Anti Fungi

Question 1

Echinocandins MOA & SE DOC

Answer 1

All IV All Daily competitively inhibit 1,3 B-D-Glucan sythase to prevent glucan synthesis in the fungal cell wall making it susceptible to osmotic stress, eventually causing cell lysis and fungicidal activity

No Activity against cryptococcus, zygomycetes and Dimorphic

DOC: C.glabrata, C.Kruseii Infusion over 1 hr increase LFTs, Rash

Question 1

AmBisome

Answer 1

Liposomal AMB 3-6 mg/kg IV daily best safety profile, DOC for CNS infection

Question 1

Griseofulvin (Grifulvin)

Answer 1

inhibits Fungal cell mitosis at metaphase, binds to human keratin making it resistant to fungal invasion 500-1000mg PO daily Pregal X

Question 2

Terbinafine (Lamisil)

Answer 2

250 PO daily

Question 3

Cancidas

Answer 3

Caspofungin 70mg IV X1 then 50mg IV daily Liver: 70mg then 35 mg

Question 3

Fungizone

Answer 3

AMB deoxycholate 0.5-1 mg/kg IV daily

Nephrotoxicity: lead to azotemia, hypokalemia, hypomagnesemia & bicarbonate wasting

Myalgia, Hypotension, thrombophlebitis (infusion related toxicity)

• Premedicate with IV hydrocortisone, APAP/IBU with diphenhydramine, meprindine

Admini over 4-6 hrs

Question 4

Voriconazole

Answer 4

taken with empty stomach potent 3A4 inhibitor non-linear kinetic through level 2-5 mcg/ml SE: vision change, avoid UV IV formulation contains cyclodextrin - CI in Renal impairment

Question 6

Abelcet

Answer 6

AMB lipid complex 5mg/kg IV daily

Question 7

Itraconazole

Answer 7

CAP: take with food and avoid PPIs, and H2RAs Solution: take on empty stomach trough level >1 mcg/ml strong 3A4 inhibitor BBW: HF

Question 8

Vfend

Answer 8

Voriconazole 6mg/kg BID X2, then 4 mg/kg BID IV 200-400mg BID PO

Question 9

Diflucan

Answer 9

Fluconazole 200-800mg PO/IV daily No activity against mold

Question 9

Eraxis

Answer 9

Anidulafungin 200mg IV X1 then 100mg IV daily spontaneous degradation to inactive metabolites no renal or liver adj needed

Question 10

Mycamine

Answer 10

Micafungin 100mg IV daily

Question 11

Noxafil

Answer 11

Posaconazole 200mg TID-QID PO susp 300mg BID X 2 then 300mg daily PO/IV

Question 13

Polyene MOA & SE & DOC

Answer 13

Direct binds ergosteril and forms pore causing lysis

Cannot be interchanged

DOC: Mucomycosis, & Cryptococcal menigitis induction with flucytosine

the only Anti-fugal used in Preg

Question 14

Azoles MOA SE

Answer 14

Inhibit 14-alpha-demethylase to prevent synthesis of ergo sterol, which is an important component of fungal cell membranes QT prolong Hepatotoxicity 3A4 inhibitors

Question 16

Molds

Answer 16

Sporothrix schenckii

Aspergillus spp

Zyogmycetes

Question 17

Dimorphic fungi

Answer 17

Grow yeast in body but mold outside Coccidioidomycosis. Histoplasmosis Blastomycosis

Question 18

Flucytosine (Ancobon)

Answer 18

convert to 5-FU

25mg/kg PO q6h X4 weeks

DOC: Cryptococcal meningitis induction with AMB

Coverage: Cryptococcus & Candida spp

Requires renal dose adjustment

SE: Bone marrow suppression .. rush, GI, reversible liver

Question 20

Posacanazole

Answer 20

taken with high fat meal required LD for acute infections IV formulation contains cyclodetrin - CI: CrCl < 50 ml/min strong 3A4 inhibitor Trough level > 1mcg/ml

Question 21

Fluconazole

Answer 21

best oral bio% 2C19, 2C9, 3A4 inhibitor required renal dose adjustment

Question 22

Sporanox, Onmel

Answer 22

Itraconazole 200mg PO daily - TID

Question 23

Amphotec

Answer 23

AMB cholesteryl sulfate complex -colloid dispersion 3-4 mg/kg IV daily require test dose