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103 Cards in this Set
- Front
- Back
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Primary Prophylaxis
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provided to pt w/ no history of OI but risk
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Secondary Prophylaxis
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pt w/ at least 1 OI
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want to start ART..early disadv
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-one disadv- IRIS- immune reconstitution inflam syndrome
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if have acute IO on ART
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-if w/i 12 weeks starting ART continue ART and tx OI
-if result of virologic failure- start tx OI, resisetance testing for ARV |
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Pneumocystis jiroveci pneumonia
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-formerly PCP, protozoa like fungus
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Pneumocystis jiroveci pneumonia
risks |
-CD4 <200,
prior PCP, oral trush, high viral load |
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Pneumocystis jiroveci pneumonia
sx |
hypoxemia,
weightloss, cough, fever |
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Pneumocystis jiroveci pneumonia
Dx |
BAL-bronchoalvelar lavage
, CXR-bilateral infultrates , biopsy worst case Labs-PO2 down, CD4<200 |
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Pneumocystis jiroveci pneumonia
Primary Prophlyaxis when |
CD4<200 or oropharyngeal candidiasis
can D/C if CD4 above 200 for 3 months |
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Pneumocystis jiroveci pneumonia
Primary Prophylaxis what |
TMP/SMX 1DS daily or 1SS daily (watch for SE, SJS, etc)
alternatives- dapsone, aerosolized pentamideine, atovaquone |
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Pneumocystis jiroveci pneumonia
Acute tx |
DOC TMP/SMX-bactrim DOT 21 days
IV severe, PO mild-mod Alt S-Pentamidine, or Primaquine + clindaymycin M/M- Primaquine+ clindamycin , Atovaquone if PO2 <70- add prednisone w/i 72h |
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Pneumocystis jiroveci pneumonia
Secondary Prophylaxis |
basically depends on CD4 200 again
if get PCP when above 200 lifelong |
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Toxoplasma gondii Encephalitis
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toxoplasmosis
-caused by protozoan in uncooked meat or cat feces oocytes |
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Toxoplasma gondii Encephalitis
sx |
-focal encephalitis- headache, confusion, motor weakness
-if untreated- seizures, stupor, coma |
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Toxoplasma gondii Encephalitis
Dx |
immune assays for IgG,
CT or MRI(one or more lesions identified), worse case brain biopsy |
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Toxoplasma gondii Encephalitis
Primary P |
+ve for IgG and CD4 under 100
stop when CD4 above 200 3 months DOC TMP/SMX 1DS daily Alt TMP/SMX-1DS 3x/w, Dapsone + pyrimethamine + leucovorin |
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Toxoplasma gondii Encephalitis
Acute tx |
Pyrimethamine + sulfadiazine + leucovorin
at least 6 weeks!!! if allergy to sulfadiazine put clinda |
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Toxoplasma gondii Encephalitis
secondary P |
- usually lifelong unless CD4 >200 >6 months
same combo as acute tx |
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Disseminated Mycobacterium avium complex (MAC)
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-found in environment, transmission via resp or GI tract
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Disseminated Mycobacterium avium complex (MAC)
when risks |
-CD4<50,
VL >100000, previous OI, previous MAC -if not on ARV- multiorgan infection -on ARV localized |
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Disseminated Mycobacterium avium complex (MAC)
Labs, Dx |
L-anemia, neutropenia, alk phos, hepatomegaly, spenomegaly, lymphadenopathy
S/Sx, blood cultures, acid fast baciili |
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MAC
Primary P |
when CD4 <50
stop when above 100 >3 months restart under 50 DOC Azithromycin 1200mg/wk or azithromycin 600mg 2x/wk or Clarithromycin 500 bid Alt Rifabutin 300 mg/d adjust... |
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MAC
Acute tx |
DOC clarithromycin 500 BID + ehtambutol 15/kg qd
Alt azithro add Rifabutin if needed at least 12 months!!!! repeat blood cultures 4-8 wks after start |
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MAC
Secondary P |
life long recommended unless IRIS
but...>12 months tx, cd4>100 >6months same as acute |
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TB
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-caused mycobacterium tuberculosis
transmission aerosolized latent vs active tb manifestation dependant on CD4 count 200-350 or <200 and any (intense and extrapulmonary) |
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TB
Dx |
Tuberculin skin test- 48-72 h
interferon gamma release assay- IGRA or enzyme linked immunospot assay in advanced immunosuppression get false negatives |
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TB
LTBI (no i dont know what it means) |
all pts should be tested
if +ve (>5mm) rule out TB w CXR and clinical eval |
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TB
Active TB Dx |
CXR, sputum sample
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TB
Latent tx |
when u have it and ur not tx it....
