PHRM 865 Exam 5 Study Set With
Actual Solution
Opportunistic Infections: OPC- Tx - ANSWER fluconazole 100mg PO QD x7-14 days
Opportunistic Infections: OPC- Alternative Tx - ANSWER Nystatin
clotrimazole troches
itraconazole
posaconazole
Opportunistic Infections: Cryptococcal Meningitis- Tx - ANSWER lipid amp B 3-4mg/kg
IV QD with flucytosine 25mg/kg then fluconazole 800mg PO or IV QD
Opportunistic Infections: Esophageal Candidiasis- Tx - ANSWER fluconazole 200mg (up
to 400) PO or IV QD for 14-21 days
Opportunistic Infections: Esophageal Candidiasis- Alternative Tx - ANSWER
itraconazole sol
voriconazole
isavuconazole
caspofungin
Opportunistic Infections: Pneumocystitis Jirovecii- Tx - ANSWER TMP-SMX
*15*-20mg/kg/day of TMP PO or IV q6-8h x*21* days
Opportunistic Infections: Pneumocystitis Jirovecii- Mod to Sev Alternative Tx - ANSWER
primaquine + clindamycin
pentamidine
When should adjunctive prednisone be given to PJP patients? - ANSWER if pt pO2 is
*less than 70* on room air
TMP can cause - ANSWER hyperkalemia
Opportunistic Infections: Pneumocystitis Jirovecii- Mild to Mod Alternative Tx - ANSWER
dapsone + trimethoprim
primaquine + clindamycin
,atovaquone
Dapsone requires what test prior to therapy? Why? - ANSWER GP6D test because
deficient patients can lead to hemolytic anemia
Opportunistic Infections: Toxoplasmosis- Tx - ANSWER pyrimethamine 200mg PO
*once* then 50-75mg QD + sulfadiazine PO q6h + leucovorin PO QD x6+ weeks
Opportunistic Infections: Toxoplasmosis- Alternative Tx - ANSWER pyrimethamine +
clindamycin
*Bactrim 5mg/kg TMP IV or PO q12h*
atovaquone +/- pyrimethamine or sulfadiazine
When should adjunctive dexamethasone be administered to toxoplasmosis patients? -
ANSWER with mass effect from focal lesions or associated edema
Pyrimethamine SE's - ANSWER rash
nausea
*bone marrow suppression* (anemia, neutropenia, thrombocytopenia)
Pyritmethamine toxicities can be reduced or reversed by - ANSWER administering
leucovorin
Opportunistic Infections: Disseminated Mycobacterium Avium Complex (MAC)- Tx -
ANSWER clarithromycin or *azithromycin* QD + ethambutol +/- rifabutin QD
Opportunistic Infections: Disseminated Mycobacterium Avium Complex (MAC)-
Alternative Tx - ANSWER add levo, moxi, amikacin, or streptomycin
Primary Prophylaxis: OPC and Candida Esophagitis/Vaginitis - ANSWER not
recommended
Primary Prophylaxis: Cryptococcal meningitis - ANSWER not recommended
Secondary Prophylaxis: OPC and Candida Esophagitis/Vaginitis - ANSWER suppressive
therapy generally not recommended unless pt has *frequent or severe* recurrences
Secondary Prophylaxis: Cryptococcal Meningitis - ANSWER required after completion of
therapy for acute infection (maintenance)
Primary Prophylaxis: PJP - ANSWER give to *all* patients with a CD4 count *<200* or
*<14%* total lymph count
Primary Prophylaxis: Toxo - ANSWER give to patients with positivie toxo IgG antibody
and a CD4 <100 cells
Primary Prophylaxis: MAC - ANSWER *not* recommended for adults who immediately
,initiate ART
recommended in pts not on full ART and CD4 *<50*
Secondary Prophylaxis: PJP - ANSWER must be given after completion of therapy for
acute infection
Secondary Prophylaxis: Toxo - ANSWER required after completion of therapy for acute
infection in all pts
Secondary Prophylaxis: MAC - ANSWER *must* be given after completion of therapy for
acute infection
Opportunistic Infections: OPC/Candida Esophagitis/Vaginitis- Prophylaxis Tx - ANSWER
*fluconazole 100-200mg PO QD*
posaconazole caps 400mg PO BID (alt)
Opportunistic Infections: Cryptococcal Meningitis- Prophylaxis Tx - ANSWER
fluconazole 200mg PO QD for *atleast 12 months*
Opportunistic Infections: PJP- Prophylaxis Tx - ANSWER Bactrim DS PO QD
Bactrim SS PO QD
Dapsone 100mg PO QD
Opportunistic Infections: PJP- Primary Prophylaxis Tx - ANSWER *Bactrim DS PO QD*
dapsone, atovaquone, or pyrimethamine (alternative)
Opportunistic Infections: PJP- Secondary Prophylaxis - ANSWER pyrimethamine PO QD
