Infectious Disease Tst4 Set2

Front 1

Non-pharma tx for LICE (6)

Back 1

1)nitpick w/ fine tooth comb (Licemeister)- time consuming
2)BugBusting- time consuming
3)style gels/mayo/cetaphil
4)wash clothes/bedding in HOT water
5)discard objects or seal in plastic for 2wks
6)vaseline for eyelashes/eyebrows

Front 2

LICE drugs (7)

Back 2

1)Lindane shampoo
2)Malathion
3)Pyrethrin 1%
4)Premethrin cream
5)Enzymatic hair gel shampoo
6)Ivermectin
7)Bactrim

Front 3

Lindane Shampoo (LICE)
a)use
b)MOA (2)
c)ADRs (5)

Back 3

a)4-5min massage then rinse, comb and repeat in 7days

b1)directly absorbed by parasites and ova thru exoskeleton
b2)stimulates nervous system resulting in seizures and death of parasite

c1)n/v
c2)seizures
c3)HA
c4)hepatits
c5)coma/death

Front 4

Malathion (LICE)
a)use (2)
b)MOA
c)warning

Back 4

a)sprinkle lotion on dry hair, massage in, wash after 12h
a)rinse and comb then repeat in 7d if needed

b)organophosphate

c)FLAMMABLE

Front 5

Pyrethrin 1% (LICE)
a)use (2)
b)MOA
c)ADR (3)
d)disadv (2)

Back 5

a1)apply for 10min, rinse, comb
a2)can be used on kids, pregnant women****

b)penetrates exoskeleton to block nerve impulses causing paralysis and death to louse

c1)irritation, eythema, swelling

d)Tx failure often
d)watch for chrysanthemum flowers allergy

Front 6

Permethrin cream (LICE)
a)use
b)MOA
c)adv/disdav (3)
d)ADR (3)

Back 6

a)apply for 10min, rinse, comb

b)disrupts Na channel in nerve membrane, delays repolarization and causes paralysis of parasite

c1)more effective than pyrethins
c2)lice can develop resistance easily
c3)NO use in kids under 2yo

d)itching, pruritis
d)burning/irritation
d)respiratory difficults

Front 7

Enzymatic hair gel shampoo (LICE)
a)use
b)MOA

Back 7

a1)apply after tx shampoo

b)loosens mucous which cements hits to hair shaft

Front 8

Ivermectin (LICE)
a)use (2)

Back 8

a1)effective on adult lice but NO effect on nits
a2)PO is effective

Front 9

Bactrium use (LICE)

Back 9

purported mechanism that abx kills gut bacteria which are essential to lice for laying fertile eggs

Front 10

Treatment Guidelines in LICE (7)

Back 10

1)need for physical nit removal is controversial
2)no need for nit removal after permethrin (b/c nits are dead)
3)first line is permethrin 1% or pyrethrins OTC
4)tx failures common w/ pyrethrins since they do NOT kill unhatched eggs
5)if tx failure w/ permethrin, recommend malathion or nit combing; Lindane is LAST line
6)Pediculocides unnecessary w/ body lice
7)improved hygiene w/ proper cleaning/drying of clothes/bedding

Front 11

Epidemiology of Scabies (4)

Etiology of Scabies (2)

Back 11

1)highly contagious, crusted scaly lesions
2)usually found in intertriginous areas (b/w fingers/toes, under breasts, all over)
3)men 15-40yo most affected
4)is endemic in many developing countries

1)caused by human mite
2)infestations are usually results of close body contact

Front 12

Mites properties (4)

Back 12

1)live for 30d
2)males live on surface
3)mites, feces, eggs cause itching
4)female burrows under skin to feed and lay eggs

Front 13

Pt presention w/ Scabies (4)

Back 13

1)complaints of severe itching, worse @ night
2)excoriated red papules, pustules, nodules
3)burrows appear as white zig-zag, thread like lines
4)can lead to secondary bacterial infexns

