Micro Final Exam

eem8u's version from 2015-05-25 17:43

Antifungal Agents

Question Answer
Histoplasma capsulatumdimorphic, OH and MI river valley, m-phage infection urine antigen test or BAL, bats! // Amphotericin B, itraconazole, voriconazole
Blastomyces dermatitidisdimorphic, great lakes & OH river valley broad-based budding, BLaST (like TB) // amphotericin B, itra, fluc
Coccidioides imitisdimorphic (SPHERULE), SanJValley/desert (soil), pneumonia (possible meningitis), arthralgia // Amphotericin B, fluconazole
Paracoccidioides brasiliensisdimorphic (Mariner's wheel), S.America, pumonary & lymphadenopathy// long latency, Itraconazole or TMP-SMZ (Ampho B if sever)
Penicillium marneffeidimorphic, binary Fision, OI for AIDS in SE Asia// Ampho B and 5Fc
Candida albicansdimporphic, OI, many manifestations, germtube, pseudohyphae // fluconazole (oral) -- vaginal, oropharynx,esophagus,UTS, IV Caspofungin for dissemintated, topical Nystatin/Ketoconazole, Ampho B if severe
Aspergillusacute-ange, thin sepatate, angioinvase, aspergilloma, ABPA... COMMON MOLD // voriconazole, Ampho B, IMMUNE recovery
Cryptococcus neoformansmonomorphic w/ CAPSULE, AIDS--pneumonia or meningitis, Latex agglutination// Fluconazole (mild) or Ampho B + flucytocine if severe (e.g. meningitis)
Zygomycetes (mucor/rhizopus)wide (right-angle) branching, nonseptate, DM/DK/Def/neutropenia = risk factors // debridement, amphotericin B, Posaconazole
Pneumocystis jiroveci (PCP)"pingpong", AIDS defining, patchy infiltrate w/ ground glass, use BAL (NO Culture) // TMP-SMZ,
Eumycetomas (madurella grisea)Subcutaneous infection -- in soil, think barefoot// Surgical debridement, voriconazole, posaconazole
Sporothrix schenckiidimorphic-- cigar shaped, rose gardener, ascending lymphangitis//Itraconazole
azoles; fungistatic or fungicidalfungistatic, target to lanosterol 14-alpha demethylase, inhibit ergosterol synthesis
antifungal Chemoprophylaxis for cancer/neutropenic patientsVoriconazole
FluconazoleCandida/ cryptoccus, No Aspergillus, good CSF// P450 interactions, oral & IV form
Itraconazole by Histoplasma, Blastomyces, Sporothrix, paracoccidio // DIARHEA,N,V, oral form used mainly
Voriconazoleno Zygomycoses, good CSF (Fluc preferred), neutropenia prophylaxis // oral & IV , visual disturbances
Amphotericin Btears” holes in fungal membrane -- Cryptococcal meningitis, zygomycetes, disseminated histoplasmosis, invasive aspergillosis// IV -- LIpid packaged, infusion & renal toxicity
Caspofungincompetitive inhibitor of beta (1,3)-D-glucan synthase (cell wall) , Fungistatic against Aspergillus/ Fungicidal against Candida

HIV treatment

Question Answer
First Line of choiceTenofovir + emitricitabine OR abacavir + lamivudine AND (PI) DaruNAVIR+Ritonavir (booster) OR 1 ( INSTI) ralTEGRAVIR/ elTEGRAvir/ dolutegravir
general NRTI toxicitiesMITO toxicity, peripheral neuropathy, hepatitis, lactic acidosis, dislipidemia, insulin resistance
general NNRTI toxicitiesCytochrome p450 interactions, early resistance, rash
general PI toxicitiesCause GI disturbances and metabolic syndrome
PK Boosters for PI's toxicitiescytochrome p450 inhibitor -> drug interactions
prophylaxisTMP-SMZ for PCP// azitrho for mycobacterium
Zidovudine, AZT NRTI, prevent maternal transfer // anemia
*lamivudine (3TC)NRTI, used w/ ABC, n/a
*Emtricitabine (FTC)NRTI, used w/ TDF, minimal tocity
*Abacavir (ABC)NRTI, used w/ 3TC, **hypersensitivity reaction
*Tenofovir (TDF)NRTI, used with FTC (emtricit), renal toxicity osteopeonia
neVIRapineNNRTI, hypersensitivity (esp women)
efaVIRenzNNRTI, neuropsych, teratogen (not used very often)
RilpiVIRineNNRTI, rash
atazaNAVIR (ATV)PI, indirect jaundice
daruNAVIRPI, rash
Ritonaivr (RTV)PK booster w/ PI, RASH
Cobicistat (cobi)PK booster
General Side effects of INSTIvery well tolerated!
Maraviroc MVCCCR5 agonist (coreceptor)
Enfuviritide (T20)fusion inhibitor, last line
prevent vertical transmissioncART, no breasfeeding, AZT to infant
PrePTDF or TDF/FTC (Truvatta)

Herpes viruses Treatment

Question Answer
HSV 1 and 2acyclovir or valacyclovir
VZVAcyclovir or valacyclovir
HSV CMV VZV diagnosisTzanck Smear (look for giant cells)
EBVrituximab (for complications)
CMV(Val)Gancyclovir or Foscarnet or Cidofovir if viral TK (UL97) resistance
ganicyclovir mecanism: DNA pol inhibitor