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39 Cards in this Set
- Front
- Back
When to initiate pneumocystis treatment
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<200
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Treatment duration for pneumocystis
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21 days
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Pneumocystis 1st line tx
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TMP/SMX 15-20mg/kg/day in 3-4 divided doses
or 2 DS tabs PO Q8H |
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Pneumocystis 2nd line tx
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Dapsone 100mg Q24H and TMP/SMX 15-20mg/kg/d PO
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Pneumocystis other alternative treatments
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-Clindamycin + Primaquine
-Atovaquone (mild-mod) -Pentamidine (severe-last line) -Trimetrexate + leucovorin |
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When do you initiate adjunctive corticosteroid treatment for hypoxia? Which corticosteroid do you use?
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PaO2 <70mmHg
Alveolar-arterial O2 gradient >35mmHg Prednisoneor methylpredinisolone x21 days |
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Pneumocystis indications for primary prophylaxis
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i.CD$+<200 OR
ii. hx of oropharyngeal candidiasis |
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Pneumocystis primary prophylaxis 1st line
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TMP/SMX 1 ss tab Q24H
OR TMP/SMX 1 DS TIW |
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Pneumocystis primary prophylaxis 2nd line alternatives
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Dapsone 100mg PO Q24H
OR Dapsone 200mg PO QWK +++ Pyrimethamine 50mg PO QWK +++ Leucovorin 25mg PO QWK Also aerosolized pentamidine qmonthly, or atovaquone |
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When is secondary prophylaxis for pnemocystis started?
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When treatment course ends
Identical to primary prophylaxis regimens |
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HIV patients are at risk of MAC infection at what CD4+ count?
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<100
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MAC initial treatment
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*Azithromycin 500mg PO Q24H
PLUS Ethambutol 15mg/kg PO Q24H For SEVERE DX, ADD Rifabutin 300mg PO Q24H (*or Clarithromycin 500mg PO Q12H) |
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If a patient does not respond after 2-4 weeks of therapy, add what?
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i.Ciprofloxacin 750mg PO Q12H
OR Levofloxacin 500mg PO Q12H ii. Amikacin 15mg/kg IV Q24H |
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Most patients receive treatment for MAC for life, unless they meet what requirement?
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Treated for atleast 12 months
AND Asymptomatic AND CD4+ >100 for 3-6 months |
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When is primary prophylaxis indicated for MAC?
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<50
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MAC primary prophylaxis treatment and alternative
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*Azithromycin 1200mg PO QWEEKLY
Alternative: Rifabutin 300mg PO Q12H *(Clarithromycin 500mg Q12H) |
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When should primary prophylaxis be discontinued ?
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When CD4>100 for 3 months
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Secondary prophylaxis for MAC
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Not recommended
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Patients at highest risk for Toxoplasmosis have a CD4+ count of what?
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<100
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What is the treatment duration for Toxoplasmosis?
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Treat for atleast 6 WEEKS followed by life long SECONDARY PROPHYLAXIS
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Toxoplasmosis preferred treatment
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Pyrimethamine 200mg PO x1, then 50mg (<60kg) or 75mg Q24H
PLUS *Sulfadiazine 1g (<60kg) or 1.5g Q24H either PO/IV given in FOUR DOSES PLUS Lecuovorin (folinic acid) 10-20mg PO Q24H *Alternatives: Clindamycin 600mg PO/IV Q6H OR Clarithromycin 1g PO Q12H OR Azithromycin 1.2-1.5g PO Q24H OR Dapsone 100mg po Q24H |
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When is primary prophylaxis for Toxoplasmosis indicated?
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<100 PLUS +toxo IgG
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Primary prophylaxis 1st line treatment and alternatives
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TMP/SMX 1 DS tab Q24H
Alternatives: -TMP/SMX 1 ss tab Q24H -Pyrimethamine 50mg QWEEK AND Dapsone 50mg Q24H AND Leucovorin |
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Secondary prophylaxis for Toxoplasmosis
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Sulfadiazene PLUS
Pyrimethamine PLUS Leucovorin Alternative: Clindamycin PLUS Pyrimethamine PLUS Lecuovorin |
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Oropharyngeal candidiasis initial episode treatment
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i. Clotrimazole troches 10mg PO 5 TIMES DAILY
ia. Nystatin suspension 4-6mL q6H ii. Fluconazole 100mg PO q24H |
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Treatment for Fluconazole refractory OC?
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a. Itraconazole oral solution
b. Amphoterecin B |
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Treatment for Esophageal candidiasis
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i. Fluconazole 100-400mg PO/IV Q24H
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Treatment for Fluconazole refractory EC
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a. Caspofungin
b. Amphoterecin B c. LIpid amphoterecin B |
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Prophylaxis for OC and EC?
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Not recommended
-fluconazole |
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Immediate vision threatening lesion treatment for CMV
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Intraocular ganciclovir implant
PLUS Valganciclovir 900mg PO Q24H |
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How often should the intraocular ganciclovir implant be changed?
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Q6-8H
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How long does treatment of CMV last?
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Until inactive dx
PLUS CD4+ >100 x 3-6months |
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CMV retinitis treatment
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Ganciclovir x14-21days OR valganciclovir x14-21days OR
foscarnet x14-21days OR cidofovir x2weeks then w/ probenecid and vigorous hydration |
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CMV esophagitis treatment
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treatment lasts 14-21 days; consider maintenance after relapse
-Ganciclovir OR Valganciclovir OR foscarnet OR cidofovir w/ probenecid and vigorous hydration |
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CMV colitis treatment
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same as CMV esophagitis
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CMV penumonitis treatment
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same as CMV esophagitis
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CMV neurological disease treatment
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Ganciclovir x14-21days PLUS foscarnet 14-21 days
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TB treatment
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Isoniazid PLUS Rifampin PLUS Pyrazinamide + Ethambutol + Pyridoxine
ADD streptomycin for suspected multi-drug resistant isolates After 2months, stop pyrazinamide and continue isoniazid/rifampin for remaining 6months |
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TB prophylaxis for HIV+ patients with +PPD
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Isoniazid 300mg x9monhts
OR rifampin and pyrazinaide x2months |