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Table of Contents

Illustrations in This Book PSAP-VII Editorial Board Welcome Faculty Potential COI Disclosure Role of ACCP Role of BPS CPE and Program Instructions Posttest Instructions Infectious Diseases I Infectious Diseases I Panel Infectious Diseases I Subscriber Evaluation iv v vi vii vii vii viii viii 1 3 5 HIV Infection and CVD Risk ART and CVD Risk Screening, Prevention, and Management Alterations in Glucose Metabolism and DM ART and Altered Glucose Metabolism Screening Management Kidney Disease Acute Kidney Injury Chronic Kidney Disease Screening and Prevention Bone Disease Osteopenia and Osteoporosis: The Role of ART Screening Non­AIDS-Defining Cancers Risk Factors and Prevention Screening and Management Role of the Pharmacist Annotated Bibliography Self-Assessment Questions 34 35 35 37 37 37 38 38 38 39 39 40 40 40 41 41 42 42 43 49

HIV Infection and AIDS

P. Brandon Bookstaver, Pharm.D., BCPS (AQ Infectious Diseases), AAHIVE Introduction Transmission and Testing Pathophysiology and Disease Course Treatment Initiating Treatment Acute HIV Syndrome Roles of the Newest Antiretrovirals Integrase Strand­Transfer Inhibitors CCR5 Inhibitors Nonnucleoside Reverse Transcriptase Inhibitors Immune Reconstitution Inflammatory Syndrome Mechanism and Presentation Treatment Risk Factors Hepatitis Coinfection HIV-HBV Coinfection HIV-HCV Coinfection Preexposure Prophylaxis Postexposure Prophylaxis Occupational Nonoccupational Opportunistic Infections Epidemiology Prophylaxis Clinical Presentation and Treatment Role of the Pharmacist Conclusion Annotated Bibliography Self-Assessment Questions 7 8 8 9 14 15 15 15 15 16 16 16 17 17 17 17 18 18 18 18 19 19 19 19 21 21 23 24 29

Tuberculosis

Rocsanna Namdar, Pharm.D., BCPS; and Charles A. Peloquin, Pharm.D., FCCP Introduction Epidemiology and Risk Factors Etiology Pathophysiology Latent Disease Primary Infection Reactivation Disease Extrapulmonary Clinical Presentation Special Populations Diagnosis and Prognosis Diagnostic Testing Culture and Susceptibility Testing Quality Patient Care TB Drugs Treatment of Active Disease Treatment in Special Populations Role of the Pharmacist Drug Monitoring Therapeutic Drug Monitoring Conclusion Annotated Bibliography Self-Assessment Questions Infectious Diseases II Infectious Diseases II Panel Infectious Diseases II Subscriber Evaluation 53 53 53 54 54 54 54 54 54 54 55 55 57 57 58 61 63 65 66 66 66 66 71 75 77 79

Primary Care in HIV

Jason J. Schafer, Pharm.D., BCPS, AAHIVE Introduction Cardiovascular Disease 33 34

PSAP-VII · Infectious Diseases

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Antimicrobial Stewardship

Marc H. Scheetz, Pharm.D., BCPS (AQ Infectious Diseases); and Michael Postelnick, BSPharm, BCPS (AQ Infectious Diseases) Introduction History Goals Multidisciplinary Approach Antimicrobial Use in Hospital Systems Antimicrobial Resistance Escalating Costs Methods of Tracking Stewardship Outcomes Antimicrobial Use Measurements Fiscal Measurements Clinical Outcomes Antimicrobial Stewardship Strategies Preauthorization/Formulary Restriction Prospective Audit and Feedback Strategies Comparisons of Strategies Recommendations from Professional Organizations Role of the Pharmacist Annotated Bibliography Self-Assessment Questions 81 81 82 82 82 82 82 83 83 84 84 85 85 86 87 87 87 87 93

Prevention/Vaccination Guidelines Inhibition of Inflammation Targets Adjunctive Therapy--Corticosteroids Nosocomial-Acquired Pathogens Alternative Antibiotics for Multidrug-Resistant Organisms Gram-positive Organisms Gram-negative Organisms Cryptococcal Meningoencephalitis Updated Treatment Recommendations Role of New Antifungals Encephalitis Herpes Simplex Virus-1 and -2 West Nile Virus Role of the Pharmacist Conclusion Annotated Bibliography Self-Assessment Questions

