Infectious Disease Exam Fall Semester
2020
•Artesunate IV bid on day 1, q d x 2d,
•PLUS,
•A full course of:
•Doxycycline, Clindamycin, Mefloquine, or Malarone
•-OR-
•Quinidine Gluconate IV Infusion* (not currently recommended due to toxicity & lack of availability in
US)If a patient is in an area that is chloroquine resistant and has severe or complicated infections with P.
falciparum P. falciparum. What is the drug therapy of choice?
<200 copiesVirologic failure
Inability to achieve or maintain suppression at a HIV RNA level of __________/mL.
Prophylaxis: TMP-SMX
D/C: CD4 count to >200 cells/μL and sustained for >3 months while on ART
Secondary: CD4 count <200 cells/μLA patient with CD4 <100 & toxoplasma IgG positive should start
what preferred prophylaxis treatment for the pathogen toxoplasma gondii Encephyalitis (TE)? When
should you discontinue the drug? When might you consider secondary/chronic suppressive
maintenance therapy?
Prophylaxis: TMP-SMX
D/C: if CD4> 200 and sustained for >3 months while on ART
Secondary: CD4 count <200 cells/μL OR
CD4 count 100-200 with detectable HIV RNAA patient with CD4 <200 should take what primary
prophylaxis treatment if there's concern for getting pneumocystis pneumonia (PCP)? When should they
discontinue using it? When might you consider secondary/chronic suppressive maintenance therapy?
,Prophylaxis: Azithromycin or Clarithromycin
D/C: HIV fully suppressed on ART (undetectable)
Secondary: CD4 count <100 cells/μLA patient with CD4 <50 should take what primary prophylaxis
treatment if there's concern for getting mycobacterium avium complex (MAC)? When should they
discontinue using it? When might you consider secondary/chronic suppressive maintenance therapy?
Primary: pre-infection
Secondary: After acute treatment (post infection)- criteria based on CD4 counts, CD4 counts at time of
infection, level of HIV suppressionWhat's the difference between secondary prophylaxis and primary
prophylaxis?
PREFERRED: Tenofovir DF 300 mg/Emtricitabine 200 mg (Truvada®) once daily
Plus either:
Raltegravir 400 mg twice daily OR dolutegravir 50 mg once daily
•Alternative:
Tenofovir DF 300 mg/Emtricitabine 200 mg (Truvada®) once daily
Plus:
Darunavir 800 mg once daily and ritonavir 100 mg once dailyWhat is the preferred post exposure
prophylaxis for HIV?
HIV-1; HIV-2Unlike persons with ______, persons with _______ should continue to undergo periodic
CD4 cell count testing even if their viral loads are persistently suppressed, because disease progression
can occur despite an undetectable viral load.
1Genotype _____: most common HCV genotype in the United States. (73%)
HBV therapy at the same time or before HCV therapyAssess for HBV coinfection prior to initiating HCV
therapy → if Positive start ___________ ?
,•Oseltamivir (Tamiflu®) - dose adjusted for renal function
-Treatment: 75 mg orally twice daily for 5 days
-Prophylaxis: 75 mg orally once daily ≥ 10 days from exposureWhat medication is indicated for
treatment and prophylaxis of influenza that's dose adjusted for renal function? What's the treatment
dose vs. prophylactic dose?
•Baloxavir Marboxil (Xofluza®)
40-80mg (weight based) oral single doseWhat medication for treatment of influenza can be given orally
as a single dose and is weight based?
1. 30 mg twice daily
2. 30 mg once daily
3. 30mg x 1 dose, then after each HD session
4. 30 mg x 1 doseIf a patient is taking Oseltamivir for treatment of influenza how might you dose if the
CrCl is...
1. >30 to 60ml/min?
2. >10 to 30mL/min?
3. ESRD on hemodialysis?
4. ESRD not on peritoneal dialysis?
1. 30 mg once daily
2. 30 mg once every other day
3. 30 mg x 1 dose, then after every other HD session
4. 30 mg x 1 dose, then once weekly.If a patient is taking Oseltamivir for prophylaxis of influenza how
might you dose if the CrCl is...
1. >30 to 60ml/min?
, 2. >10 to 30mL/min?
3. ESRD on hemodialysis?
4. ESRD not on peritoneal dialysis?
Oseltamivir (Tamiflu®)What medication for treating influenza can have neuropsychiatric events in
pediatric patients?
•uncomplicated Influenza in patients ≥ 12yro
Initiate <48 hours of symptom onsetBaloxavir Marboxil (Xofluza) is indication for the treatment of what?
When would you want to initiate it?
oral once daily for 4 weeks & ideally within 72 hours of exposure.A patient taking medications for post
exposure prophylaxis (PeP) should take it for a minimum of how much time?
quinidine; artesunate (IV)What medication was indicated parenterally for severe falciparum malaria but
is now discontinued, as an IV administration, do to numerous ventricular and atrial arrhythmias? What is
now recommended instead?
1. corticosteroids (anti-inflammatories) for managing elevated intracranial pressure
2. antiseizure drugs (#1 cause of new onset seizures worldwide which is why you want to use these
drugs!)
3. Antihelminthic drugsNeurocysticercosis is a preventable parasitic infection of the central nervous
system and is caused by the pork tapeworm Taenia solium. How would you treat if a patient got this?
ChloroquineWhat is the most appropriate drug for tx (and prophy in travellers) for malaria when the
cdc.gov website or recent Yellow Book indicates endemic malaria, but very low rates of resistance in the
area?