Front 14

Nonpharma Scabies Tx (3)

Back 14

1)mixture of 6% sulfur ointment in petrolatum (cover entire body for 3 straight nights)
2)clean/store contaminated clothing and bedding for week or two
3)important to tx cause, not just symptoms

Front 15

Drugs for Scabies (3)

Back 15

1)Permethrin 5%***
2)Crotamiton 10%
3)Lindane 1%

Front 16

Use of:
a)Permethrin 5% (2)
b)Crotamiton 10% (2)
c)Lindaine 1% (2)

SCABIES

Back 16

a1)apply to entire body
a2)remove by bathing after 8-14h

b1)massage into entire body @ bedtime for 2-5d
b2)bathe after 24-48h

c1)apply thin layer to skin for 8-12h
c2)do NOT apply after warm bath: can incr absorption thru skin and lead to neurotoxicity

Front 17

Crotamiton 10% ADR's (3) (Scabies)

Back 17

1)irritation/burning
2)n/v
3)ab pain

Front 18

Tx Guidlines for Scabies (3)

Back 18

1)sulfur and petrolatum preferred tx in infants less than 2 months old and pregnant or nursing mothers
2)itching caused by infestation can go on for weeks (even after mites are dead), leading pt to believe he/she is still infected
3)can use antihistamine regularly, steroid creams SPARINGLY

Front 19

Passive Immunity (2) and 5 classes

Back 19

1)opsonize foreign objects in body marking them for removal and destruction
2)produced by plasma cells

IgM: 1st line of defense, found in vascular space
IgG: long half-lfie, crosses placenta, passive immunization, recall immunity, most prominent Ig in blood
IgA: protects secretory surfaces like GI/eyes
IgE: major factor in elimination of parasites, fixes to mast cells
IgD: role unsure

Front 20

3 dichotomies of Ig Therapy

Back 20

1)human or animal
2)IM or IV
3)polyclonal or monoclonal

Front 21

Ig products available (4)

Back 21

1)IGIM
2)IGIV
3)anti-infective IG
4)Immunosuppressive IG (RhoD)

Front 22

Anti-infective IG's for...(7)

Back 22

1)HepB
2)Rabies
3)Tetanus
4)CMV
5)RSV
6)Vaccinia
7)Varicella-Zoster

Front 23

Heterologous Antisera's available (3)

Back 23

1)antitoxins (botulism, diphtheria)
2)antivenins
3)immunosuppressive (anti-thymocyte globulin-- from horses or rabbits)

Front 24

IVIG Products properties (5)

Back 24

1)contain 90-99% IgG and only trace amounts of IgM/IgA
2)prepared from pooled plasma of several thousand donors
3)contains a wide spec of IgG to pathogens prevalent in the area the donors were from
4)plasma half-life is approximately 15-30d
5)no need to adjust for hepatic/renal dysfxn

Front 25

IMIG uses (diseases) (7 and 1 not for)

Back 25

1)primary immunodeficiency states
2)HepA exposure AND prophy
3)HepB exposure
4)HepC exposure
5)Measles
6)Rubella
7)Varicella

NOT for prevention of rubella, mumps, polio

Front 26

IVIG uses (7)

Back 26

1)doses used depend on prep/product chosen

6 APPROVED USES******
a)primary immunodeficiency (IgA)
b)ITP
c)kawasaki disease
d)chronic lymphocytic leukemia
e)pediatric HIV
f)BMT (allogenic)

Front 27

IMIG ADR's (2)

Back 27

1)pain/tenderness
2)muscle stiffness for hrs/days after injexn

Front 28

IVIG ADR's and prevention (5 and 2)

Back 28

1)1% of immunocompetent persons have rxns
2)10% of immunocompromised persons have rxns
3)chills, fever, flushing (LOTS of other nonspecific rxns)
4)MOSTLY DUE TO RATE OF INFUSION
5)can occur during any infusion (1st or 9th)

