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Fall Pharm Block 3 > Anti-Fungals > Flashcards

Anti-Fungals Flashcards

1
Q

List 6 types of fungi we are concerned about and what is unique about each.

A

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

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2
Q

Describe the severity and treatment of the two types of candida.

A

Table Grade: thrush, vag yeast, skin infections - almost everything kills this
Glabrata and Krusei - hard to kill

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3
Q

What anti-fungal is commonly used to kill table grade candida?

A

Fluconazole

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4
Q

In what area is histoplasmosis most common? What occupation in this area get histoplasmosis?

A

Ohio river valley

Construction workers and farmers

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5
Q

In what population is cryptococcus most common?

A

Immunosuppressed patients –> HIV

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6
Q

What do HIV patients exposed to cryptococcus get?

A

Cryptococcal Meningitis

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7
Q

What is mucor most known for?

A

Very rare fungus –> flesh eating fungus

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8
Q

What region is blastomycosis commonly found?

A

Southwest US and Mexico

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9
Q

How is fluconazole eliminated and what is the clinical significance?

A

renally eliminated –> use caution if CrCl < 50

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10
Q

By what route is fluconazole most commonly administered and why?

A

PO because PO bioavailability is ~ 90% and IV form is expensive

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11
Q

How long do patients usually take fluconazole?

A

Short courses –> sometimes a single dose

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12
Q

What is a life threatening caution of fluconazole?

A

QT prolongation

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13
Q

Which drug is most commonly used to treat histoplasmosis?

A

Itraconazole

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14
Q

In what formulation is itraconazole commonly administered?

A

PO capsules in a solution that require acid to be absorbed in the stomach

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15
Q

What is the black box warning for itraconazole?

A

CHF s/p negative inotropy

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16
Q

What is the drug most commonly used to treat aspergillus?

A

Voriconazole

17
Q

What is the most common AE of Voriconazole?

A

Visulal side effects

18
Q

By what routes is voriconazole administered?

A

PO and IV

19
Q

What is the IV formulation of voriconazole mixed with and why?

A

Mixed with cyclodextrin because voriconazole is difficult to get into solution. Cyclodextrin gets things into solution

20
Q

What is the AE associated with cyclodextrin that affects IV voriconazole?

A

Nephrotoxicity

21
Q

What infections is posaconazole used to treat?

A

Aspergillus plus mucor

22
Q

In what circumstance is posaconazole typically used?

A

Second-line treatment for aspergillus and mucor

23
Q

Describe the potency of isavuconazole.

A

Very potent –> highest of the Azoles

24
Q

In what circumstance is isavuconazole typically used?

A

Last line –> people on isavuconazole have issues

25
Q

What is the original version of amphotericin B and what is its key AE?

A

Amphotericin B Deoxyxholate –> very hydrophilic and thus very nephrotoxic.

26
Q

What changed in the new formulations of amphotericin B and how many of the new versions are there?

A

Wrapped in lipids to keep it away from the kidneys. There are three such formulation.

27
Q

T/F: all of the new amphotericin B formulations are dosed the same.

A

False –> they all have different doses

28
Q

What is amphotericin B most commonly used to treat?

A

Kills almost all fungi –> atomic bomb of anti-fungals

29
Q

List the 3 most common AEs associated with amphotericin B.

A
  1. Infusion Rxns –> rigors and fever
  2. Nephrotoxicity
  3. Electrolyte abnormalities: HypoK and HypoMg
30
Q

What drugs are used prophylactically against the infusion reaction associated with amphotericin B?

A

acetaminophen, diphenhydramine, prednisone, meperidine

31
Q

For what infection is amphotericin B the drug of choice?

A

Invasive CNS infections –> HIV patients with cryptococcal meningitis

32
Q

By what route is nystatin administered and why?

A

Only topical - systemic use associated with many AEs - can be swish and spit for thrush.

33
Q

What is onychomycosis and what allylamine drug is used in treatment?

A

Nail bed infection

Treated with PO terbinafine

34
Q

What lab value must be followed when administering terbinafine?

A

LFTs

35
Q

What drugs are typically found in OTC anti-fungal creams?

A

nafitifine and terbinafine

36
Q

What infections are Echinocandins commonly used to treat and by what route are they administered?

A

IV drugs used for serious candida infections including glabrata

37
Q

What are the two most common Echinocandins?

A

caspofungin and micafungin

38
Q

How is flucytosine administered and for what infection is it used?

A

PO only –> used to treat crytpococcal meningitis along with amphotericin B.

Fall Pharm Block 3 (8 decks)

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