when ur -ve but in contact w/ those who do hx ofuntreated or inadequate txed tb Primary Isoniazid (INH) 9 months `if resist Rifampin (RIF)4 months if not on ART, INH and rifapentine 12 weeks |
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TB
Active tx |
DOT recommended, 2 phase
phase 1, 2 months INH + RIF or rifabutin (RFB) + pyrazinamide (PZA) + ethambutol (EMB) (EMB possibly early D/C) continued phase (4 (pul) or 7 (extrapul) months) INH + RIF or RFB daily or 3x/wk or 2/wk but not 2x if CD4<100 if drug resistant: to INH then just keep others on for 6 months then d/c PZA to rifamycin then put in FQ but prolly not work |
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TB
ARV interactions |
no interaction w/ NRTIs
NNRTI and PI interaction (hepatic metab) PI based regimen-- NOT WITH RIF....use RFB RIF- adjust EFV, rest dont coadmin CCR5- RIF not recomm. |
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Mucocutaneos Candidiasis
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-candida albicans
-most common oropharyngeal, esophageal - CD4<200 -resistance- C. glabrata Primary p not recommended |
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Mucocutaneos Candidiasis
sx |
-white plaques, painless that can be scrapped off
-with esophageal can have discomfort -Vulvovaginitis (VVC)- discharge from well u know, creamy yellow, burns and itches... |
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Mucocutaneos Candidiasis
Dx for each |
oro- clincal manifistation, lesions
eso-clincal and endoscopy vulvo- KOH preperation, clinical |
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Mucocutaneos Candidiasis
oro tx |
7-14 days
fluconazole 100 mg daily clotrimaole troches nystatin susp Alt itraconazole Posaconazole |
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Mucocutaneos Candidiasis
tx Eso |
14-21 days
Pre Fluconazole 100mg up to 400 PO/IV daily Alt- who fuck cares |
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Mucocutaneos Candidiasis
tx Vag and secondary P overall |
uncompl- fluconazole x1, topical azoles 4-7 days
compl- same but more doses (>7 days... 2-3 doses flu) secondary- for eso only flu 100 daily D/C >200 CD4 |
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Cryptococcal Meningitis
Sx and Primary P |
-no primary
Sx-neck stiffness and photophobia, mental disturbances |
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Cryptococcal Meningitis
Dx |
check CSF- lumbar puncture,
elevated serum protein, decreased lymphocytes, culture |
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Cryptococcal Meningitis
Tx |
DOC
phase 1- amphotericin B + flucytosine > 2 wks phase 2- fluconazole x8 wks Alt: 1- amphotericin + fluconazole 4-6 wks OR- fluconazole + flucytosine 2- itraconazole |
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Cryptococcal Meningitis
second preve |
once 10 wks complete, D/C >200 + on ARV >6 months
use flu |
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Cytomegalovirus (CMV) retinitis
what, risk, leads to, proph |
double stranded DNA herpes
risk-CD4 <50 can lead blindness no P prophylax |
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Cytomegalovirus (CMV) retinitis
Sx and Dx |
retinitis- floaters,
decreased retinal acuity, fluffy yellow white retinal lesions dx- clincal present, ophtalmoscopic examination |
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Cytomegalovirus (CMV) retinitis
Tx |
for sight threatening:
IO ganciclovir implant + valganciclovir 900 mg pO ...14-21 days for small lesions: valganciclovir 14-21 Alt- fuck em |
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Cytomegalovirus (CMV) retinitis
secondary P |
prolly lifelong
Cd4>100 3-6 months, ask the eye man |
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Two types of STDs
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Dischargers...
