors?

A
  • buvir
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40
Q

Hep C:

Which suffix indicates NS5A inhibitors?

A

-asvir

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41
Q

Hep C:

sofosbuvir/ledipasvir dose?

A

400mg/90mg daily

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42
Q

Hep C:

Which genotypes are covered by sofosbuvir/ledipasvir?

A

1, 4, 5, 6

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43
Q

Hep C:

Which genotypes are covered by grazoprevir/elbasvir?

A

1, 4

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44
Q

Hep C:

What is grazoprevir/elbasvir dose?

A

100mg/50mg QD

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45
Q

Hep C:

What is sofosbuvir/velpatasvir dose?

A

400mg/100mg QD

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46
Q

Hep c:

What genotypes are covered by sofosbuvir/velpatasvir?

A

1-6

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47
Q

Hep C:

What genotypes are covered by glecaprevir/pibrentasvir?

A

1-6

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48
Q

Hep c:

What is the dose of glecaprevir/pibrentasvir?

A

100mg/40mg 3 tabs daily with food

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49
Q

Hep C:

What genotypes are covered by sofosbuvir/velpatasvir/voxilaprevir?

A

1-6

mainly reserved for pts with prior DAA failures

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50
Q

Hep C:

What is the dose for ribavirin?

A

< 75kg: 1g in 2 divided doses
> 75kg: 1.2g in 2 divided doses

TAKE WITH FOOD!

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51
Q

Hep C:

Which protease inhibitors should be avoided in pts with decompensated cirrhosis?

A

NS3/4A

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52
Q

What treatment is usually added for Hep C in decompensated cirrhosis?

A

ribavirin

or treatment extended to 24 weeks

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53
Q

Hep C:

Which genotype is the most difficult to treat in setting of prior tx and/or cirrhosis?

A

genotype 3

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54
Q

Hep C:

What Tx is approved for pts >=3 years old?

A

sofosbuvir/ledipasvir

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55
Q

Hep C:

Which Tx is approved for pts >=12 years old?

A

glecaprevir/pibrentasvir

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56
Q

Discontinue Hep C Tx if ALT is how high?

A

> =10 times the ULN

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57
Q

What lab is needed for Hep C pts on ribavirin?

A

CBC

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58
Q

When is HCV viral load tested post-treatment?

A

12 weeks post treatment

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59
Q

HIV:

HLA5701*B testing is recommended with prior to using which NRTI?

A

abacavir

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60
Q

Which NRTI causes renal impairment, bone demineralization, and a DECREASE in lipids?

A

tenofovir disoproxil fumarate (TDF)

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61
Q

Which NRTI causes weight gain and INCREASES lipids?

A

tenofovir alafenamide (TAF)

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62
Q

Which 2 INSTIs should be separated from cations by 2 hours before or 6 hours after?

A
  • bictegravir

- dolutegravir

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63
Q

FDA approval for which INSTI is expected any day now?

A

cabotegravir

injectable in combo with rilpivirine

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64
Q

3 NNRTIs that cause rash, elevated LFTs, and DDIs?

A
  • doravirine
  • efavirenz
  • rilpivirine
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65
Q

Which NNRTI can be taken with or without food?

A

doravirine

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66
Q

Which NNRTI should be taken at bedtime on empty stomach?

A

efavirenz

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67
Q

Which NNRTI should be taken with whole glass of water and normal/high calorie meal?

A

rilpivirine

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68
Q

Which 2 NNRTIs should not be used if HIV viral load is > 100,000 copies?

A
  • efavirenz

- rilpivirine (also if CD4 < 200)

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69
Q

Which protease inhibitor is only used as a boosting agent?

A

ritonavir

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70
Q

4 first line therapies for MOST pts with HIV:

A
  • tenofovir alafenamide/emtricitabine + bictegravir
  • abacavir/lamivudine + dolutegravir
  • tenofovir (either)/emtricitabine + dolutegravir
  • tenofovir (either)/emtricitabine + raltegravir
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71
Q

What two drugs/classes should be avoided in HIV pts with high cardiac risk?