+ sulfadiazine PO QD + leucovorin PO QD
Opportunistic Infections: PJP- Secondary Prophylaxis Alternative therapy - ANSWER
clarithromycin + pyrimethamine + leucovorin
bactrim DS
atovaquone +/- pyrimethamine and leucovorin
Opportunistic Infections: MAC- Primary Prophylaxis Tx - ANSWER *azithromycin 1200mg
PO weekly (1st line)*
clarithromycin PO BID or azithromycin PO twice weekly
Opportunistic Infections: MAC- Secondary Prophylaxis - ANSWER clarithromycin PO BID
+ ehtambutol PO QD +/- rifabutin
When to stop secondary prophylaxis for Cryptococcal meningitis? - ANSWER
asymptomatic pts with CD4 count *100 or more* for MORE than 3 months and
, suppressed ART
When to stop prophylaxis for PJP? - ANSWER CD4 count *200 or more* for MORE than 3
months
When to stop primary prophylaxis for Toxo? - ANSWER CD4 count > 200 for more than 3
months
When to stop secondary prophylaxis for Toxo? - ANSWER CD4 count >200 for more than
6 months
When to stop primary prophylaxis for MAC? - ANSWER patients initiated on ART and
CD4 count > 100 for 3 or more months
When to stop secondary prophylaxis for MAC? - ANSWER patients who completed 12
months of therapy, asymptomatic, and CD4 count > 100 for 6 or more months in
response to ART
primary prophylaxis - ANSWER administration of an anti-infective agent to *prevent the
1st episode*
secondary prophylaxis - ANSWER maintenance with an anti-infective agent to prevent
*further REcurrences*
immune reconstitution inflammatory syndrome (IRIS) - ANSWER high fever, malaise, and
worsening symptoms of the OI due to starting ART during OI episode
IRIS can be found in what infections? - ANSWER MAC
tb
PJP
toxo
cryptococcus
CMV
when does IRIS typically occur? - ANSWER within the first 4-8 weeks of initiation of ART
When do clinicians initiate ART (not tb or crypto) in regards to OI tx? - ANSWER 2 weeks
after clinical response to OI therapy
When do clinicians initiate ART in *Tb* in regards to OI tx? - ANSWER 2 weeks if CD4 <
50
Actual Solution
Opportunistic Infections: OPC- Tx - ANSWER fluconazole 100mg PO QD x7-14 days
Opportunistic Infections: OPC- Alternative Tx - ANSWER Nystatin
clotrimazole troches
itraconazole
posaconazole
Opportunistic Infections: Cryptococcal Meningitis- Tx - ANSWER lipid amp B 3-4mg/kg
IV QD with flucytosine 25mg/kg then fluconazole 800mg PO or IV QD
Opportunistic Infections: Esophageal Candidiasis- Tx - ANSWER fluconazole 200mg (up
to 400) PO or IV QD for 14-21 days
Opportunistic Infections: Esophageal Candidiasis- Alternative Tx - ANSWER
itraconazole sol
voriconazole
isavuconazole
caspofungin
Opportunistic Infections: Pneumocystitis Jirovecii- Tx - ANSWER TMP-SMX
*15*-20mg/kg/day of TMP PO or IV q6-8h x*21* days
Opportunistic Infections: Pneumocystitis Jirovecii- Mod to Sev Alternative Tx - ANSWER
primaquine + clindamycin
pentamidine
When should adjunctive prednisone be given to PJP patients? - ANSWER if pt pO2 is
*less than 70* on room air
TMP can cause - ANSWER hyperkalemia
Opportunistic Infections: Pneumocystitis Jirovecii- Mild to Mod Alternative Tx - ANSWER
dapsone + trimethoprim
primaquine + clindamycin
,atovaquone
Dapsone requires what test prior to therapy? Why? - ANSWER GP6D test because
deficient patients can lead to hemolytic anemia
Opportunistic Infections: Toxoplasmosis- Tx - ANSWER pyrimethamine 200mg PO
*once* then 50-75mg QD + sulfadiazine PO q6h + leucovorin PO QD x6+ weeks
Opportunistic Infections: Toxoplasmosis- Alternative Tx - ANSWER pyrimethamine +
clindamycin
*Bactrim 5mg/kg TMP IV or PO q12h*
atovaquone +/- pyrimethamine or sulfadiazine
When should adjunctive dexamethasone be administered to toxoplasmosis patients? -
ANSWER with mass effect from focal lesions or associated edema
Pyrimethamine SE's - ANSWER rash
nausea
*bone marrow suppression* (anemia, neutropenia, thrombocytopenia)
Pyritmethamine toxicities can be reduced or reversed by - ANSWER administering
leucovorin
