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49 Cards in this Set
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PCP
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-prophylaxis at CD4<200 or renal transplant
-cysts in lungs What to monitor or give with Tx |
-Give steroids if PO2<70
--solumedrol IV or prednisone 20-40 for 15-21 days, tapering off -most common Pneumocystis Jiroveci Pneumonia |
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Prophylaxis for PCP
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-Bactrim DOC (DS or SS daily to TIW)
-Dapsone 100mg daily -Atovaquone 1500mg daily -pentamidine 300mg q28 days via inhalation |
21-28 days of therapy
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Treatment of PCP
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-bactrim 15-20mg/kg/day TID
-dapsone 100mg daily with trimethoprim 15-20mg/kg/day BID -pentamidine 4mg/kg IV -primaquin/clindamycin -atvaquone 750mg BID |
only caspofungin or echinocandins have activity
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PCP
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it is fungal infection, pneumonia like infection
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historically, thought it was a bacterial infection
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Bactrim
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-15-20mg/kg day for tx or 1ds or 1 ss qd or tiw
IV bactrim has a volume problem. 1mg/mL -Bactrim not stable in NS -renally excreted - dosing based on trimethoprim -when prophylaxis for PCP, also prophylaxis for Toxoplasmosis - |
ADR:
-RASH -NVD -Anemia -Thrombocytopenia -Agranulocytosis -Hyperkalemia |
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Pentamidine, Pentam
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-4 mg/kg IV or 300mg q28d
-very NEPHROtoxic -pancreatitis (strong toxin) -blood sugar abnormalities (high/low)[biggest worry is hypoglycemia] |
ADR
-leukopenia -hypotension -thrombocytopenia -sterile abscess -metallic taste in mouth -hypocalcemia -phosphate |
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Dapsone
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100mg +/- 15-20mg/kg TMP
ADR -agranulocytosis -aplastic anemia -methemaglobinemia |
must be with trimethoprim for treatment
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Atovaquone (Mepron)
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1500mg QD tx; 10mg QD for px
-bad taste -take with fat -yellow liquid stains -mild PCP |
ADR
-NVD -fever -rash |
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Primaquin and Clindamycin
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-give with clindamycin
dose 15-30mg PO ADR: NV, abdominal pain -granulocytopenia -hemolytic anemia -methemoglobinemia |
Clindamycin: 300-900 Oral or IV
ADR: pseudomembranous colitis -NV -Rash -Diarrhea |
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PCP (things to do)
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before or after: START HAART WHEN POSSIBLE
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after: secondary prophylaxis
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Bactrim, TMP monitoring
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-CBC
SCr/BUN, K -Na, Alb |
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Dapsone monitoring
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-CBC
-SCr/BUN, K -methemaglobin, G6PD |
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Pentamide monitoring
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-SCr/BUN
-Amylase/Lipase -Glucose -CVC |
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Primaquine monitoring
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-CBC
-methemaglobin -G6PD |
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Clindamycin monitoring
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-diarrhea
-BUN/SCr -electrolytes -toxic megacolon |
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Steroids monitoring
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-blood sugar
-fluid retention |
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PCP monitoring
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-breathing
-CXR -ABG/O2 saturation |
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Cytomegalovirus
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CMV
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-prophylaxis <50, transplants
-have primary and secondary prophylaxis -treatment 14-21 days |
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Ganciclovir
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IV use
-induction 5mg BID maintenance 5-10mg daily -dose to renal function, need neupogen |
ADR:
-granulocytopenia -THROMOCYTOPENOA -NEUTROPENIA -anemia (minor) -HA -confusion -renal |
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Valganciclovir
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Oral
-900mgBID, then 900mg daily -need neupogen |
-granulocytopenia
-THROMBOCYTOPENIA -NEUTROPENIA -nausea -headache -anemia (minor) -renal -confusion |
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Foscarnet
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IV
90mgBID, then 90mg daily -hydration -calcium replacement |
ADR
-renal dysfunction -hypokalemia -hypomagnesemia -hyponatremia -phosphate -hypocalcemia -NV -anemia -HA |
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Cidofovir
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5mg QW, then QOW
-need hydration -need probenecid 4 grams on treatment days |
ADR:
-NEPHROTOXIC -avoid other nephrotoxins |
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Ganciclovir and Valganciclovir monitoring