123 124 124 124 125 125 125 126 126 126 127 127 127 128 128 128 133

Methicillin-Resistant S. aureus Infections

Vanthida Huang, Pharm.D.; and Phillip Owen, Pharm.D., BCPS Introduction Epidemiology, Risk Factors, and Transmission Molecular Characteristics of CA-MRSA and HA-MRSA Management of MRSA Infections Role of Incision and Drainage Pharmacotherapy--First-line Agents Combination Therapy: Rifampin and Fluoroquinolones Alternative Therapies Emerging Therapies Prevention of MRSA Infection Role of the Pharmacist Quality Assurance Conclusion Annotated Bibliography Self-Assessment Questions Infectious Diseases III Infectious Diseases III Panel Infectious Diseases III Subscriber Evaluation 139 140 140 141 141 141 144 145 145 146 147 147 147 147 153 157 159 161

Ophthalmic and Otic Infections

By Ryan P. Moenster, Pharm.D., BCPS (AQ Infectious Diseases) Ophthalmic Infections Pathogenesis, Clinical Manifestations, and Microbiology Pharmacotherapy Role of the Pharmacist Otic Infections Pathogenesis, Microbiology, and Diagnosis Pharmacotherapy Role of the Pharmacist Annotated Bibliography Self-Assessment Questions 97 97 101 103 105 105 106 107 107 111

Central Nervous System Infections

Lisa M. Avery, Pharm.D., BCPS Introduction Epidemiology--Impact of Vaccines Outcomes Associated with Delayed Therapy Diagnosis Rapid Diagnostic Testing Blood Diagnostic Tests Bacterial Meningitis Score S. pneumoniae Empiric Therapy Patient Allergies/Drug-Resistant Strains N. meningitidis 115 116 116 117 117 117 119 119 120 121 122

Bone and Joint Infections

Jamie S. Winner, Pharm.D., BCPS (AQ Infectious Diseases) Introduction Bone Infections Pathophysiology Etiology Diagnostic Criteria Treatment 163 163 163 164 165 166

Front Matter

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PSAP-VII · Infectious Diseases

Joint Infections Septic Arthritis Prosthetic Joint Infections Role of the Pharmacist Outpatient Parenteral Antibiotic Therapy Monitoring Plans Conclusion Annotated Bibliography Self-Assessment Questions

168 168 169 170 170 171 171 171 175

Intra-abdominal Infections

David T. Bearden, Pharm.D. Introduction Pathophysiology Microbiology Diagnostic Considerations Clinical Presentation Severity of Illness Abbreviations in This Chapter Treatment Fluid Resuscitation Source Control Empiric Antibiotic Therapy Monitoring Role of the Pharmacist Pharmacoeconomics Appropriate Antimicrobial Use Antimicrobial Stewardship Conclusion Annotated Bibliography Self-Assessment Questions 179 179 180 180 180 180 180 181 181 181 181 183 184 184 184 184 185 185 189

Introduction Contemporary Epidemiology of Influenza Virus Seasonal Influenza Novel H1N1 Influenza A of Swine Origin Influenza A H5N1 Diagnosis Viral Culture RT-PCR Rapid Diagnostic Tests Symptoms Treatment of Confirmed or Suspected Influenza Antiviral Therapy Supportive Care Antiviral Chemoprophylaxis Treatment Indications Antiviral Therapy Outbreak Control Vaccination Role of the Pharmacist Conclusion Annotated Bibliography Self-Assessment Questions Reference Values for Common Laboratory Tests

207 208 208 209 210 210 211 211 212 212 213 213 215 215 215 215 216 216 220 220 220 225 230

C. difficile Infection

Kevin W. Garey, Pharm.D., M.S. Introduction History Epidemiology and Economics Microbiology and Pathophysiology Clinical Presentation Diagnosis of CDI Treatment Goals Pharmacotherapy Alternative Therapies for CDI Other Therapies for CDI Role of the Pharmacist Conclusion Annotated Bibliography Self-Assessment Questions 193 193 193 193 195 195 195 195 198 199 199 199 199 203

Influenza

By Michael E. Klepser, Pharm.D., FCCP; and Jennifer K. Hagerman, Pharm.D., AE-C

PSAP-VII · Infectious Diseases

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