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22 Cards in this Set
- Front
- Back
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CD4 cells < 200 + Hypoxemia
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PCP
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low pO2
increased LDH (^ 500) -lactic acid dehydrogenase |
PCP
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PCP tx and how many days?
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Septra for 21 days
IV for severe: PaO2 < 70 mmHg PO for mild-mod |
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alternative tx for PCP?
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Dapsone
Atorvaquone Pentam (Rispirgard II nebulizer) |
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when to give PRIMARY prophylaxis for PCP?
(4) |
1. CD4 <200 cells/mm3
2. Oropharyngeal candidiasis 3. CD4 < 14% 4. Hx of AIDS definiing illness |
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when to give SECONDARY prophylaxis for PCP?
When do you stop? |
soon as pt done with 21d (hx of PCP)
Septra DS QD! stop when CD4 >200 for 3 months |
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When to add steroids for our PCP pt?
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when PaO2 < 70 mmHg
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CD4: 250- 350 and s/sx wt loss, fatigue, night sweats, productive cough, frank hemoptysis
Labs: (+) AFB - acid fast bacilli |
Pulmonary TB
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CD4 < 200 and s/sx high fevers, rapid progression, sepsis syndrome w/ pleuritis, pericarditis, meningitis, lymphadenitis
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Extrapulmonary TB
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What is the diagnosis of TB?
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Tuberculin skin test (TST): Postive; induration >5mm at 48-72 hrs
False negative may be seen in advanced immuno (<200 CD4) |
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Latent TB treatment, what does that mean?
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(+) LTBI and no dx of tx for active/latent tx
(-) LTBI test but in close contact w/infected persons Hx of untreated or inade. txed TB |
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What are the tx for latent TB?
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tx for latent TB
Isoniazid for 9 months DIRECTLY OBSERVED THERAPY (DOT) - for adherence! |
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If resistant to isoniazid?
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If resistant to isoniazid
Rifampin/rifabutin for 4 months |
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If HIV pt NOT taking ART, what is the tx for latent TB?
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If HIV pt NOT taking ART
Isoniazid + Rifapentine for 12 weeks and DOT |
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There are 2 phases for the tx of active TB, what is phase 1 and how long is phase 1 tx?
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Phase 1 --> Initial phase. TWO months
Isoniazid + RIF/RFB + Pyrazinamide(PZA) + Ethambutol (EMB) QD |
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when can EMB be D/C before completetion of 2 months (initial phase) tx of active TB?
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EMB be D/C before completetion of 2 months if confirmed susceptibility to INH, RIF, PZA
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what is phase 2 and how long is phase 2 tx?
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phase 2 --> Continuation phase. 4-7 months.
Isoniazid + RIF/RFB daily OR 2-3x/week |
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2x/week is NOT recommended for active TB pt with what?
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2x/week is NOT recommended for active TB pt with CD4 < 100 cells/mm3 due to RELAPSE
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what to do if Pt with HIV but is Tx-Naive with active TB?
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ARV Naive and active TB
START therapy immediately CD4 < 200: start ARV within 2-4 wks of TB therapy CD4 200-500: start ARV within 2-4 wks; may delay til 8 wks after CD4 > 500: start ARV within 8 weeks of TB therapy |
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Do not co-admin Rifampin with what drugs?
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PROTEASE INHIBITORS
(use Rifabutin instead, dose adj required) Miraviroc (CCR5-containing regimen) |
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Do not co-admin Rifampin with what NNRTIs?
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Etravirine (Intelence, ETR)
Nevirapine (Viramune, NVP) Delavurine (Rescriptor, DLV) Rilipivirine (Edurant, RPV) OK with sustiva (efavirenz), dose adjustment 800mg |
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Must monitor what when tx TB
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LFTs (baseline, 1month, 3 months, w/sx of hepatitis)
monthly F/Us Sputum specimens after 8 weeks of tx! |