A

abacavir

protease inhibitors

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72
Q

Which tenofovir lowers lipids?

A

disoproxil fumarate

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73
Q

Which tenofovir should be avoided in pts with kidney disease?

A

disoproxil fumarate

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74
Q

Which drug/class should be avoided in HIV pts with hyperlipidemia?

A

efavirenz

protease inhibitors

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75
Q

Which tenofovir should be avoided in pts with osteoporosis?

A

disoproxil fumarate

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76
Q

What 2 NNRTIs should be avoided in pts with psychiatric illnesses?

A
  • efavirenz

- rilpivirine

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77
Q

What 2 NNRTIs cause QTc prolongation?

A
  • efavirenz

- rilpivirine

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78
Q

What tenofovir should be avoided if weight gain concerns?

A

alafenamide

especially in combo with an INSTI

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79
Q

Which PrEP is for all people at risk through sex or injection drug use?

A

tenofovir disoproxil fumarate + emtricitabine (Truvada)

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80
Q

Which PrEP is for people at risk through sex except those assigned female at birth at risk from vaginal sex?

A

tenofovir alafenamide + emtricitabine (Descovy)

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81
Q

PrEP:

Which PrEP has a generic available?

A

tenofovir disoproxil fumarate + emtricitabine

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82
Q

How long does PrEP take to be effective?

A

21 days

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83
Q

How often are labs performed with PrEP?

A

every 3 months

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84
Q

How long is PEP used?

A

28 days

Most effective if started ASAP within 72hours of exposure

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85
Q

What combo is used as HIV PEP?

A

tenofovir disoproxil fumarate + emtricitabine + dolutegravir or raltegravir

86
Q

Opportunistic infection:

PJP pneumonia prophylaxis Tx?

A

SMX/TMP 1 DS PO daily

CD4 < 200

87
Q

Opportunistic infection:

PJP pneumonia mild to moderate Tx?

A

SMX/TMP 5-7mg/kg PO TID x 21 days

88
Q

Opportunistic infection:

PJP pneumonia moderate to severe Tx?

A

SMX/TMP 15-20mg/kg/day IV q6-8hrs x 21 days

89
Q

opportunistic infection:

Toxoplasmosis prophylaxis?

A

SMX/TMP 1DS PO daily

CD4 < 100

90
Q

opportunistic infection:

Mycobacterium avian complex (MAC) prophylaxis?

A

azithromycin 1200mg PO once weekly

CD4 < 50 and not on suppressive ART

91
Q

opportunistic infection:

Mycobacterium avian complex (MAC) treatment?

A

clarithromycin 500mg PO BID + ethambutol 15mg/kg PO daily

12 months of therapy

92
Q

opportunistic infection:

Toxoplasmosis treatment?

A

combo at least 6 weeks of induction, then maintenance

pyrimethamine, sulfadiazine, and leucovorin

93
Q

opportunistic infection:

Immune reconstitution inflammatory syndrome (IRIS) treatment?

A

supportive care

94
Q

opportunistic infection:

Immune reconstitution inflammatory syndrome (IRIS) prophylaxis?

A

delay ART by about 2 weeks of induction

95
Q

Does acyclovir have activity against CMV?

A

no

96
Q

Which antiviral has activity against adenovirus, CMV, HSV, and VZV?

A

cidofovir

ganciclovir is +/- for adenovirus

97
Q

2 first line treatments for CMV?

A
  • ganciclovir

- valganciclovir

98
Q

Which 2 CMV drugs need CBC with differential and BMP at baseline/weekly?

A

ganciclovir

valganciclovir

99
Q

What 2 drugs are IV only and used for resistant CMV?

A
  • foscarnet

- cidofovir

100
Q

What resistant CMV drug must be given with fluid electrolyte replacement?

A

foscarnet

101
Q

What resistant CMV drug must be given with probenecid?

A

cidofovir

102
Q

Which CMV drug is for prophylaxis only?

A

letermovir

103
Q

What mab works on the spike proteins of SARS COV2?

