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Skills PBE #2
Infectious Disease
| Question | Answer |
|---|---|
| Increased Risk Factors for Fungal Infections are | Neutropenia, Organ and BMT, HIV/AIDS, CYtotoxic chemotherapy, use of indwelling catheters, increased use of potent broad spectrum antibiotics, Chemotherapy, Radiotherapy, Corticosteroids, CMV, Cantral venus line, mucositis, TPN, hospital environment |
| signs, symptoms, pathogens, and treatment of vulvovaginal candidiasis | b. Thick, white, curdy vaginal discharge ("cottage cheese-like")Uncomplicated VVC- OTC: Lactobacillus acidophilus,& Clotrimazole if ComplicatedComplicated VVC- Increase length of therapy: 7-14 days of topical therapy, or 150 mg oral dose of fluconozole |
| risk for oropharyngeal candidiasis | Exogenous- Steroids, Antibiotics, Dentures, Xerostomia (Dry mouth), Smoking, Disruption of oral mucosaDisease states-Immunosuppressed,Neonates,Elderly,HIV/AIDS,Diabetes,Malignancies,Malnutrition |
| treatment or prophylactic regimen for oropharyngeal candidiasis | Clotrimazole 10 mg troche, Nystatin 100,000 units/ml suspension- 5 ml swish and swallow QID x 7-14 days |
| Histoplasmosis-Grows in Nitrogen soils of Ohio & Miss valley- s/s and treatment | Flu-like, fever chills, HA, non-productive cough, enlargement of spleen, Mild- Itraconazole 200mg BID or severe Ampotercin B 0.7mg/kg/day +- prednisone followed by itraconazole for >6months |
| Blastomycosis- The fungi lives in warm moist soils with decayed vegetation, or pigion feces, s/s and treatment | , night sweats, chest pain, productive coughDisseminated infection (lesions) can occur in immunocompromised patients- skin, bone, joints, may appear 1-3 after pulmonaryMild- Itraconazole 200mg BID or severe Ampotercin B 0.7mg/kg/day +- prednisone followed |
| Coccidiodomycosis-Presents in hot dry sandy areas of southwest s/s and treatment | HA, cough-necrosis of pulmonary tissue, sore throat, maylgias, fatigue, maculopapular rash, - Mild- Itraconazole 200mg BID or severe Ampotercin B 0.7mg/kg/day +- prednisone followed by itraconazole for >6months |
| Sporotrichosis-Called Rose Gardener’s Disease- South America s/s and treatment | painless ulcerations in linear patternTopical- Potassium iodide (SSKI), terbiniafine Generalized- Amphotericin B or itraconazole, voriconazole |
| Candida AlbicansGerm - tube positive treatment is | Fluconazole IV/PO 6-12 mg/kg /day (400-800mg/day)( normal renal function) |
| CandidaGerm - tube negative = non albicans Candida: treatment | 1st line - Caspofungin IV 70 mg load x1 then 50 mg IV q24h, 2nd line - Lipid Amphotericin B 5 mg/kg IV q24h, 3rd line - Amphotericin B 0.5 - 1 mg/kg IV qd |
| Aspergillosis + galactomannan assay s/s and treament | Invasive (CNS), Pulmonary (most common), Allergic bronchopulomonary- 1st line: IV Voriconazole 6mg/kg IV q12h x 2 doses then 4mg/kg IV q12h (note only use IV if Clcr > 30ml/min because of accumulation of cyclodextran) |
| Cryptococcosis Non-HIV and Non-CNS s/s and treatment | Presents as ARDSMild-moderate symptoms: fluconazole 400mg qd for 6 -12 months |
| Cryptococcosis HIV-s/s and treatment | Pulmonary- Mild to moderate- Fluconazole 200-400mg/d for life or Fluconazole + flurosyine x 10 weeksCNS- Amibsome (lipid formulation of AMPB) + Flusytosine 2 weeks, then fluconazole x 10 weeks- maintence Fluconazole life long. |
| Ringworm –Tinea corporis treatment | Topical azole, or Severe-PO Azole-Fluconazole, Ketoconazole, Itraconazole |
| Amphotericin B-MOA- | Binding to ergosterol leading to intercalation of cell membrane causing leakage of intracellular cations and proteins |
| Amphotericin B SE | Nephrotoxic,Acute infusion related reaction, Hypokalemia, electrolyte abnormalities, anemia, hepatic dysfunction |
| Amphotericin B-DI- | Other nephrotoxic agents & Agents that effect electrolytes |