1)slow rate if pt is having rxns
2)premedicate w/ antihistamines and antipyretic

Front 29

CMV-IVIG
a)indication (2)
b)other (2)

Back 29

a1)prophylaxis of CMV w/ other transplants
a2)attenuation of primary CMV associated w/ kidney transplant

b1)contains IgG antibodies from healthy persons w/ high titers of Ig's to CMV
b2)vaccination w/ live viruses should wait 3months after admin

Front 30

RhoIG
a)use (2)
b)other (2)

Back 30

a)suppresses Ig response and formation of anti-RhoD in RhoD (-) women exposed to RhoD (+) blood
a)prevents erythroblastosis fetalis in subsequent pregnancies w/ RhoD (+) fetus

b)preparaed from human sera
b)admin IM to mom within 72h of delivery

Front 31

Tetanus Ig
a)use (2)
b)other (2)

Back 31

a1)passive immunity to tetanus after exposure in non-immunized or suboptimal immunized person
a2)tx of tetanus @ very high doses

b1)prep from hyperimmunized persons
b2)not given IV due to serious ADRs (ONLY IM)

Front 32

HepB Ig
a)use (4)
b)prep

Back 32

a1)passive immunization following exposure to HepB
a2)for infants born to mothers who are HepB carriers
a3)use ASAP after acute exposure and does NOT recommend use after 14d
a4)usually just need a single dose

b)compiled of pooled plasma from small group of hyperimmunized donors

Front 33

Rabies Ig
a)use (2)
b)other (2)

Back 33

a1)used in conjunction w/ rabies vaccine as part of post-exposure management
a2)not recommended beyond 8d after initiation of vaccine series

b)never given IV; only IM
b)compiled of plasma from donors who have been hyperimmunized w/ rabies vaccine

Front 34

Varicella-zoster Ig (VZIG)
a)use (3)
b)other (2)

Back 34

a1)pasive immunization of susceptible immunodeficient pts exposed to chicken pox
a2)for adults/kids @ very high risk of complications/death if they contract varicella
a3)use within 48h of exposure

b)duration of protection is 3wks
b)may NOT prevent infexn; just attenuate

Front 35

Susceptible immunodeficient pts exposed to chicken pox (7)

Back 35

1)neoplastic diseases
2)primary or acquired immunodeficiency
3)immunosuppression therapy
4)pregnancy
5)newborn of mother w/ chickenpox 5 days prior to delivery or 48h after delivery
6)premie older than 28wks w/o maternal history of chickenpox
7)premie under 28wks old or less than 1000g regardless of mother's history

Front 36

RSV Ig
a)use
b)other (3)

Back 36

a1)passive immunization of kids under 24months w/ BPD or prematurity (less than 35wks)

b1)administered monthly by infusion during RSV season (Oct to Apr)
b2)ADR's related to infusion rate
b3)been replaced by MAb

Front 37

Botulism Immune Globulin IV (BabyBIG)
a)use (2)
b)ADR

Back 37

a1)for tx of pts less than 1yo w/ infant botulism
a2)one time IV infusion

b)ADR's related to infusion rate

Front 38

Vaccinia Immune Globulin IV (VIGIV)
a)use (3)
b)other (2)

Back 38

a1)passive immunization after complications from exposure to vaccinia (smallpox)
a2)for tx and/or modification of inadvertant infexns induced by vaccinia
a3)vaccinia infexns in: eye, mouth

b1)orphan drug status
b2)only get it from CDC

Front 39

4 parts of MAb name

Back 39

prefix (variable)

target

source

all end in -mab

Front 40

Target prefix =
a)-bac
b)-cir
c)-col
d)-fung
e)-got
f)-gov

Back 40

a)bacterial
b)CV
c)colonic tumor
d)fungal
e)testicular tumor
f)ovarian tumor

Front 41

Target prefix =
a)-kin
b)-les
c)-lim
d)-mar
e)-mel
f)-mul

Back 41

a)IL
b)infectious lesions
c)immune system
d)mammary tumor
e)melanoma
f)musculoskeletal

