Week 7 Flashcards
First line of treatment for coccidiomycosis
Fluconazole for isolated
Amphotericin B for severe
A tissue microscopy shows yeast with pseudohyphae, what is the most likely causal pathogen?
Candida
Yeast forms pseudohyphae (can grow hyphae)
Thrush in mouth, endocarditis in IVDU, Vaginal
A tissue microscopy shows yeast with large capsules, what is the most likely causal pathogen?
Cryptococcus- Meningitis
A tissue microscopy shows mold with septate hyphate, what is the most likely causal pathogen?
Aspergillus- mold with septate hyphae
Fungus ball in lungs, wound burn infections, indwelling catheter infections, sinusitis
A tissue microscopy shows mold with nonseptate hyphae, what is the most likely causal pathogen?
Mucor and Rhizopus- mold with nonseptate hyphae
Mucormycosis- necrotic lesion formed when mold invades blood vessels
Aspergillus treatment
Voriconazole, oral, as prophy
Tx: IV or oral voriconazole or ampho B
Fluconazole (Diflucan) indications are what
Candidiasis, Candida prophylaxis, cryptococcal meningitis
What do you need to check before perscribing an antifungal
LFTs- moniter for hepatotoxicity
What drugs are contradindicated with Antifungals
CYP inhibitors
St. John’s wart
What are the indications of itraconazole
Coccidiomycosis, blastomycosis, histoplasmosis, aspergillosis (but try voriconazole for aspergillus)
What is given to treat vaginal candidiasis
Fluconazole 150mg 1x for vaginal candidiasis- preemtive treatment if giving broad spectrum abx
Do you perscribe ketoconazole po or topically, and what do you perscribe it for?
Perscribe it topically only because of hepatotoxicity
Used for sebhorreic dermaititis
Describe echinocandins and their indications
Treat all candida infections
IV only
caspofungin, anidulafungin, micafungin.
Go to for serious fungal infections or in immuncompromized patients.
Does not cause drug interactions like fluconazole does
Amphotericin B is active against what
active fungi- works against most things, but is very toxic (nephrotoxicity and electrolight abnormalities, infusion reactions).
BUT, effective.
Not easily tolerated- must pre-hydrate patients
Fluconazole works against what bugs
Candida, crypto, cocci (3 c’s)
Echinocandins (fungins) works against what bugs
Candida
Itraconazole works against what bugs
Dimoprhic fungi (blasto, cocci, histo)
Voriconazole works against what bugs
Aspergillus
Ampho B works against what bugs
Effective against most fungals, but only IV and toxic
Metronidazole is indicated where
Protozoa (giardia), H. Pylori, Trichomonas, BV, Bite wounds, rosacea
What two drugs have a disulfram-like reaction?
Metronidazole and tinidazole–> do not drink alcohol with them or take disulfram with them.
Flagyl is best choice if you don’t trust your patient to not drink.
Toxicities of Metronidazole with systemic and long term use
Neurotoxicity, Disulfram-like reaction if mixed with alcohol ( headache, digestive upset)
How do you treat HSV and VZV
Acyclovir/Valacyclovir
CMV prevention drug of choice
valganciclovir
Can use Acyclovir for low risk CMV prevention
Dosing of acyclovir vs valacyclovir or famciclovir
Acyclovir- 5x per day
Valacyclovir and famciclovir- 3x per day
Key toxicities of acyclovir and valcyclovir
Interstitial nephritis- even worse with given IV - Nephritis/ Kidney injury
Neurotoxicity (especially in elderly)
When do you give antivirals in herpes zoster
Antivirals if <72 hours of onset of lesions
Valacyclovir and famciclovir preferred due to less frequent doses
CMV first line of treatment
ganciclovir and valganciclovir
Ganciclovir and Valganciclovir Toxicities BBBws
- Hematologic- thrombocytopenia, leukopenia, neutropenia
- Infertility
- Fetal toxicity, birth defects
- Carcinogenic
Screening before you start PrEP
- Negative HIV test before starting, then q3 months
- Renal function at least yearly
- HBV
When is HIV considered to be AIDS
When CD4 drops below 200 cells/mm3
Develop an AIDS-defining condition
High risk of opportunisitic infection
What are AIDs defining illnesses
Conditions: Kaposka sarcoma, lymphoma
Infections: Pneumocystis jirovecci, toxoplasmosis, mycobacterium avium complex (MAC)
Is routine antibiotic prophylaxis recommdended for HIV patients
NO- mostly fungal infections or yeast, not typically bacterial, and can cause resistance
After SOT, what prophylaxes do pts require
Against PJP
Anti-fungal against candida and aspergellus
Anti-viral against HSV and CMV
Which cancers are the most immunosuppressive
Bone metastases or solid tumors because they involve the bone marrow and disrupt the normal immune response
Give very cytotoxic chemo for solid tumors
Neutropenic patients with fevers should be started on what antibiotic
started on anti-pseudomonal antibiotics emperically. Typically gram - organisms or enterobacteria.
Pneumocystis jiroveci treatment first line
TMP-SMX
IV or PO
20mg/kg/day divided in 3-4 doses
Treatment: 21 days
Side effects: nephrotoxicity
pneumocystis jiroveci prophy first line
1 DS or SS tablet PO daily or 1 DS PO TIW (3x/week)
MAC treatment
2-3 antibiotics for at least 12 months
Macrolides (Azithro, clarithro)
Rifamycins (rifampin, rifabutin)
Ethambutol
MAC Prophylaxis
Azithromycin 1200mg po weekly for HIV patients who have CD4 <50.
Most common manifestation of CMV in HIV patients
Retinitis (visual impairments, floaters or flashers)
CMV diagnostics
Histopathology- biopsy of infected tissue- shows enlarged cells with viral inclusion bodies
