GID Final Exam

nuriyupu's version from 2016-04-28 13:47


Question Answer
Sub-Saharan Africawomen
South Africawomen and orphans
Western AfricaHIV-2 (NNRTIs ineffective)
AsiaIVDU, MSM, sex workers, children (Vertical transmission or sex industry)
Southeast Asiasex workers, MSM, transgenders, IVDU
Eastern Europe/Central AsiaIVDU, unprotected sex
Latin AmericaMSM, unprotected sex, IVDU, refills enforced by police
CaribbeanMSM, unprotected sex
Middle East/North AfricaIVDU (Iran), MSM, unprotected sex - largely unreported
Oceaniaunprotected sex, IVDU
USAA, MSM, bisexual
When to start ARTregardless of CD4 count
Preferred ARTTDF (tenofovir DF) + 3TC (lamivudine) + EFV (efavirenz)
Boilingmost reliable to inactivate all common waterborne pathogens -- must do for 1 minute to kill virus and bacteria and at high altitudes do for 3-5 mins
HalogensIodine or Chloride -- depends on concentration of chemical used, contact time, water temperature and water quality (pH/organic matter)
Filtrationcollects and removes organisms from water by absorbing them to activated carbon or preventing their passage through ceramic material
Distillationwater heated to boiling, collect water vapor, kill microbes, many contaminants turn to gas and are released
High risk destinationsAfrica, Asia, Middle East, Latin America
Artesian Waterfrom a well
Mineral watermust not contain more than ppm solids -- from underground water source
Purified waterfrom a municipal source
Spring water from an underground source which water flows naturally to the surface of the earth
Sparkling waterafter treatment it gets carbon dioxide
EPAprotects tap water
FDAprotects bottled water
Bottled Waterhas treating frequency for bacteria once per week and for synthetic organic chemicals once per year
Carbonated waterno regulation
Tap Watertreats for frequency of bacteria hundreds of times per month and regulates everything else
Cautioned plastics3, 6, 7
Safe for 1 time use1, 2
Appears to be safe and reusable4, 5
ArtemisinCombo = Coartam ; works on blood stage, induces 3A4 and 2B6, frequent dosing, teratogen, neuro/hepatotoxicity
AtovaquoneCombo = Malarone ; works on blood and liver stage, take it with a fatty meal, 99% ppb, excreted unchanged in feces, DDI with ppb drugs
PyrimethamineCombo = Daraprim ; works on blood stage, slow-acting, expensive, not recommended anymore
Quinolineswork on blood stage, mainstay of therapy
Chloroquinegiven once a week, 2D6 inhibitor, don't use with epilepsy or myasthenia gravis
Quininepartnered with tetracyclines, metabolized by 3A4, cardio, oto and hemo toxicities
Mefloquinepartnered with artemisins, given once a week, metabolized by 3A4, neuro toxicities and teratogenic
Primaquinepartnered with chloroquine, induces 1A2, avoid in G6PD deficiency, teratogenic
Central AmericaChloroquine
Middle EastChloroquine
Northern AfricaChloroquine
South AmericaMalarone
Asia/Southeast AsiaMalarone
Sub-Saharan AfricaMalarone
Rural forested ThailandDoxycycline
Border of CambodiaDoxycycline
Chloroquine dosingonce a week start 1 week before travel and continue 4 weeks after
Malarone dosingonce a day start 1-2 days before travel and continue 7 days after
Doxycyline dosingonce a day start 1-2 days before travel and continue 7 days after
tx. of uncomplicated malaria without chloroquine-resistant strainschloroquine or hydroxychloroquine
tx. of uncomplicated malaria with chloroquine-resistant strainsMalarone or Coartem, quinine + a tetracycline, Lariam
P. malariae and P. knowlesino widespread resistance to chloroquine - use chloroquine or hydroxychloroquine
P. vivax and P. ovaleuse chloroquine or hydroxychloroquine + primaquine
P. vivax in papa new guinea or Indonesiause quinine + doxy + primaquine OR Malarone + primaquine OR Lariam + primaquine
tx. of severe malariaquinidine + doxy or clinda
1st line TB agentsrifampin, isoniazid, ethambutol, pyrazinamide -- tx. 2 months then rifampin and isoniazide for 7 more months
mono-resistant TBonly resistant to isoniazid
multidrug-resistant TBresistant to at least rifampin AND isoniazid
extensively drug-resistant TBresistant to rifampin AND isoniazide AND any quinolone AND injectable agents
1st line against resistant TB pyrazinamide, ethambutol, rifabutin
injectable agents TBcapreomycin, kanamycin, amikacin, streptomycin
quinolones for TBmoxi, levo, oflox
bacteriostatic 2nd line agents for TBpara-aminosalicylic acid, cycloserine, terizidone, ethionamide, protionamide
unclear role agents for TBlinezolid, Augmentin, imipenem/cilastatin, clofazimine, thioacetazone, high-dose isoniazide, clarithromycin
MDR-TB txuse at least 4 drugs that has susceptibility -- quinolone + injectable agent and treat for 21-24 months
XDR-TB tx.use 4-6 drugs use bacteriostatic and those in unclear role and

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