Front 42

Target prefix=
a)-neur
b)-os
c)-pro
d)-toxa
e)-tum
f)-vir

Back 42

a)nervous system
b)bone
c)prostate tumor
d)toxin
e)misc tumor
f)viral

Front 43

Source prefix =
a)-a
b)-axo
c)-e
d)-i
e)-o

Back 43

a)rat
b)rat/murine hybrid
c)hamster
d)primate
e)mouse

Front 44

Source prefix=
a)-u
b)-xi
c)-xizu
d)-zu

Back 44

a)human
b)chimeric
c)chimeric and humanized
d)humanized

Front 45

Anti-coagulant Antibody

Back 45

Abciximab

Front 46

Anti-infective Ig
a)drug
b)composition
c)MOA/use (3)
d)admin

Back 46

a)Palivizumab

b)95% human, 5% murine

c1)virus neutralizing and fusion-inhibiting activity
c2)prevention of RSV
c3)used only in ppl high risk of RSV

d)IM at 15mg/kg monthly for 5 months during RSV season

Front 47

Anti-inflammatory Ig
a)drug
b)composition
c)MOA (2)

Back 47

a)Infliximab

b)chimeric MAb specific from human TNFalpha

c)binds strongly to soluble TNFalpha
c)AND to cell bound forms on the surface of TNFalpha producing cells (macrophages) which may be killed

Front 48

Anti-neoplastic Ig
a)drug
b)properties (2)

Back 48

a)Rituximab

b1)refractory RA
b2)PREMEDICATE W/ ANTIEPILEPTIC*****

Front 49

Tratuzumab
a)for.... (2)

Back 49

a)metastatic breast cancer where tumor overexpressses HER
b)degree of HER2 overexpression appears to be a predictor of efficacy

Front 50

Immunoantidote Ig's
a)drug
b)use/PK (2)

Back 50

a)Digoxin Immune Fab (Digibind)

b)immunoantidote for serious cardiac glycoside intoxication
b)Fab fragments have half-life of 15-20h and are excreted in urine

Front 51

Immunosuppressive Ig's
a)3 drugs (w/ 3,1)

Back 51

Muromonab-CD3
a)murine MAb
b)indicated for tx of acute allograft rejection in renal transplant
c)anti-murine Ig's develop in 80% of pts by 2nd week of tx

Daclizumab/Basiliximab
a)prophylaxis of acute allograft rejection in renal transplant pts

Front 52

Hepatotoxic drugs (4)

Back 52

1)isoniazid
2)rifamycin
3)pyrazinamide (limit tx to 2months)
4)azoles

Front 53

Hyperuricemia causing drugs (2)

Back 53

1)Ethambutol
2)Pyrazinamide

Front 54

Candida species most likely to be resistant to azole's (2)

Back 54

1)C. krusei (also resistant to 5-FC/AmphoB)
2)C. glabrata (also resistant to AmphoB)

Front 55

Risk factors for candidiasis (7)

Back 55

1)neutropenia
2)leukemia/lymphoma
3)CVC (central venous catheter)
4)TPN
5)burns
6)renal failure/hemodialysis
7)mechanical ventilation

Front 56

Risk factors for aspergillosis (6)

Back 56

1)PROLONGED NEUTROPENIA
2)chemotherapy
3)cancer
4)DM
5)immunodeficiency
6)BMT

Front 57

Antifungal susceptibility testing role (4)

Back 57

1)NOT routinely done
2)still in development and NOT as sophisticated as bacterial susceptibility testing
3)most useful for non-albicans Candida infexns
4)S,I,R and SS-DD (susceptible dose-dependent= larger dose of antifungal may over come resistance)

