Anti-Fungals Flashcards
List 6 types of fungi we are concerned about and what is unique about each.
Candida: candida is everywhere
Histoplasmosis: present in Ohio river valley
Cryptococcus: usually only immunocompromised pt’s
Mucormycosis: very uncommon
Blastomycosis: common in Mexico and SW
Aspergillus
Describe the severity and treatment of the two types of candida.
Table Grade: thrush, vag yeast, skin infections - almost everything kills this
Glabrata and Krusei - hard to kill
What anti-fungal is commonly used to kill table grade candida?
Fluconazole
In what area is histoplasmosis most common? What occupation in this area get histoplasmosis?
Ohio river valley
Construction workers and farmers
In what population is cryptococcus most common?
Immunosuppressed patients –> HIV
What do HIV patients exposed to cryptococcus get?
Cryptococcal Meningitis
What is mucor most known for?
Very rare fungus –> flesh eating fungus
What region is blastomycosis commonly found?
Southwest US and Mexico
How is fluconazole eliminated and what is the clinical significance?
renally eliminated –> use caution if CrCl < 50
By what route is fluconazole most commonly administered and why?
PO because PO bioavailability is ~ 90% and IV form is expensive
How long do patients usually take fluconazole?
Short courses –> sometimes a single dose
What is a life threatening caution of fluconazole?
QT prolongation
Which drug is most commonly used to treat histoplasmosis?
Itraconazole
In what formulation is itraconazole commonly administered?
PO capsules in a solution that require acid to be absorbed in the stomach
What is the black box warning for itraconazole?
CHF s/p negative inotropy
What is the drug most commonly used to treat aspergillus?
Voriconazole
What is the most common AE of Voriconazole?
Visulal side effects
By what routes is voriconazole administered?
PO and IV
What is the IV formulation of voriconazole mixed with and why?
Mixed with cyclodextrin because voriconazole is difficult to get into solution. Cyclodextrin gets things into solution
What is the AE associated with cyclodextrin that affects IV voriconazole?
Nephrotoxicity
What infections is posaconazole used to treat?
Aspergillus plus mucor
In what circumstance is posaconazole typically used?
Second-line treatment for aspergillus and mucor
Describe the potency of isavuconazole.
Very potent –> highest of the Azoles
In what circumstance is isavuconazole typically used?
Last line –> people on isavuconazole have issues
What is the original version of amphotericin B and what is its key AE?
Amphotericin B Deoxyxholate –> very hydrophilic and thus very nephrotoxic.
What changed in the new formulations of amphotericin B and how many of the new versions are there?
Wrapped in lipids to keep it away from the kidneys. There are three such formulation.
T/F: all of the new amphotericin B formulations are dosed the same.
False –> they all have different doses
What is amphotericin B most commonly used to treat?
Kills almost all fungi –> atomic bomb of anti-fungals
List the 3 most common AEs associated with amphotericin B.
- Infusion Rxns –> rigors and fever
- Nephrotoxicity
- Electrolyte abnormalities: HypoK and HypoMg
What drugs are used prophylactically against the infusion reaction associated with amphotericin B?
acetaminophen, diphenhydramine, prednisone, meperidine
For what infection is amphotericin B the drug of choice?
Invasive CNS infections –> HIV patients with cryptococcal meningitis
By what route is nystatin administered and why?
Only topical - systemic use associated with many AEs - can be swish and spit for thrush.
What is onychomycosis and what allylamine drug is used in treatment?
Nail bed infection
Treated with PO terbinafine
What lab value must be followed when administering terbinafine?
LFTs
What drugs are typically found in OTC anti-fungal creams?
nafitifine and terbinafine
What infections are Echinocandins commonly used to treat and by what route are they administered?
IV drugs used for serious candida infections including glabrata
What are the two most common Echinocandins?
caspofungin and micafungin
How is flucytosine administered and for what infection is it used?
PO only –> used to treat crytpococcal meningitis along with amphotericin B.