A

bamlanivimab

administer within 10 days of Sx onset

104
Q

Cidofovir MOA?

A

selective inhibition of viral DNA synthesis

105
Q

What 2 BBWs does foscarnet have?

A
  • renal impairment

- seizures

106
Q

Which 2 CMV drugs have BBW for bone marrow suppression?

A
  • ganciclovir

- valganciclovir

107
Q

Which CMV drug has MOA of inhibiting DNA terminate complex preventing proper viral DNA length and vision maturation?

A

letermovir

only indicated for CMV prophylaxis in bone marrow transplant recipients

108
Q

Which CMV drug is an adenosine nucleostide prodrug that competitively inhibits RNA polymerase causing chain termination?

A

remdesivir

109
Q

Which CMV drug has a BBW for hemolytic anemia?

A

ribavirin

take capsule WITH food

110
Q

How is CMV transmitted?

A

contact with fluids

111
Q

How is coronavirus transmitted?

A

droplet
airbone
fomites
GI

largely depends on strain

112
Q

How is VZV transmitted?

A

direct contact

113
Q

How is measles transmitted?

A

droplet

airborne

114
Q

How is mumps transmitted?

A

contact

droplet

115
Q

How is VZV prevented?

A
  • immunizations

- avoid contact for 4-5 days after lesions heal

116
Q

Fungal infections:

What is the general MOA for flucytosine and griseofulvin?

A

replication/division inhibitors

117
Q

Fungal infections:

Do echinocandins work on the cell wall or membrane?

A

wall

Beta-1,3-D glucan synthesis inhibitors

118
Q

What is the general MOA for triazoles and polyenes (amphotericin B)?

A

cell membrane ergosterol inhibitors/binders

119
Q

Which antifungal is DOC for blastomyces/histoplasma and coccidioides?

A

itraconazole

120
Q

Which antifungal is DOC for Aspergillus?

A

voriconazole

121
Q

Which azole is DOC for C. albicans if susceptible?

A

fluconazole

122
Q

Which azole is DOC for dimorphic molds?

A

itraconazole

123
Q

What is the dose for liposomal AmB?

A

3-5mg/kg IV daily

124
Q

Which echinocandin is dose adjusted for Child-Pugh class?

A

caspofungin

125
Q

Micafungin dose?

A

100mg IV q24h

126
Q

Which triazole is IV:PO 1 to 1 ratio and prolongs QTc?

A

fluconazole

127
Q

Which 3 triazoles need TDM?

A
  • itraconazole
  • voriconazole
  • posaconazole

all triazoles need LFTs weekly and BMP every 2-3 days

128
Q

Which triazole needs visual exam if used > 28 days?

A

voriconazole

129
Q

Which triazole has capsules taken with food, solution taken without food?

A

itraconazole

formulations not interchangeable

130
Q

Which triazole causes visual disturbances, hallucinations, skin cancer, and prolongs QTc?

A

voriconazole

131
Q

Which triazole suspension requires food (ginger ale) for acidic environment?

A

posaconazole

132
Q

Which triazole shortens QTc?

A

isavuconazole

133
Q

Which triazole SHORTENS QTc?

A

isavuconazole

134
Q

Which two triazole antifungals require a loading dose?

A
  • voriconazole

- isavuconazole

135
Q

Antifungal TDM:

Voriconazole lower bound (ug/mL)?

A

1-1.5

136
Q

Antifungal TDM:

Voriconazole upper bound (ug/mL)?

A

5-6

137
Q

Antifungal TDM:

Posaconazole lower bound (ug/mL)?

A

> 0.5

138
Q

Antifungal TDM:

Posaconazole upper bound (ug/mL)?

A

1.5

139
Q

Antifungal TDM:

Itraconazole lower bound (ug/mL)?

A

> 0.5

140
Q

Antifungal TDM:

Itraconazole upper bound (ug/mL)?

A

1-3

141
Q

Antifungal TDM:

Flucytosine lower bound (ug/mL)?