Front 58

Clinically important species in Candidiasis (8)

Back 58

1)C. albicans
2)C. glabrata
3)C. krusei
4)C. tropicalis
5)C. parapsilosis
6)C. lusitaniae
7)C. guilliermondi
8)C. dubliniensis

Front 59

Candidemia
a)Treatment in Non-neutropenic adults (3)

Back 59

a1)remove CVC PLUS
a2)fluconazole (for documented C. albicans and empiric therapy)
a3)Echinocandin (good for non-albicans Candida)

Front 60

Candidemia
a)efficacy monitoring (5)

Back 60

1)blood cultures
2)temperature
3)WBC
4)clinical improvement
5)duration of therapy lasts 2wks after last (+) blood culture AND when s/sx of infexn resolved

Front 61

Candida cystitis (UTI)
a)tx (3)
b)monitoring (2)

Back 61

a1)none for asymptomatic pts (maybe just remove/change urinary catheter)
a2)fluconazole (x14d) good urine []s, limited effectiveness for non-albicans
a3)5-FC (x5-7d) monotherapy OK here

b)repeat UA and urine culture
b)resolution of s/sx

Front 62

Vulvovaginal Candidiasis (VVC)
a)risk factors (6)
b)monitoring

Back 62

a1)sexual activity (VVC is NOT an STD)
a2)contraceptive use (diaphragm, sponge, IUD)
a3)recent abx use
Complicated VVC
a)pregnancy
b)immunosuppression
c)DM

b)complete resolution of s/sx

Front 63

Vulvovaginal Candidiasis tx
a)uncomplicated (2)
b)complicated
c)recurrent
d)what to watch for

Back 63

a1)topical azole for 1-7d
a2)systemic fluconazole oral single dose

b)same as a) but use for 10-14d

c)induction therapy x 10-14d, then maintenance x6months

d)oral azoles are teratogenic**, topical azoles OK in pregnancy

Front 64

Clinically important species for invasive Aspergillosis (4)

Back 64

1)A. fumigatus
2)A. flavus
3)A. niger
4)A. terreus

Front 65

Tx of invasive PULMONARY aspergillosis

Monitoring (2)

Back 65

1)VORICONAZOLE

1)duration of therapy: weeks to months depeding on pt factors
2)con't therapy until all s/sx of infexn have resolved and radiologic abnormalities have resolved

Front 66

Histoplasmosis
a)risk factors (2)

Back 66

a1)immunosuppression (but infexn can occur in immunocompetent pts too)
a2)contact w/ contaminated sites (construction/demolition sties, remodeling, exploring caves)

Front 67

Disseminated histoplasmosis disease tx (in immunocompetent and immunocompromised)
a)mild to moderate
b)moderately severe to severe
c)long term secondary prophylaxis

Back 67

a)itraconazole for atleast 1yr
b)lipid amphotericin B for 1-2wks, followed by itraconazole for atleast 1yr
c)give itraconazole to AIDS and immunosuppressed pts

Front 68

Monitoring disseminated histoplasmosis (3)

Back 68

1)repeat urine and serum antigen
2)fungal blood culture and/or biopsy if relpase suspected
3)itraconazole serum levels to confirm adequate absorption of drug (draw random steady-state []s)

Front 69

Blastomycosis tx
a)who to tx (3)
b)mild to moderate pulmonary or disseminated disease
c)all others (including immunocompromised and CNS disease)

Back 69

a1)ALL immunocompromised pts
a2)progressive pulmonary disease
a3)disseminated disease (extrapulmonary)

b)itraconazole for 6-12months

c)amphotericinB (regular form) as initial therapy, then an oral azole (usually itraconazole)

Front 70

Blastomycosis monitoring (2)

Back 70

1)resolution of s/sx
2)clearance of B. dermatitidis from involved tissues

Front 71

Coccidioidomycosis tx
a)primary pneumonia (2)
b)disseminated disease (non-meningeal)
c)Meningitis (2)