Genital Ulcer Diseases |
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Dischargers are
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HIV
Chlamydia Gonorrhea Trichomoniasis |
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Genital Ulcer Diseases
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Herpes
Syphilis Chancroid HPV |
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Chlamydia
cause who, transmission |
C. trachomatis bacteria
lack PG wall likes women and black ppl trans- infected fluids, also mother to newborn |
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Chlamydia
Sx s |
females- endocerical canal, urethra, rectum
60% asymptomatic, screening useful abnormal discharge... complication in pelvic infalm disease men or wmoen also reiter syndrome |
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Chlamydia
Dx |
hx
culture NAAT (amplification test) EIA (enzyme immunoassay) DNA hybrid DFA |
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Chlamydia
Tx |
uncomp:
rec- azithromycin once or doxycycline 7 days alt ofloxacin 7 days levofloxacin 7 erythromycin 7 prego: -- follow up fur sur rec- azithromycin once amoxicillin 7 days alt erythromycin 7 days |
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Chlamydia
other considerations |
dont forget about parnter managment 60 days from symptoms
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Gonorrhea
what, trans |
N. gonorrhoeae
trans- body fluids like chlamy and prego to baby |
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Gonorrhea
where sx |
most common in male- urethra
female-endocervical canal watch eye for blind general asymptomatic discharge... |
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Gonorrhea
complications |
f- pelvic inflammatory dx
b- disseminated gonorrhea |
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Gonorrhea
dx |
gram stain smears great for sym males
NAAT hybrid tests dont have sex 7 days after single dose therapy |
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Gonorrhea
tx |
uncomp ceftriaxone IM
cefixime cefoxitin IM once w/ probenecid once cefotaxime IM plus chlamydia if not ruled out alt cefpodoxime once plus chlam disseminated ceftriaxone IM, iV q 24h alt cefotaxime IV or ceftizoxime IV q 8 hs prego- ceftriaxone IM once plus chlam alt azithromycin |
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Syphilis
what trans |
Treponema pallidum- spirochete
strong HIV association trans- direct contact with infected membranes or lesions prego to child after 12 wks gestation |
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Syphilis
different types |
Primary
Secondary Latent- early and late latency... Teriary |
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Syphilis
presentations of types |
1- appearance single sore or multiple sores
2-skin rash and mucous membrane lesions L-nothin 3-gummatous lesions, CV, neuro (meningitis) |
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syphilis
more about times |
Primary- single painless, lesion, highly infectious...persist up 2 8 weeks
Secondary- 2-8 after initial if untreated, multisystem involvement, rash, disappears 4-10 wks latent- positive serological testing, early and late latency before or after year Tertiary-10-30 yrs after initial, CNS, heart, eyes, bones, joints |
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Syphilis
dx |
s/ Sx
screening - non-treponemal test- VDRL or RPR confirmatory- FTA-ABS, measure IgG |
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Syphilis
tx |
1, 2, early latent:
