Pharmacotherapeutics IV-Opportunistic infections

Start Studying!

Terms

undefined, object

copy deck

When to initiate pneumocystis treatment: <200
Treatment duration for pneumocystis: 21 days
Pneumocystis 1st line tx: TMP/SMX 15-20mg/kg/day in 3-4 divided doses

or 2 DS tabs PO Q8H
Pneumocystis 2nd line tx: Dapsone 100mg Q24H and TMP/SMX 15-20mg/kg/d PO
Pneumocystis other alternative treatments: -Clindamycin + Primaquine

-Atovaquone (mild-mod)

-Pentamidine (severe-last line)

-Trimetrexate + leucovorin
When do you initiate adjunctive corticosteroid treatment for hypoxia? Which corticosteroid do you use?: PaO2 <70mmHg

Alveolar-arterial O2 gradient >35mmHg

Prednisoneor methylpredinisolone x21 days
Pneumocystis indications for primary prophylaxis: i.CD$+<200 OR
ii. hx of oropharyngeal candidiasis
Pneumocystis primary prophylaxis 1st line: TMP/SMX 1 ss tab Q24H
OR
TMP/SMX 1 DS TIW
Pneumocystis primary prophylaxis 2nd line alternatives: Dapsone 100mg PO Q24H
OR
Dapsone 200mg PO QWK +++ Pyrimethamine 50mg PO QWK +++ Leucovorin 25mg PO QWK

Also aerosolized pentamidine qmonthly, or atovaquone
When is secondary prophylaxis for pnemocystis started?: When treatment course ends

Identical to primary prophylaxis regimens
HIV patients are at risk of MAC infection at what CD4+ count?: <100
MAC initial treatment: *Azithromycin 500mg PO Q24H
PLUS
Ethambutol 15mg/kg PO Q24H

For SEVERE DX, ADD Rifabutin 300mg PO Q24H

(*or Clarithromycin 500mg PO Q12H)
If a patient does not respond after 2-4 weeks of therapy, add what?: i.Ciprofloxacin 750mg PO Q12H
OR
Levofloxacin 500mg PO Q12H

ii. Amikacin 15mg/kg IV Q24H
Most patients receive treatment for MAC for life, unless they meet what requirement?: Treated for atleast 12 months
AND
Asymptomatic
AND
CD4+ >100 for 3-6 months
When is primary prophylaxis indicated for MAC?: <50
MAC primary prophylaxis treatment and alternative: *Azithromycin 1200mg PO QWEEKLY

Alternative: Rifabutin 300mg PO Q12H

*(Clarithromycin 500mg Q12H)
When should primary prophylaxis be discontinued ?: When CD4>100 for 3 months
Secondary prophylaxis for MAC: Not recommended
Patients at highest risk for Toxoplasmosis have a CD4+ count of what?: <100
What is the treatment duration for Toxoplasmosis?: Treat for atleast 6 WEEKS followed by life long SECONDARY PROPHYLAXIS
Toxoplasmosis preferred treatment: Pyrimethamine 200mg PO x1, then 50mg (<60kg) or 75mg Q24H
PLUS
*Sulfadiazine 1g (<60kg) or 1.5g Q24H either PO/IV given in FOUR DOSES
PLUS
Lecuovorin (folinic acid) 10-20mg PO Q24H

*Alternatives:
Clindamycin 600mg PO/IV Q6H OR Clarithromycin 1g PO Q12H OR Azithromycin 1.2-1.5g PO Q24H OR Dapsone 100mg po Q24H
When is primary prophylaxis for Toxoplasmosis indicated?: <100 PLUS +toxo IgG
Primary prophylaxis 1st line treatment and alternatives: TMP/SMX 1 DS tab Q24H

Alternatives:
-TMP/SMX 1 ss tab Q24H
-Pyrimethamine 50mg QWEEK AND Dapsone 50mg Q24H AND Leucovorin
Secondary prophylaxis for Toxoplasmosis: Sulfadiazene PLUS
Pyrimethamine PLUS
Leucovorin

Alternative: Clindamycin PLUS Pyrimethamine PLUS Lecuovorin
Oropharyngeal candidiasis initial episode treatment: i. Clotrimazole troches 10mg PO 5 TIMES DAILY
ia. Nystatin suspension 4-6mL q6H

ii. Fluconazole 100mg PO q24H
Treatment for Fluconazole refractory OC?: a. Itraconazole oral solution
b. Amphoterecin B
Treatment for Esophageal candidiasis: i. Fluconazole 100-400mg PO/IV Q24H
Treatment for Fluconazole refractory EC: a. Caspofungin
b. Amphoterecin B
c. LIpid amphoterecin B
Prophylaxis for OC and EC?: Not recommended

-fluconazole
Immediate vision threatening lesion treatment for CMV: Intraocular ganciclovir implant
PLUS
Valganciclovir 900mg PO Q24H
How often should the intraocular ganciclovir implant be changed?: Q6-8H
How long does treatment of CMV last?: Until inactive dx
PLUS
CD4+ >100 x 3-6months
CMV retinitis treatment: Ganciclovir x14-21days OR valganciclovir x14-21days OR
foscarnet x14-21days OR cidofovir x2weeks then w/ probenecid and vigorous hydration
CMV esophagitis treatment: treatment lasts 14-21 days; consider maintenance after relapse
-Ganciclovir OR Valganciclovir OR foscarnet OR cidofovir w/ probenecid and vigorous hydration
CMV colitis treatment: same as CMV esophagitis
CMV penumonitis treatment: same as CMV esophagitis
CMV neurological disease treatment: Ganciclovir x14-21days PLUS foscarnet 14-21 days
TB treatment: Isoniazid PLUS Rifampin PLUS Pyrazinamide + Ethambutol + Pyridoxine

ADD streptomycin for suspected multi-drug resistant isolates

After 2months, stop pyrazinamide and continue isoniazid/rifampin for remaining 6months
TB prophylaxis for HIV+ patients with +PPD: Isoniazid 300mg x9monhts
OR
rifampin and pyrazinaide x2months

Start Studying!

Deck Info

Number of cards 39