Back 71

a)uncomplicated- watch and wait w/ regular follow up
a)high-risk for severe, disseminated disease (immunosupp, pregnancy): fluconazole or itraconazole for 3-6months

b)oral fluconazole/itraconazole for atleast 1yr

c)high dose ORAL fluconazole/itraconazole FOR LIFE
c)intrathecal conventional amphoB for pts NOT responding to azole's

Front 72

Coccidioidomycosis efficacy monitoring (2)

Back 72

1)resolution of s/sx
2)lumbar puncture (meningitis)

Front 73

Pathogens causing
a)Histoplasmosis
b)Blastomycosis
c)Coccidioidomycosis

Back 73

a)H. capsulatum

b)B. dermatitidis

c)C. immitis

Front 74

Fluconazole doses
a)IFI (invasive fungal infexn)
b)candida UTI
c)vulvovaginal

Back 74

a)6mg/kg/d (400-800mg/d) IV or PO

b)200mg/d PO or IV

c)150mg PO x1

Front 75

Polyenes (amphotericinB) major toxicities (4)

Back 75

1)nephrotoxicity
2)severe infusion rxns
3)decr Mg/K
4)hypoxia

Front 76

Monitoring for polyenes (3)

Back 76

1)renal fxn
2)electrolytes
3)pulmonary fxn

Front 77

Echinocandins drugs (3)

Back 77

1)Caspofungin
2)Micafungin
3)Anidulafungin

Front 78

Echinocandins monitoring
a)caspofungin
b)micafungin (3)
c)anidulafungin

Back 78

a1)interaxn w/ cyclosporine

b1)interaxns w/ sirolimus/nifedipine
b2)LFTs
b3)renal fxn

c)LFTs

Front 79

Proper use of Echinocandins

Back 79

slow infusion rate or premedicate w/ diphenhydramine may help w/ infusion rxns

Front 80

Lipid AmphotericinB vs. normal AmphoB (3)

Back 80

1)equal efficacy
2)less renal toxicity
3)less infusion toxicity

than normal AmphoB

Front 81

Pyrimidine Analgo
a)drug
b)toxicities (3)

Back 81

a)5-FC

b1)leukopenia
b2)thrombocytopenia
b3)n/v/d

Front 82

5-FC
a)monitoring (3)
b)other

Back 82

a1)CBC
a2)serum []s
a3)drug interaxns

b)RARELY USED AS MONOTHERAPY (only in Candidia cystitis)

Front 83

Fluconazole
a)major toxicities (3)
b)monitoring
c)other (2)

Back 83

a1)well tolerated
a2)GI side effects
a3)reversible alopecia

b)renal fxn (BUN/SCr)

c)PO form highly bioavailable
c)TERATOGENIC

Front 84

Itraconazole
a)major toxicities (4)
b)monitoring (4)
c)other (3)

Back 84

a1)severe n/d (w/ PO solution)
a2)hepatoxicity
a3)hypokalemia
a4)edema (avoid in CHF)

b1)CYP inhibitor (drug interaxns)
b2)LFTs
b3)electrolytes
b4)serums []s

c1)TERATOGENIC
c2)w/ CAPSULE take w/ food and avoid PPI/H2
c3)w/ SOLUTION take on empty stomach

Front 85

Voriconazole
a)major toxicity (3)
b)monitoring (3)
c)other (2)

Back 85

a1)VISUAL DISTURBANCES****
a2)phototoxic rash
a3)hepatotoxic

b1)interaxns (CYP inhibitor)
b2)LFTs
b3)serum []s

c1)PO form highly bioavailable
c2)teratogenic

Front 86

Admin of Posaconazole

Back 86

incr absorption w/ high-fat meal & MDD?

Front 87

_____ is never used for invasive candidiasis

Back 87

itraconazole