Anti Infectives Flashcards
Which treatment for TB?
What are there ADRs
Which supplement do you give with one of them?
RIPE
Give B6 with Isoniazid
Rifampicin — red/orange urine/secretion
Isoniazid — peripheral neuritis
Pyra-ZIN-amide — gout, toe, uric acid
Ethambutol — eye, visual problems
Learning objectives
What is the most common cause of noncandidal invasive fungal infection in immunocompromised patients?
Sites of infection?3
Which species?
What is prophylaxis?
What is the treatment?
+ what if invasive?
Aspergillus (Aspergillosis)
—lungs🫁
—sinus 👃
—CNS 🧠
—species: aspergillus fumigatus
—voriconazole drug or choice for prophylaxis and treatment
—if invasive:
—IV voriconazole + amphotericin B
-azole antifungals
What do you treat with these:
fluconazole: 3 what is the dose for one of the treatments?
itraconazole: 2
Posconazole
Voriconazole
Isavuconazole
Toxicities ? 2
Clinical pearls? 2
—fluconazole — candidasis x3 Tx / candidiasis proph / cryto meningitis proph / 150mg x 1 for vaginal
—itraconazole — blastomycosis, histoplasmosis
—Posconazole — invasive aspergillosis
—Voriconazole — invasive aspergillosis
—Isavuconazole* — invasive aspergillosis
QTc prolongation 📈& hepatotoxicites 🟩
1.Isavuconazole doesn’t prolong QT
2.all are CYP inhibitors — watch for DD rxns
Which agent would you use for candidiasis, candida proph. Cryptococcal meningitis ?
Fluconazole
Which agent would you use for blastomycosis, histoplasmosis (aspergillosis, oropharyngeal or esophageal candidiasis)
Itraconazole
Which agent would you use for
—invasive aspergillosis
—oropharyngeal candidiasis
—proph against invasive fungal infections in i.c patients
Posaconzaole
can also use Isavuconazole for invasive aspergillosis
can also use fluconazole for candidiasis
Which agent would you use to treat invasive aspergillosis, most commonly ? 2
Voriconazole
Isavuconazole (+invasive mucormycosis)
What is the MOA of amphotericin B?
—binds to ergosterol
—forms pores
—leaks cellular contents
What are the amphotericin B toxicities? 2
What are the two main pearls?
—infusion related rxns:
—rigours
—phlebitis
—nephrotoxicity
—electrolyte abnormalities
pearls
—limited use due to toxicity
—lipid formulation less toxic
What do you add with amphotericin B?
Primary use?
BBW?
flucytosine
—crypto meningitis b/c combined, can penetrate CNS
BBW: pts with renal dysfunction — extreme caution!!
Summary of antifungals
Try to learn them bug > drug and drug > bug
Metronidazole
What are all the uses. Know them all (9)
What are the toxicities? 2 big ones, 3 other
Indications:
—GI: balantidiasis, amebiasis, giardiasis, H.pylori BAGH
—GU: trichomoniasis (PO), bacterial vaginosis (gel)
—bite wounds
—C.difficile (3rd line)
—rosacea
Toxicities
—neurotoxicities 🧠 💫😵💫 (peripheral neuropathy)
—disulfiram reaction if mixed with alcohol 🍺 don’t mix.
—metallic taste 👅🪨
Alcohol + metronidazole/tinidazole = disulfiram-like reaction?
What is a disulfram-like reaction, sx?
What is the brand name for Metronidazole?
What is the guidance?
Flagyl
Note: disulfiram is given to alcoholics as a deterrent
They’ll get flush, nauseous, tachypnic, dyspnea etc.
That’s why it’s termed a “disulfiram-like reaction” in metronidazole
—no disulfiram meds for 2 weeks ❌
—then take metronidazole 💊
—then no alcohol for 3 days ❌🥂
What do you treat scabies and lice with?
2 concentrations
If refractory?
1%
—for lice
—sensitive areas public
—repeat in 7d
5%
—for scabies
—affects the whole body
—leave on for 8-14h
—repeat in 14d
If refractory
—oral ivermectin
What is the most frequently used anti parasitic drugs in the US? Brand name?
MOA
What is it for? 2 and 1 off label
Ivermectin Stromectal
Binds to chloride ion channels in nerve/muscle cells — hyperpolarisation - death
—strongyloidosis
—onchocerciasis (river blindness)
—off label: lice & scabies
—weight based drug
What are these also used for?