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-SCr
-CBC (frequent for platelets) |
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Foscavir monitoring
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-SCr/BUN
-Na, K, Mg, Ca, Phos -CBC |
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Cidofovir monitoring
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- SCr/BUN
-Urine (proteinuria) -medication list (nephrotoxins) |
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Toxoplasmosis
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-seen when CD<50
-treatment for 6 months -treat until CD4> 100 |
-can be in eye
-also can be in encephalitis, AMS, seizures, unconscious. |
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Toxoplasmosis treatment
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1. pyrimethamine/Leucovorin
2. sulfadiazine, clindamycin, azithromycin, or atovaquone or 3.Bactim mono therapy 5mg/kg bid |
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Pyrimethamine plus leucovin
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-must use leucovin (activated folic acid)
dose is 75mg plus 10mg of leucovin |
ADR:
-megaloblastic anemia -LEUCOCYTOPENIA, THROMBOCYTOPENIA -PANCYTOPENIA -NV -HA -malaise |
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Sulfadiazine
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ADR:
-rash -NV -anemia -neutropenia -peripheral neuropathy |
-dose is 1-1.5 grams QID
-not monotherapy |
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Clindamycin T0xoplasmosis
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ADR:
-colitis -diarrhea |
-dose 300-900 qid
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Azythromycin Toxoplasmosis
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ADR:
-diarrhea -tinnitus -abdominal cramping -nausea |
-600mg qd
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Pyrimethamine monitoring
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-CBC
-leucovin |
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Sulfadiazine
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-CBC
-SCr |
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Toxoplasmosis monitoring
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-medication intake
HAART tx -CD4 count |
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MAC
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-propylaxis at CD4<50
-MAComa during HAART -ingested |
-will present with TB symptoms plus DIARRHEA or GI
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MAC prophylaxis and treatment
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prophylaxis
-azithromycin 1200 QW -clarithromycin 500mg BID -rifabutin 300mg daily |
treatment:
-ethambutol and 2nd gen macrolide -add others if needed |
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Rifabutin MAC
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Dosing normal:
-300mg daily With PI -150mg daily With boosted PI -150mg TIW Efavirenz -450-600mg daily Fluconazole-uveitis |
ADR
-rash -discolored urine/feces/tears/saliva -NV -neutropenia/leukopenia |
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azithromycin MAC
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ADR:
-N/D dyspepsia tinnitus |
-600mg daily
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clarithromycin MAC
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ADR:
-N/D -loss of hearing -dyspepsia -bad taste in mouth |
-500mg BID
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Ethambutol MAC
-dosed 20mg/kg/day |
ADR:
-anorexia -NV -fever -malaise -HA/dizziness -peripheral and optic neuropathies |
Need azith or clarity.
clarith favored BASE DRUG FOR TREATMENT |
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Toxoplasmosis intubated which means NPO
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-Bactim IV
-Clindamycin and Azithromyic IV |
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Amikacin or Streptomycin
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ADR:
-renal -ototoxicity -injection site reaction |
streptomycin 1gm/day IM
amikacin 10-12mg/kg IV |
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Fluroquinolone
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ADR:
-nausea -confusion -dizziness -glucose agnormalities -QT prolongation |
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Rifabutin monitoring MAC
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-LFT
-CBC |
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Ethambutol monitoring MAC
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-SCr
-CBC |
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Aminoglycosides monitoring MAC
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-SCr
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MAC monitoring
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-fever
-diarrhea -weight -HAART -CD4 cells -Medication adherence |
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Cryptosporidium
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-from water
-causes diarrhea and weight loss -lack of absorption in GI is problem -dehydration is problem -hydrate -you can use multiple anti-diarrhea |
TX: HAART
-Humatin (Paromomycin) (like vanc for C.Dif) -ALINIA (Nitazoxanide) GI side effects. DOC!! -Azithromycin IV is plus |
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Kaposi Sarcoma
HHV8 |
-dermal, but can grow on other tissues.
-dermal less serious -classic, endemic, transplant, aids associated |
Tx
1. HAART -cutaneous HAART includes radiotherapy, alitretinoin gel, laser therapy, cryo or laser therapy -systemic HAART include liposomal antracyclines (rubicins) and paclitaxel |