benzathine PCN G 2.4 MU IM once alt: doxy x 14days, tetra x 14days, ceftriaxone 10-14day IM/IV, azithromycin once tertiary, late latent or unknown: benz PCN G, 2.4 MU IM once weekly x3 alt: doxy x 28 days, tetra 28days |
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Syphilis
prego and followup |
prego- PCN additional dose recommended, ADR-jarisch herxheimer
followup- 1 and 2 at 6 and 12 months latent- 6, 12, 24 months sexual partners w/i 3 months |
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Bacterial Vaginosis
risks sx |
risk- multiple partner, new partner, douching, lack lactobacilli
sx- thin white discharge, fishy odor.... vulvar itching |
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Bacterial Vaginosis
Dx |
gram stain or clinical criteria,
at least 3- thin white discharge, fishy odor, presence clue cells microscoped, pH vag >4.5 |
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Bacterial Vaginosis
Tx |
sex partners no need tx
Non preg Metro PO 7 days or gel for 5 days or clindamycin cream 7 days Alt clindamycin 7 clinda ovules intravag 3 days tinidazole 3 days or 5days depend on dose Prego: metro PO 7 days or clindamycin 7 days |
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Trichomoniasis
who what how |
Protozoal
-both men and women -direct exposure contaminated surfaces or sexual contact, mother to newborn |
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Trichomoniasis
where Sx |
-M-urethra, usually asymp,
F- endocervical canal -Sx-yellow, green foamy discharge.... vulvar irritation, strawberry spots (surface errosions 90%) |
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Trichomoniasis
Dx |
elevated vaginal pH
, strawberry spots , wet mounts microscoper , culture, EIA |
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Trichomoniasis
Tx |
Metro 1x
or Tinidazole x1 Alt Metro 7 days lower dose Prego metro x1 Failure use alternate avoid sex until asymp, treat partners |
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Herpes
what types who trans |
virus
HSV-1 oral infections HSV2 genital lesions more women trans- direct contact, symptomatic lesions, asymptomatic lesion shedding, mother to newborn |
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Herpes
stages |
Primary mucocutaneous infxn->infxn ganglia->
latency-->reavtivation-->recurrent infxn |
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Herpes
primary recurrent DX |
P-painful multiple vescular lesions on external genitalia, also systemic flu like
shedding lasts 11-12 days R: worse in HSV2, less systemic, more severe women, prodromal symptoms, viral shedding 4 days Dx- physical exam, virologic test-culture, PCR assays, type specific testing |
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Herpes
Tx |
first 7-10 acyclovir 5x/day, famciclovir, valacyclovir
recurrent x5 or 2x 5x or 1x or 2x 3x or 5x (in order of above) daily supress- more than 6 episodes / year (can use for up to 6 years..?) prego- acyclovir- risk trans to neonate still |
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HPV
what... risks |
Condylomata Acuminata
-HPV types 6 and 11 -warts on genital/perianal areas... -risk cervical cancer... men too oral cancer risks- sex partners, <25yo, sex younger, uncircumcised males |
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HPV
trans Sx complications |
T- intercourse, genital/gential,
manual genital, oral genital Sx- cauliflower like....painful, weeks or months after intercourse -complications malignacies |
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HPV
Dx |
physical,
pap smear, PCR detect HPV-DNA |
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HPV Tx
provider |
- remove visible warts..
