Anti-fungal and Antivirals

Question 1

most pathogenic type of mold

Answer 1

aspergillus

Question 2

mucorales risk factor

Answer 2

immuno compromised and DM at risk

Question 3

where is histoplasmosis endemic to?

Answer 3

eastern and midwest US

Ohio and Mississippi river valley

Question 4

where is blastomyces endemic?

Answer 4

eastern and central US

Question 5

where is coccidioides endemic to?

Answer 5

southwest almost exclusively

Question 6

patients at high risk of fungal infection?

Answer 6

Hematologic malignancies – AML, ALL and other leukemias - Due to the malignancy itself or chemotherapy

Transplant patients (bone marrow, stem cell or solid organ)

Patients on chronic steroids or immunosuppressive meds

immunocompromised

burn patients

prolonged abx

Question 7

list anti fungal coverage - greatest to least coverage

Answer 7

fluconazole < voriconazole < posaconazole

Question 8

fluconazole DOC

Answer 8

for initial treatment of infections due to C. albicans and C. parapsilosis

Do not cover molds (aspergillus)

Question 9

voriconazole DOC

Answer 9

aspergillosis

enhanced activity against aspergillus and candida

Question 10

only azalea that covers yeasts, molds and mucorales

Answer 10

posaconazole

Question 11

echinocandins

Answer 11

covers candida and aspergillus

poor coverage of molds and yeasts

Question 12

amphotericin B

DOC

Answer 12

severe disseminated infections

covers candida species, aspergillus, mucorales

Question 13

when should isolation of fungi be treated as a true pathogen?

Answer 13

blood cultures are always true pathogen

Question 14

when should a fungal culture be treated as a colonization?

Answer 14

urine and sputum cultures

Question 15

fluconazole drug interactions

Answer 15

not that many

just be sure and not high dose

Question 16

fluconazole ade

Answer 16

infrequent

HA, hair looks, loss of appetite

hepatotoxity (rare)

Question 17

voriconazole DI

Answer 17

no coadministration – carbamazepine, phenobarbital

statins

sirolimus

ritonavir

Question 18

voriconazole ADE

Answer 18

visual disturbances

neurological complications

rash (SJ, TEN)

photosensitivity

prolonged therapy = alopecia

Question 19

posaconazole DI

Answer 19

statins
quinidine
sirolimus

Question 20

posaconazole ADE

Answer 20

N/v
fever
rash
hepatotoxicity (rare)

Question 21

fluconazole DOC

Answer 21

initial treatment of infections due to C. albicans and C. parapiloslis

Prophylaxis in immunocompromised (ineffective for aspergillosis and mucormycosis)

Question 22

Itraconazole DOC

Answer 22

cutaneous sporotrichosis

Question 23

voriconazole DOC

Answer 23

aspergillosis

Question 24

safest of anti fungal classes?

Answer 24

echinocandins

Question 25

echinocandins

Answer 25

lowest adverse effects, low potential for renal and hepatic toxicity

Question 26

amphotericin DOC

Answer 26

severe disseminated infections

Question 27

amphotericin adverse effects

Answer 27

nephrotoxicity

can use lipid based formulation

Question 28

indication of terbinafine

Answer 28

onychomycosis

must treat until infection grows out (6 wks finger, 12 wks nail)

Question 29

who might need prophylaxis with posaconazole

Answer 29

neutropenic patients for >10-15 days

Question 30

clinical infections that you would use fluconazole?

Answer 30

peritonitis
suspected disseminated Candidasis 
candida esophagitis 
UTI 
refractory candidiasis  (not for yeast infection)

Question 31

clinical infections that you would use echinocandins ?

Answer 31

possible disseminated candidiasis

febrile neutorpenia

empiric candidemia

candida crowing in sterile culture (CSF, blood, peritoneal fluid)

Question 32

prodrug

Answer 32

medication or compound that after administration is metabolized into pharmacologically active drug

Question 33

antiviral prodrug examples

Answer 33

valacyclovir (acyclovir)

valganciclovir (ganiciclovir))

Question 34

indications of acyclovir

Answer 34

HERPES

oral and genital (active and chronic)
varicella zooster
disseminated HSV, VSV
herpes encephalitis

Question 35

valganciclovir indications

Answer 35

CMV prophylaxis

toxicity - CNS toxicity

Question 36

ganciclovir use

Answer 36

CMV prophylactically

Question 37

BBW of ganciclovir

Answer 37

blood dyscrasias (also birth defects)

Question 38

patients high risk for influenza

Answer 38

children < 2 
adults >65 
patient with chronic disease 
immunocompromised 
pregnancy/post partum 
obsese