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  #1  
Old 08-04-2012
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Default CMV treatment in pt with AIDS

A 42-year-old woman with AIDS complains of impaired vision in both eyes. Ophthalmoscopic examination shows perivascular hemorrhage and retinal scarring. Laboratory studies show a white blood cell count of 1300/mm3, with a differential of 26% neutrophils. Renal function is within normal limits. The patientís records indicate that she is seropositive for cytomegalovirus (CMV) and her last CD4+ count was 85 cells/mm3. She has been unable to tolerate the hematologic manifestations of zidovudine or trimethoprim-sulfamethoxazole and is currently taking lamivudine, zalcitabine, indinavir, and atovaquone. Which drug would be preferred for the management of this patientís ophthalmologic problems?

a) Acyclovir
b) Amantadine
c) Foscarnet
d) Ganciclovir
e) Pentamidine
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Old 08-04-2012
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foscarnet.....
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Old 08-05-2012
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why not gancyclovir?
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Old 08-05-2012
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answered too quickly, "hematologic manifestations", right, sorry.

Foscarnet is the correct answer.
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Old 08-05-2012
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Default correct answer

The answer is c) Foscarnet

The patient has symptoms consistent with CMV retinitis, the most common presentation of CMV infection in patients with CD4+ counts under 100 cells/mm3. Foscarnet directly inhibits viral DNA polymerases and sometimes causes nephrotoxicity.
Ganciclovir is a prodrug that undergoes nonspecific triphosphorylation and is associated with bone marrow suppression (neutropenia). Since this patient has a low absolute neutrophil count and has exhibited intolerance to myelosuppressive drugs in the past, foscarnet would be preferable to ganciclovir for the treatment of her CMV retinitis.
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