pregors not use Imiquimod, podophyllin, podofilox- remove warts Provider: cryotherapy- freeze them bitches podophyllin resin trichloroactetic acid surgical removal when large affected area |
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HPV Tx
Pt applied |
podofilox 3x 4 cycles
imiquimod 3 times 16 weeks sinecatechins 16 weeks |
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Pharmacist intervention
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prevention:
abstinence preexposure vaccine condoms other contraceptives abstince during tx compliance theres a herpes hotline....and dating site.....James why is that ur number |
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Different types of UTI
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Uncomplicated- lower tract - women, health, no abnormalities
-Bladder - cystitis -Prostate - prostatitis -epididymis (epididmytitis) Complicated- lower and upper, men and women, possible abnormality -kidneys - pyelonephritis -ureters (comp) vs urethra (uncomp) |
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UTI Organisms
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E Coli - 85%
Staph saprophyticus Kleb pneumo Enterobacter Proteus Pseudomonas aeruginosa |
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UTI
Virulence factors Host defenses |
V- adherence to tissues,
production hemolysin (breaks down cells) and aerobactin (binds iron) HD-low pH, osmolar extremes, urea [ ], anti adhereance mechs, inflam response, lactobacillus |
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UTI
risks complicated risks |
gender,
obstruction, incomplete emptying , prego, spermicide, menopause, immunosupressed Comp-environment |
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UTI presentation
comp vs uncomp |
Lower- dysuria, freq/urgency, some blood (hematuria), suprapubic discomfort
Upper- flank pain, fever, chills, N/V, more generallized seemingly |
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UTI
labs |
bacteriuria,
nitrate in urine, leukocyte esterse urine , antibody covered bacteria (in upper) |
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UTI
Dx |
-midstream clean catch method (use gloves!!) gold standard
-urinalysis by dipstick, nitrate, leukocyte esterase -cloudy, alkaline, positive for other shit >10WBC... - do bacterial susceptibility testing |
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UTI
adjunct therapy |
fluids,
cranberry juice, topical estrogen (post menopause), UT analgesics |
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UTI
Tx |
TMP/SMX, FQ, nitrofurantoin, beta lactams
do susceptbility test, consider allergies duration- usually 7-14 women, at least 10 men, can do short term or one dose if STD associated azithro or tetra |
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UTI
Acute complicated cystitis |
E coli.....Kleb, Proteus, saphrophytucis
Nitrofurantoin- 5 days TMP/SMX- 3 days DS |
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UTI
Acute Pyelonephrisitis |
complicated- can have temp and severe flank pain
E coli, Kleb, proteus,, +ves- faecalis saphro and others IV antiobiotics for severe FQ, AG and Amp, broad ceph.....betalactamases, bactrim mild- bactrim, FQ OP DOT 14 days!!! can stop IV 3 days then PO for 14 total |
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UTI
Symptomatic Abacteriuria |
acute urethral syndrome
sex..? E coli, Staph spp, Chlam -tx bactrim 1 DS 3 days or azithromycin/ doxy for 7 days |
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UTI
Asymptomatic bacteriuria |
elderly, children, pregos
relapse E Coli, do cultures TX THEM IF CHILD OR PREGO amoxicillin/ clav 7 days or ceph 7 days, bactrim 7 days (not thrid) |
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UTI in males
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complicated
BPH risk, instrumentation, catheter, stones uncomplicated rare obtain culture!!! prior therapy usually BACTRIM or FQ - high renal tissue [ ] DOT 10 -14 days!!!! not short or single course!!!! |
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UTI in pregos
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risk dilation pelvis, less tone bladder, less bacteria defence....
E Coli tx or prematurity, low birth weight, still birth Tx try to use Amox/ clav or amox, cephalexin, nitrofurantion, not bactrim in thrird) |
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UTI in catheterized
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risk- 30 days, open system, poor aseptic technique
complications- pyelonephritis, bacteremia remove catheter... durrr symptomatic- start tx copmlicated |
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Recurrent UTI
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women...again
class ify 2, 3, more 3 risks- sex, spermicides greater than 3 eventually start long term low dose tx |
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Prostatitis
categories what |
increased inflam cell in prostate gland - infectious or inflammatory
Category I- Acute Bacterial Prostatitis Category II- Chronic Bacterial Prostatitis 2 others but who cares they werent bolded!! |
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Prostatitis
bacteria |
-E coli, pseudomonas, serratia, kleb, proteaus +ve- entercoccus, saphro,.....
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Prostatitis acute
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more generalized systems and severe, tender and swollen- urine culture!!
complications- bacterimia, sepsis, epidiymitis, abscess, chronic tx- initial IV maybe proxy 3-5 days, febrile 48 hours bactrim,, FQ, Amp w/ gent DOT 4-6 wks!!!! |
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Prostatitis
chronic |
Chronic- difficult and less intense, enlarged- pre/ post massage test!!!
tx- FQ need to reach [ ] also bactrim (TMP) tx 6-12 wks!!!! |
