Id Therapeutics Exam 2: Set 2

Front 1

1. Inhibits viral DNA polymerase
2. Active against Herpes simplex, Herpes zoster, does not treat CMV
3. PO/IV
4. 5-10 mg/kg IV every 8 h
5. Dosage adjustment for renal impairment
(Good urine output, can crystallize in the kidney; ensure hydration)

Back 1

acyclovir

Front 2

valacylcovir dose

1. herpes simplex treatment
2. herpes simplex suppression
3. herpes zoster

Back 2

1. herpes simplex treatment = 1 g BID
2. herpes simplex suppression = 500mg -1g QD
3. herpes zoster = 1 g TID

Front 3

1. Inhibits Viral DNA polymerase
2. Available IV/PO
3. Active against Cytomegalovirus (CMV)
4. Dose CMV disease:
Induction: 5 mg/kg IV Q12H
Maintenance: 5 mg/kg IV QD or 6 mg/kg IV QD five days/week

Back 3

ganciclovir

Front 4

AE of ganciclovir (7)

Back 4

1. bone marrow suppression
2. neutropenia
3. thrombocytopenia
4. nausea
5. vomiting
6. confusion
7. LFT elevation

Front 5

dose of valganciclovir

1. induction
2. maintenance

Back 5

1. induction 900 mg q 12 (w/food)
2. maintenance 900 mg QD (w/food)

Front 6

1. Dose: Induction: 60 mg/kg IV Q8H or 90 mg/kg Q12H; Maintenance: 90 mg/kg QD
2. Inhibits viral DNA polymerase.
3. Active against Cytomegalovirus (CMV) and acyclovir resistant herpes symplex virus
4. Dosage adjustment for renal impairment uses modified Cockroft and Gault equation.(MALES mL/min/kg = (140 - age)/(serum creatinine x 72)
FEMALES Use above formula and multiply by 0.85)
5. Primary toxicity is nephrotoxicity (~50%).
Dose adjustment should be made for renal dysfunction.
6. Other toxicities include: nausea, vomiting, anorexia, seizures, hypocalcemia, and hypomagnesemia.
7. Less well tolerated than ganciclovir/ valganciclovir.
8. Infuse over at least 1 mg/kg/minute following a 2 hour prehydration infusion of 1 liter normal saline. (1 hour of 500 ml before maintenance doses)

Back 6

foscarnet

Front 7

1. Dose: Induction: 5 mg/kg IV weekly for 2 weeks; Maintenance: 5 mg/kg IV every 2 weeks
2. Second-line agent. (very toxic)
3. Inhibits viral DNA polymerase. Requires intracellular activation.
4. Should be administered with probenecid (2 g three hours before, 1 g two hours after, and 1 g eight hours after dose.)
5. One liter of normal saline should be administered one hour before drug infusion.
6. Primary toxicity is nephrotoxicity. Nausea, fever, alopecia, myalgia, and neutropenia, have also been reported.
7. Urinary protein and serum creatinine levels should be obtained prior to the administration of each dose.

Back 7

cidofovir

Front 8

clinical presentation of CNS infections (7)

Back 8

1. neck stiffness
2. fever
3. headache
4. photophobia
5. N/V
6. seizures
7. altered consciousness.

Front 9

clinical presentation of CNS infections in children (3)

Back 9

1. irritability
2. vomiting
3. seizures

Front 10

clinical presentation of CNS infections in elderly (2)

Back 10

1. low grade fever
2. altered consciousness

Front 11

treatment for meningitis?

<1 month

common bacterial pathogens: Streptococcus agalactiae, Escherichia coli, Listeriamonocytogenes, Klebsiella species

(2)

Back 11

1. Ampicillin plus cefotaxime
2. ampicillin plus an aminoglycoside

Front 12

treatment for meningitis?

1-23 months

common bacterial pathogens: Streptococcus pneumoniae, Neisseria meningitidis,S. agalactiae, Haemophilus influenzae, E. coli

Back 12

Vancomycin plus a third-generation cephalosporin

Front 13

treatment for meningitis?

2–50 years

common bacterial pathogens: N . meningitidis, S. pneumoniae

(1)

Back 13

Vancomycin plus a third-generation cephalosporin

Front 14

treatment for meningitis?

>50 years

common bacterial pathogens: S. pneumoniae, N. meningitidis, L. monocytogenes,
aerobic gram-negative bacilli

(1)

Back 14

Vancomycin plus ampicillin plus a third-generation
cephalosporin

Front 15

when treating meningitis what are your options for 3rd generation cephalosporins? (2)

Back 15

1. cefotaxime
2. ceftriaxone

Front 16

_____ are consistent with meningococcal meningitis, but may also occur
with streptococci or H. influenzae.

Back 16

Petechial or purpuric rashes

Front 17

_____may occur with pneumococcus meningitis.

Back 17

Macular rash

Front 18

______ are more common in
pneumococcal meningitis

Back 18

Changes in mental status and neurologic
abnormalities

Front 19

prophylaxis for bacterial meningitis: exposed to hemophilis influenzae

Back 19

HiB – residing with index case for >4 hrs; (unvaccinated contacts)
daycare – same day care for 5-7 days prior to onset



1. Rifampin 20 mg/kg po (NTE 600 mg) Q24 x 4 doses; Adults 600 mg Q24 x4 doses

Front 20

prophylaxis for bacterial meningitis: exposed to neisseria meningitidis

Back 20

close contact for at least 4 hrs during
week before illness; exposure to secretions



Cipro 500 mg x1; Ceftriaxone 250 mg IM X1 (adolescent)
ceftriaxone 125 mg IM x1 (< 15 yrs)
OR Rifampin 600 mg PO Q12 x 4 doses (adult)

Front 21

How would you treat viral meningitis?

Back 21

1. enteroviral infections are self-limited
2. supportive: fluids, antipyretics, analgesics
3. acyclovir IV if herpes meningitis is suspected

Front 22

direct infection of the brain parenchyma.

Viruses are by far the most common pathogen associated, although fungi, rickettsiae, and protozoans have also been implicated.

Back 22

encephalitis

Front 23

viruses associated with encephalitis (8)

Back 23

1. arboviruses
2. varicella zoster
3. herpes simplex
4. measles
5. mumps
6. cytomegalovirus
7. HIV
8. rabies

Front 24

clinical presentation for encephalitis prodromal period (5)

Back 24

lasts for several days

1. myalgia
2. fever
3. malaise
4. rash
5. mild upper respiratory symptoms

Front 25

clinical presentation for encephalitis for period after prodromal period (4)

Back 25

1. headache
2. drowsiness
3. mental status changes
4. meningismus

all signify development of enchephalitis