Opportunistic Infections: Disseminated Mycobacterium Avium Complex (MAC)- Tx -
ANSWER clarithromycin or *azithromycin* QD + ethambutol +/- rifabutin QD
Opportunistic Infections: Disseminated Mycobacterium Avium Complex (MAC)-
Alternative Tx - ANSWER add levo, moxi, amikacin, or streptomycin
Primary Prophylaxis: OPC and Candida Esophagitis/Vaginitis - ANSWER not
recommended
Primary Prophylaxis: Cryptococcal meningitis - ANSWER not recommended
Secondary Prophylaxis: OPC and Candida Esophagitis/Vaginitis - ANSWER suppressive
therapy generally not recommended unless pt has *frequent or severe* recurrences
Secondary Prophylaxis: Cryptococcal Meningitis - ANSWER required after completion of
therapy for acute infection (maintenance)
Primary Prophylaxis: PJP - ANSWER give to *all* patients with a CD4 count *<200* or
*<14%* total lymph count
Primary Prophylaxis: Toxo - ANSWER give to patients with positivie toxo IgG antibody
and a CD4 <100 cells
Primary Prophylaxis: MAC - ANSWER *not* recommended for adults who immediately
,initiate ART
recommended in pts not on full ART and CD4 *<50*
Secondary Prophylaxis: PJP - ANSWER must be given after completion of therapy for
acute infection
Secondary Prophylaxis: Toxo - ANSWER required after completion of therapy for acute
infection in all pts
Secondary Prophylaxis: MAC - ANSWER *must* be given after completion of therapy for
acute infection
Opportunistic Infections: OPC/Candida Esophagitis/Vaginitis- Prophylaxis Tx - ANSWER
*fluconazole 100-200mg PO QD*
posaconazole caps 400mg PO BID (alt)
Opportunistic Infections: Cryptococcal Meningitis- Prophylaxis Tx - ANSWER
fluconazole 200mg PO QD for *atleast 12 months*
Opportunistic Infections: PJP- Prophylaxis Tx - ANSWER Bactrim DS PO QD
Bactrim SS PO QD
Dapsone 100mg PO QD
Opportunistic Infections: PJP- Primary Prophylaxis Tx - ANSWER *Bactrim DS PO QD*
dapsone, atovaquone, or pyrimethamine (alternative)
Opportunistic Infections: PJP- Secondary Prophylaxis - ANSWER pyrimethamine PO QD
+ sulfadiazine PO QD + leucovorin PO QD
Opportunistic Infections: PJP- Secondary Prophylaxis Alternative therapy - ANSWER
clarithromycin + pyrimethamine + leucovorin
bactrim DS
atovaquone +/- pyrimethamine and leucovorin
Opportunistic Infections: MAC- Primary Prophylaxis Tx - ANSWER *azithromycin 1200mg
PO weekly (1st line)*
clarithromycin PO BID or azithromycin PO twice weekly
Opportunistic Infections: MAC- Secondary Prophylaxis - ANSWER clarithromycin PO BID
+ ehtambutol PO QD +/- rifabutin
When to stop secondary prophylaxis for Cryptococcal meningitis? - ANSWER
asymptomatic pts with CD4 count *100 or more* for MORE than 3 months and
, suppressed ART
When to stop prophylaxis for PJP? - ANSWER CD4 count *200 or more* for MORE than 3
months
When to stop primary prophylaxis for Toxo? - ANSWER CD4 count > 200 for more than 3
months
When to stop secondary prophylaxis for Toxo? - ANSWER CD4 count >200 for more than
6 months
When to stop primary prophylaxis for MAC? - ANSWER patients initiated on ART and
CD4 count > 100 for 3 or more months
When to stop secondary prophylaxis for MAC? - ANSWER patients who completed 12
months of therapy, asymptomatic, and CD4 count > 100 for 6 or more months in
response to ART
primary prophylaxis - ANSWER administration of an anti-infective agent to *prevent the
1st episode*
secondary prophylaxis - ANSWER maintenance with an anti-infective agent to prevent
*further REcurrences*
immune reconstitution inflammatory syndrome (IRIS) - ANSWER high fever, malaise, and
worsening symptoms of the OI due to starting ART during OI episode
IRIS can be found in what infections? - ANSWER MAC
tb
PJP
toxo
cryptococcus
CMV
when does IRIS typically occur? - ANSWER within the first 4-8 weeks of initiation of ART
When do clinicians initiate ART (not tb or crypto) in regards to OI tx? - ANSWER 2 weeks
after clinical response to OI therapy
When do clinicians initiate ART in *Tb* in regards to OI tx? - ANSWER 2 weeks if CD4 <
50
