Anti-fungals Flashcards
how do azoles affect the metabolism of statins and CCBs?
they are substrates and dramatically increase serum levels of statins and CCBs (resulting in bradycardia and hypotension)
fungal infx in groin area including scrotum: tinea cruris or candida?
candida
groin fungal infx with satellite papules or pustules that extend beyond redness: tinea cruris or candida?
candida
what class: Ketoconazole (topical)
Miconazole
Clotrimazole
imidazoles
what class: Fluconazole (Diflucan®)
Itraconazole (Sporanox®)
Voriconazole (Vfend®)
Posaconazole (Noxafil®)
triazoles
which triazole has good CNS penetration?
Fluconazole (Diflucan®)
what class: Terbinafine (Lamisil®)
allyalamine
what class: Caspofungin (Cancidas), Micafungin (Mycamine), Anidulafungin (Eraxis)
echinocandins
imidazoles contraindications
no systemic azoles in pregnancy (esp 1st trimester). Liver disease
azoles adverses effects
GI upset, rash, photosensitivity, hepatoxicity
fluconazole is mainly for what?
candida
AE of long term triazole use
peripheral neuropathy
monitor what for all triazoles?
LFTs, serum drug concentration/theraputic drug monitoring
Itraconazole (Sporanox®)
contraindication
ventricular dysfunction, CHF
which azole treats endemic mycoses?
Itraconazole (Sporanox®)
Treatment of choice for Aspergillosis and Environmental molds(black mold).
Voriconazole (Vfend®)
SE: Rash, Hepatic enzymes, Visual disturbances (IV), Photosensitivity (oral) that is severe and can lead to skin cancers
Voriconazole (Vfend®)
what antifungal can lead to cardiomyopathy w/ long term use?
Itraconazole (Sporanox®)
least drug interactions and largest Therapeutic Index of all azoles
Fluconazole (Diflucan®)
Broadest spectrum Azole:
Posaconazole (Noxafil®)
OTC 1st line for athlete’s foot
Terbinafine (Lamisil®)
most effective Onychomycosis treatment
Terbinafine (Lamisil®)
contraindication for terbinafine
Avoid in hepatic and renal impairment
monitor what for terbinafine?
LFTs before initiation and monthly
pt counseling for terbinafine topical
put on 1 inch of surrounding skin and continue for 1 wk after resolution.
how must amphotericin B be given?
central line IV
Mainstay of treatment of patients with severe endemic fungal infection.
amphotericin B
Broadest spectrum of all antifungals
amphotericin B
main SE of amphotericin B
Nephrotoxicity (preceded by hypokalemia and hypomagnesemia)
monitoring for amphotericin B
Monitor serum electrolytes and renal function carefully. amphoTERRIBLE for kidneys
nystatin treats
candida
Vaginal candidiasis OTC
clotrimazole, miconazole
Vaginal candidiasis Rx topical
butoconazole, terconazole
vaginal candidiasis Rx PO
fluconazole
first-line treatment for recurrent VVC
oral fluconazole 100-, 150-, or 200-mg weekly for 6 months
oral fluconazole stays in vaginal secretions for __ hrs
72
preferred treatment for pregnant vaginal candidiasis
clotrimazole
1st line for Oropharyngeal Candidiasis
topical clotrimazole, miconazole, nystatin
1st line for esophageal candidasis
PO fluconazole
causes of oraal candidasis
from broad-spectrum antibiotic use, tissue damage (due to chemotherapy, catheter tubing, trauma, or smoking), hyposalivation (anti-cholinergics), or immune deficiency
most common opportunitis infx in pts w/ HIV
oropharyngeal candidiasis
most common acquired immunodeficiency syndrome (AIDS)–defining disease
Esophageal candidiasis
counseling for Oropharyngeal & Esophageal Candidiasis
counseling: Medication should provide relief in 2-3 days and resolution at 7-10 days
1st line for tinea capitis
oral Griseofulvin for 6-8 weeks OR terbinafine
contras for Griseofulvin
hepatic failure or pregnancy
counseling for oral Griseofulvin
Take with a fatty meal to decrease upset stomach and increase absorption
onychomycosis treatmetn
PO Itraconazole (BID for 1 week/month OR daily x 12 weeks) OR terbinafine (daily x 12 weeks)
treatment for Candida intertrigo
nystatin powder
treatment for Non-candida intertrigo
Topical azole antifungal cream (eg,ketoconazole,clotrimazole,miconazole,econazole)
treatment for Diaper rash secondary fungal infx
Topical Nystatin, Clotrimazole (Lotrimin), Miconazole. Greer’s Goo (nystatin cream, Zinc oxide paste, hydrocortisone cream 1%)
treatment for endemic mycoses
“Mild: intraconazole
Severe: amphotericin B”
treatments for PJP
Bactrim, dapsone
most common opportunistic fungal pathogens encountered in hospitals
candida
does an asymptomatic urinary candidiasis req treatment
no
main treatment for candida
fluconazole
Aspergillosis treatment
voriconazole IV or PO; isavuconazole
what dz is fatal unless caught early?
Aspergillosis
“Cryptococcus neoformans treatment
6-12 months of PO/IV fluconazoleif it does not resolve on its own
If meningitis: Amphotericin B followed by 10 weeks of oral fluconazole “