A

30

142
Q

Antifungal TDM:

Flucytosine upper bound (ug/mL)?

A

80

avoid >100

143
Q

Oropharyngeal candidiasis (thrush) mild Tx?

A

daily x 7-10 days or miconazole mucoadhesive

144
Q

Oropharyngeal candidiasis (thrush) moderate to severe Tx?

A

fluconazole 100mg-200mg daily x 7-14 days

fluconazole refractory use itraconazole or posaconazole

145
Q

Recurrent esophagitis Tx?

A

fluconazole 100-200mg TIW

146
Q

Esophageal candidiasis Tx?

A

fluconazole 200-400mg PO daily x 14-21 days

If NPO: fluconazole 400mg daily, micafungin 150mg IV daily, caspofungin 70mg LD then 50mg IV daily, anidulafungin 200mg IV daily

147
Q

Empiric candidemia Tx?

A

echinocandin

148
Q

Definitive candidemia Tx?

A

fluconazole 12mg/kg load, then 6mg/kg daily

voriconazole 6mg/kg BID x 2 doses then 3mg/kg BID

149
Q

How long is candida endocarditis step down therapy?

A

> = 6 weeks after surgery

150
Q

Candida endocarditis empiric Tx?

A

AmpB

for native valve: lipid Amp B

151
Q

Intra-abdominal candidiasis empiric Tx?

A

micafungin 100mg, caspofungin 70mg, andiulafungin 200mg LD, then 100mg daily

152
Q

Cryptococcal meningoencephalitis induction Tx?

A

AmpB liposomal 3-4mg/kg day + flucytosine 100mg/kg/day in 4 divided doses

153
Q

Cryptococcal meningoencephalitis consolidation Tx?

A

fluconazole 6mg/kg/day x 8 weeks

154
Q

pulmonary cryptococcosis for immunosuppressed pts Tx?

A

fluconazole 6mg/kg/day PO x 6-12 months

155
Q

Pulmonary cryptococcosis for immunocompetent Tx?

A

fluconazole 400mg PO x 6-12 months

severe: treat like CNS disease

156
Q

Pulmonary blastomycosis mod -severe Tx?

A

liposomal AmpB 3-5mg/kg/day x 1-2 weeks, then itraconazole 200mg PO TID x 3 days, then 200mg PO BID for 6-12 months

157
Q

CNS blastomycosis Tx?

A

liposomal AmB 5mg/kg/day x 4-6 weeks, then oral triazole x 12 months or until resolution of CSF abnormalities

158
Q

Coccidioidomycosis PNA Tx?

A

fluconazole >= 400g daily for 3-6 months

159
Q

Mod-severe Histoplasmosis Tx?

A

lipid AmB 3-5mg/kg/day x 1-2 weeks, then itraconazole 200mg PO TID x 3 days, then BID x 12 weeks

160
Q

Mild-Moderate acute histoplasmosis Tx?

A

itraconazole 200mg PO TID x 3 days, then BID x 6-12 weeks

161
Q

Aspergillosis invasive pulmonary Tx?

A

voriconazole for 6-12 weeks

162
Q

Which dimorphic mold is found in midwestern, east coast, and Great Lakes states?

A

blastomycoses

163
Q

Which dimorphic mold is found in the Southwest and desert areas?

A

coccidioidomycosis

164
Q

Which dimorphic mold is found in the Ohio and Mississippi River valleys?

A

histoplasmosis

165
Q

Dimorphic molds:

What is mild-moderate coccidioidomycosis Tx?

A

observation and supportive therapy

166
Q

Dimorphic molds:

What is severe coccidioidomycosis Tx?

A

fluconazole >= 400mg daily or itraconazole

167
Q

Dimorphic molds:

What is mild-moderate blastomycosis Tx?

A

itraconazole 200mg 1-2 times/day

168
Q

Dimorphic molds:

What is severe blastomycosis Tx?

A

liposomal AmB 3-5mg/kg/day x 2 weeks or until improvement, then itraconazole 200mg PO TID x 3 days, then 200mg PO BID

169
Q

What is general Tx for C. albicans?