| Azoles-MOA- | Bind C-14-alpha-demethylase blocking the conversion of lantosterol to ergesterol |
| Azoles-SE | N/V, GI symptoms, rash, hepatic disfunction-Voriconazole has extra precautions: Increase in LFT, Visual disturbances, photosensitivity. |
| Azoles-DI- | Voriconazole has many P450interactions. Rifampin, phenytoin, carbamezepine, Phenobarbital, warfarin, loratidine, protease inhibitors, chemotheraputics. |
| Flucytosine-MOA- | Inhibition of cytosine deaminase which is intrinsic only in fungi. Leads to decrease in 5FU and decrease in DNA synthesis |
| Flucytosine-SE | Bone marrow toxcity, hepatologic issues if >100mcg/mL, and photosensitivity. |
| Flucytosine-DI- | Etoh, MgOH-delays absorption, and use with bone marrow suppresants leads to adverse effects |
| Echinocandins-Fungicidal-Caspofungin, anidulafungin, micafungin MOA | Inhibition of B(1-3)glucan synthesis results in killing hyphae at their growth tips and branching points. |
| Echinocandins-Fungicidal-Caspofungin, anidulafungin, micafungin SE | N/V, HA, dizziness, Infusion related reactions (anti-histamine) , flushing, pain , SOB, Hepatotoxcity |
| Echinocandins-Fungicidal-Caspofungin, anidulafungin, micafungin DI's | Cyclosporin increases concentration of caspofungin by 35% |
| Nikkomycin MOA | Competitive inhibition of chitin synthase-investigational. |
| Signs and symptoms associated with Aspergillus infections | Lungs most common site: Filamentous fungi, associated with pneumonia symptoms-CXR, Fever, tachychardic, tachypnic, sputum, decreased urine output |
| Monitoring for Clinical improvement | Resolution of fever, restoration of pulse, RR, BP in about 4-5 days |
| Renal adjustment needed with the following medications | Ampotercin B, Fluconazole (90%), |
| Voriconazole has the most | P40 DI and must be monitored- Phenytoin-lowers, cannot take with sirolimus or rifabutin |
| Caspofungin must be adjusted in | Severe hepatic dysfunction |
| Considerations related to treatment of infection and/or preventio of infection are | Adequate nutrition (take off TPN ASAP), Aseptic technique or PICC line |
| Renal monitoring for Itraconizole and Voriconazole are need because | They have the excipient cyclodextran which can accumulate |
| Must monitor the following DI's of Voriconazole | Warfarin, Cyclosporin, Tacrolimus, Sirolimus, Phenytoin, Carbamazepine, Rifabutin, Protease inhibitors, Vincristine, DIgoxin, Loratadine, Diltazem, Statins |
| Fluconazole should be monitored by | Periodic LFT, alkaline phosphatase, Renal-Scr, BUN, electrolytes, and relief of s/s |
| Malaria treatment is | 1st line-Chloroquine, 2nd-Quinidine Gluconate +/- Pyrimethamine-sulfodoxine |
| Entamoeba histolytica treatment is | Metronidazole |
| Giardia treatment is | Metronidazole |
| Hookworms and Ascariasis treatment is | Mebendazole |
| Enterobiasis (pinworm) treatment is | 1st-Pyrantel pamoate2nd-Mebendazole, 3rd-Albendazole |
| Lyme Disease treatment is | Bullet rash- & joint swelling- Treated with Doxycycline |
| Rocky Mountain Spotted Fever treatment is | Rash, diarrhea- Treatment is Doxycycline |
| Ehrlichiosis treatment is | It is a small gram negative bacteria that require a eukarytoic cell for growth- Leukopenia, acute respiratory failure, Rash, coagulopathy- Treatment is Doxycycline or Rifampin (pregnancy) |
| Southern Tick Associated Rash Illness (STARI) treatment is | Eruption 2-12 days Doxycycline |
| Tick-Borne Relapsing Fever treatment is | Fever, chills, HA, myalgia, lasts for 3 days, then relapse occurs 1 week later- Doxycycline |
| Babesiosis treatment is | a Protoza that attcks the RBC and can appear 1-4 weeks after bite cause maliase, fever, chills-Treat with Clindamycin + Quinine |
Created by:
liza001
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