09 Fungus Drug Table Questions

Question 1

What are the only anti-fungals to cover Zygomycoses (Rhizopus, Mucor)?

Answer 1

AMB. Pozaconazole

Question 2

What are the only anti-fungals to cover Fusarium?

Answer 2

AMB. Voriconazole. Pozaconazole

Question 3

What are the only anti-fungals to cover Cryptococcus neoformans?

Answer 3

AMB. Fluconazole

Question 4

What are the only anti-fungals to cover Histoplasma blastomyces?

Answer 4

AMB. Fluconazole

Question 5

What are the only anti-fungals to cover Histoplasma capsulatum?

Answer 5

AMB. Ketoconazole

Question 6

What are the only anti-fungals to cover Coccidioides immitus?

Answer 6

AMB. Oral Azoles (all of them except Pozaconazole)

Question 7

What are the only anti-fungals to cover Blastomyces dermatidis?

Answer 7

AMB. Ketoconazole

Question 8

What are the only anti-fungals to cover Scedosporium?

Answer 8

Voriconazole. Pozaconazole

Question 9

What are the only anti-fungals to NOT cover Candida parapsilosis?

Answer 9

Echinocandins

Question 10

What are the only anti-fungals to NOT cover Candida lusitaniae?

Answer 10

AMB. Fluconazole. Itraconazole

Question 11

What are the only anti-fungals to NOT cover Candida krusei?

Answer 11

Fluconazole. Itraconazole

Question 12

What are the only anti-fungals that have NO Aspergillus spp. coverage?

Answer 12

Ketoconazole. Fluconazole

Question 13

What are the only anti-fungals to NOT cover Aspergillus terreus?

Answer 13

AMB. Ketoconazole. Fluconazole

Question 14

What form is AMB administered?

Answer 14

IV only

Question 15

Where does AMB have POOR distribution?

Answer 15

CSF, brain, bone, eye

Question 16

What are the goal levels of Azoles?

Answer 16

Maintain AUC:MIC > 50, or 1-2x MIC for entire dosing interval

Question 17

What is the CYP450 inhibition heirarchy for Azoles?

Answer 17

Vori, Itra > Posa > Flu

Question 18

What form is Ketoconazole administered?

Answer 18

PO only

Question 19

What is a rare side effect of Ketoconazole?

Answer 19

Gynecomastia, Oligospermia, Decreased libedo, Adrenal insufficiency

Question 20

What form is Fluconazole administered?

Answer 20

IV and PO

Question 21

What is the main route in which Fluconazole is cleared?

Answer 21

80% renally

Question 22

What form is Itraconazole administered?

Answer 22

Capsules. Oral solution

Question 23

What is important to remember about Voriconazoles PK?

Answer 23

Non-Linear. large change in AUC w/ small change in dose. Differs among all patients

Question 24

What form is Voriconazole administered?

Answer 24

IV and PO

Question 25

What is dose adjustment like for Voriconazole?

Answer 25

Hepatic: Normal LD, decrease MD by 50% for Child-Pugh A, B. Renal: avoid in CrCl < 40 (d/t cyclodextran carrier accumulation)

Question 26

What is dose adjustment like for Fluconazole?

Answer 26

Requires renal dose adjustment

Question 27

What drugs are CI with Voriconazole?

Answer 27

Rifampin. Carbemazepine. Long-Acting Barbiturates. Sirolimus

Question 28

What form is Pozaconazole administered?

Answer 28

PO only

Question 29

What form are Echinocandins administered?

Answer 29

IV only d/t very low BA

Question 30

What is the elimination of Anidulafungin like?

Answer 30

100% biliary

Question 31

What is often used clinically for an Aspergillus infection?

Answer 31

DOC: Voriconazole (best for pulmonary aspergillosis). Other agents: L-AMB, echinocandins

Question 32

What is often used for Coccidiomycosis treatment (Pulmonary cavitation)?

Answer 32

Oral azoles (onlyl if symptomatic). Ruptured lesions need lobectomy + antifungals

Question 33

What is often used for Coccidiomycosis treatment (Chronic Progressive Fibrocavitary Pneumonia)?

Answer 33

Immediate therapy with oral Azole for 1 year

Question 34

What is often used for Coccidiomycosis treatment (Disseminated (extra pulmonary))?

Answer 34

AMB. If meningitis: High dose Fluconazole or Intrathecal AmphoB