2020
•Artesunate IV bid on day 1, q d x 2d,
•PLUS,
•A full course of:
•Doxycycline, Clindamycin, Mefloquine, or Malarone
•-OR-
•Quinidine Gluconate IV Infusion* (not currently recommended due to toxicity & lack of availability in
US)If a patient is in an area that is chloroquine resistant and has severe or complicated infections with P.
falciparum P. falciparum. What is the drug therapy of choice?
<200 copiesVirologic failure
Inability to achieve or maintain suppression at a HIV RNA level of __________/mL.
Prophylaxis: TMP-SMX
D/C: CD4 count to >200 cells/μL and sustained for >3 months while on ART
Secondary: CD4 count <200 cells/μLA patient with CD4 <100 & toxoplasma IgG positive should start
what preferred prophylaxis treatment for the pathogen toxoplasma gondii Encephyalitis (TE)? When
should you discontinue the drug? When might you consider secondary/chronic suppressive
maintenance therapy?
Prophylaxis: TMP-SMX
D/C: if CD4> 200 and sustained for >3 months while on ART
Secondary: CD4 count <200 cells/μL OR
CD4 count 100-200 with detectable HIV RNAA patient with CD4 <200 should take what primary
prophylaxis treatment if there's concern for getting pneumocystis pneumonia (PCP)? When should they
discontinue using it? When might you consider secondary/chronic suppressive maintenance therapy?
,Prophylaxis: Azithromycin or Clarithromycin
D/C: HIV fully suppressed on ART (undetectable)
Secondary: CD4 count <100 cells/μLA patient with CD4 <50 should take what primary prophylaxis
treatment if there's concern for getting mycobacterium avium complex (MAC)? When should they
discontinue using it? When might you consider secondary/chronic suppressive maintenance therapy?
Primary: pre-infection
Secondary: After acute treatment (post infection)- criteria based on CD4 counts, CD4 counts at time of
infection, level of HIV suppressionWhat's the difference between secondary prophylaxis and primary
prophylaxis?
PREFERRED: Tenofovir DF 300 mg/Emtricitabine 200 mg (Truvada®) once daily
Plus either:
Raltegravir 400 mg twice daily OR dolutegravir 50 mg once daily
•Alternative:
Tenofovir DF 300 mg/Emtricitabine 200 mg (Truvada®) once daily
Plus:
Darunavir 800 mg once daily and ritonavir 100 mg once dailyWhat is the preferred post exposure
prophylaxis for HIV?
HIV-1; HIV-2Unlike persons with ______, persons with _______ should continue to undergo periodic
CD4 cell count testing even if their viral loads are persistently suppressed, because disease progression
can occur despite an undetectable viral load.
1Genotype _____: most common HCV genotype in the United States. (73%)
HBV therapy at the same time or before HCV therapyAssess for HBV coinfection prior to initiating HCV
therapy → if Positive start ___________ ?
,•Oseltamivir (Tamiflu®) - dose adjusted for renal function
-Treatment: 75 mg orally twice daily for 5 days
-Prophylaxis: 75 mg orally once daily ≥ 10 days from exposureWhat medication is indicated for
treatment and prophylaxis of influenza that's dose adjusted for renal function? What's the treatment
dose vs. prophylactic dose?
•Baloxavir Marboxil (Xofluza®)
40-80mg (weight based) oral single doseWhat medication for treatment of influenza can be given orally
as a single dose and is weight based?
1. 30 mg twice daily
2. 30 mg once daily
3. 30mg x 1 dose, then after each HD session
4. 30 mg x 1 doseIf a patient is taking Oseltamivir for treatment of influenza how might you dose if the
CrCl is...
1. >30 to 60ml/min?
2. >10 to 30mL/min?
3. ESRD on hemodialysis?
4. ESRD not on peritoneal dialysis?
1. 30 mg once daily
2. 30 mg once every other day
3. 30 mg x 1 dose, then after every other HD session
4. 30 mg x 1 dose, then once weekly.If a patient is taking Oseltamivir for prophylaxis of influenza how
might you dose if the CrCl is...
1. >30 to 60ml/min?
, 2. >10 to 30mL/min?
3. ESRD on hemodialysis?
4. ESRD not on peritoneal dialysis?
Oseltamivir (Tamiflu®)What medication for treating influenza can have neuropsychiatric events in
pediatric patients?
•uncomplicated Influenza in patients ≥ 12yro
Initiate <48 hours of symptom onsetBaloxavir Marboxil (Xofluza) is indication for the treatment of what?
When would you want to initiate it?
oral once daily for 4 weeks & ideally within 72 hours of exposure.A patient taking medications for post
exposure prophylaxis (PeP) should take it for a minimum of how much time?
quinidine; artesunate (IV)What medication was indicated parenterally for severe falciparum malaria but
is now discontinued, as an IV administration, do to numerous ventricular and atrial arrhythmias? What is
now recommended instead?
1. corticosteroids (anti-inflammatories) for managing elevated intracranial pressure
2. antiseizure drugs (#1 cause of new onset seizures worldwide which is why you want to use these
drugs!)
3. Antihelminthic drugsNeurocysticercosis is a preventable parasitic infection of the central nervous
system and is caused by the pork tapeworm Taenia solium. How would you treat if a patient got this?
ChloroquineWhat is the most appropriate drug for tx (and prophy in travellers) for malaria when the
cdc.gov website or recent Yellow Book indicates endemic malaria, but very low rates of resistance in the
area?