A

fluconazole

170
Q

What is general Tx for C. glabrata?

A

echinocandin

171
Q

What is general Tx for C. tropical?

A

fluconazole

172
Q

What is general Tx for C. parapsilosis?

A

fluconazole

173
Q

What is general Tx for C. krusei?

A

echinocandin

174
Q

What is first line empiric Tx for mild oropharyngeal candidiasis?

A

clotrimazole or miconazole

175
Q

What is first line empiric Tx for mod-severe oropharyngeal candidiasis?

A

fluconazole

176
Q

What is alternative Tx for oropharyngeal candidiasis?

A

nystatin

177
Q

What is first line empiric Tx for esophageal candidiasis?

A

fluconazole

178
Q

What is alternative Tx for esophageal candidiasis?

A

echinocandin HD

179
Q

What is first line empiric Tx for candidemia?

A

echinocandin

180
Q

What are 2 alternative Tx for candidemia?

A
  • fluconazole

- voriconazole

181
Q

What is first line empiric Tx for candida IEC?

A

AmpB +/- flucytosine, then fluconazole

182
Q

What is first line empiric Tx for intra-abdominal candidiasis?

A
  • source control

- echinocandin

183
Q

What are 2 alternative agents for intra-abdominal candidiasis?

A
  • fluconazole

- voriconazole

184
Q

Do not use the NNRTI efavirenz if HIV viral load is what?

A

> 100,000 copies

185
Q

VZV infectious period?

A

48 hrs before vesicle formation through 4-5 days after vesicles crust over

186
Q

Measles infectious period?

A

4 days before to 4 days after rash onset

187
Q

Kopek spots are associated with what condition?

A

measles

188
Q

Subacute sclerosing pan encephalitis (SSPE) is a complication of what condition?

A

measles

can occur 7 years after infection

189
Q

What Ro indicates the disease is spreading?

A

> 1

190
Q

What is the Ro of measles?

A

18

191
Q

Aseptic meningitis and encephalitis are associated with what disease?

A

mumps

192
Q

Sleeping less than ___ hours/night is a risk factor for coronavirus

A

7

193
Q

What % of the population should be vaccinated to stabilize Covid-19 spread?

A

60%

more than 60% to decrease the spread

194
Q

What age is a risk factor for covid/

A

> =60

195
Q

What is the Ro of Covid?

A

2.5

196
Q

What is used to treat Amphotericin related rigors?

A

meperidine

197
Q

What is main AE of flucytosine?

A

bone marrow suppression

198
Q

ANC < __ is risk factor for invasive fungal infection.

A

500

neutropenia

199
Q

Duration of candidemia treatment?

A

2 weeks from first negative culture

200
Q

Dilated opthamalogical exam is done within 1 week of diagnosis of what fungal infection?

A

Candida caveats

201
Q

What is an encapsulated yeast?

A

cryptococcus

202
Q

Do echinocandins have in vivo activity?

A

no

203
Q

With cryptococcal meningoencephalitis in HIV pts wait how long to start ARTs after initiation of antifungals to avoid risk of IRIS?

A

2-10 weeks

204
Q

The dimorphic mold Blastomycoces clinical presentation is similar to what?

A

CAP or chronic PNA

205
Q

Which dimorphic mold causes extreme fatigue?

A

cocciodiomycosis

incubation period 1-4 weeks

206
Q

Solid organ transplant, hematopoietic stem cell transplant, prolonged neutropenia, and hematologic malignancy are risk factors for what mold?

A

Aspergillus

207
Q

What test is specific to Aspergillosis?

A

galactomannan

CT halo sign specific to Aspergillosis:
halo sign
air crescent
nodules

208
Q

Which mold is angio-invasive?

A

Mucormycosis

209
Q

Reverse halo sign is specific to ___.

A

Mucormycosis

210
Q

Mucor treatment?

A

Liposomal AmB 5-10mg/kg OR

posaconazole 300mg daily

7451 ID Block 4 (2 decks)

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