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Pharm > Antifungal abx > Flashcards

Antifungal abx Flashcards

1
Q

What are the types of fungal infections?

A

-invasive aspergillosis
-esophageal candidiasis
- crytococcosis
-blastomycosis
-histoplasmosis
-onychomycosis
-murcormycosis
-dermatophytoses
-

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2
Q

What information could be used to diagnose a pt with a fungal infection?

A 
-smyptomes 
    fever or inflammatory 
    response
    (increased WBC, topical 
    redness,etc.
  • risk factors
  • tissue/blood cultures
  • radiography
  • serological testing (look for ab)
  • galactomannan assay (aspergillus)
  • B-glucan (candidia)
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3
Q

What are the risk factors for developing a fungal infection?

A

-increases in immunosuppressed patients

  • metabolic stress (surgery)
  • myelosuppression from chemo
  • immunosuppressive drugs used after solid organ or stem cell transplant
  • immunosuppressive disease (HIV)
  • alterations in normal flora due to use of broad-spectrum abx
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4
Q

Fungistatic

A

drugs inhibit growth

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5
Q

fungicidal

A

drugs kill fungal pathogens

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6
Q

Classes of antifungals: Flucytosine

A

MOA: DNA synthesis

  • -> taken up by fungal cells and converted to 5-FU and then 5-FdUMP and 5-FdUTP
  • -> inhibit fungal DNA and RNA synthesis
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7
Q

Classes of antifungals: Polyenes

A

MOA: Cell Membrane

  • Nystatin
  • Amphotericins
    • Amphotericin B deoxycholate
    • lipid amphotericins
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8
Q

Classes of antifungals: Flucytosine

A

MOA: DNA synthesis

  • -> taken up by fungal cells and converted to 5-FU and then 5-FdUMP and 5-FdUTP
  • -> inhibit fungal DNA and RNA synthesis
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9
Q

Classes of antifungals: Echinocandins

A

MOA: Cell Wall

  • Caspofungin
  • Micafungin
  • Anidulafungin
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10
Q

Empiric use of antifungals

A
  • tx of a possible or probable fungal infection

- based on the presence of symptoms consistent with a fungal infection, no positive culture data

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11
Q

Targeted use of antifungals

A
  • definitive positive culture data exists

- allow for targeted tx

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12
Q

Prophylactic use of antifungals

A
  • Preventive tx of a specific pathogen in an at-risk pt
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13
Q

Side Effects of Fluconazole

A

GI upset
increased LFTs

NO ACTIVITY AGAINST ASPERGILLUS

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14
Q

Side effects of Flucytosine

A

Myelosuppresssion

Hepatotoxicity (LFTs)

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15
Q

Side effects of caspofungin

A

immunosuppression
avoid concomitatn use if possible

GI
infusion rxns
LFTS increase

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16
Q

side effects of isavuconazole

A

infusion-related rxns

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17
Q

side effects of amphotericin

A

Infusion related rxns
- therefore premedicate with acetaminophen, diphenhydramine

  • chronic use
    • renal toxicity
    • hepatotoxic
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18
Q

side effects of itraconazole

A

BBW: can worsen heart failure

19
Q

side effects of voriconazole

A

visual changes

dose adjustments in hepatic impairment

20
Q

side effects of terbinafine

A

Hepatotoxicity (LFTs) with oral tablets

21
Q

What is myelosuppression

A

anemia
thrombocytopenia
leukopenia

22
Q

Two drugs (oral) that can be used for onychomycosis?

How do they work?

A

ORAL

  • Itraconazole
  • terbinafine
23
Q

Two drugs (topical) that can be used for onychomycosis?

How do they work?

A

TOPICAL

  • efinaconazole
  • tavaborole
24
Q

Two drugs (oral) that can be used for onychomycosis?

A

ORAL

  • Itraconazole
  • terbinafine
25
Q

Two drugs (topical) that can be used for onychomycosis?

How do they work?

A

TOPICAL
- efinaconazole
apply once daily to clean dry nail (entire surface, nail folds, nail bed, and under tip) for 48 weeks

-tavaborole
apply once daily to affected nail (entire surface and under. tip) for 48 weeks

26
Q

Explain the loading and maintenance dosing methods used with isavuconazole?

A

Loading dose:

  • 372 mg= 200 mg
  • give q8 hr for 6 doses over first 2 days
maintenance dose:
372 mg (=200 isa) daily , 12-24 h after last LD
27
Q

Explain the loading and maintenance dosing methods used with voriconazole?

A

iv loading dose
- 6mg/kg q12 x2

maintenance dose

  • 3-4 mg/kg IV bid
  • use 200mg bid oral dose if >40kg ; 100 mg BID if < 40kg
28
Q

Explain the loading and maintenance dosing methods used with posaconazole?

A

Prophylaxis- IV/tabs

  • loading dose is 300mg BIDx2
  • maintenance dose 300 mg daily

OPC-PO

  • loading dose: 100 mg PO BID
  • maintanence dose 100 mg x13 days
29
Q

Describe the mechanism of drug interactions caused by azole antifungals via CYP450 enzymes and how it varies based on being members of imidazole or triazole groups.

A

Azoles inhibit human CYP450 enzymes

  • Cyp450 3a4 is a major target
  • azoles confuse human with fungal cyp enzymes
  • results in inhibition of both
  • effects on humans is inhibition of CYP enzymes which reduces metabolism of drugs

imidazoles lack of selectivity results in more significant drug interactions than triazoles

30
Q

Describe another mechanism of drug interactions that involves only some of the oral azoles and none of the intravenous formulations

A

Reduced biovailability when tabs/caps taken with acid reducers (h2 antagonists, PPIs, antacids)–> need acidic environment to be absorbed

31
Q

Describe any pertinent food interactions that may increase or decrease bioavailability of applicable agents.

A

Itraconazole–> should be taken with food and Coke

Posaconazole –> increased bioavailability when taken after a full meal and or with an acidi carbondated beverage

32
Q

Explain the benefits and limitations of lipid formulations of amphotericin.

A

Created to improve tolerablility

Reduces toxicity, but does not eliminate it

Just as effective

High expense

Higher dose needed

IV only – can be made into other forms like rinses and ointments (not sterile)

33
Q

Systemic azoles that are pregnancy category C and D.

What does this means for use in women who are pregnant or may become pregnant during treatment.

A

Category C: Animal studies have shown AEs on the fetus, no adequate studies in humans. Potential benefits may warrant the use of the drug in pregnant women.
1-day dosing products
Fluconazole – ONLY IF used 150mg x1 dose for VVC (otherwise, Cat D)
Category D: There is positive evidence of human fetal risk based on adverse rxn data from studies in humans, but potential benefits may warrant the use of the drug in pregnant women.

7 day topical azoles (like creams for VVC) are category B

34
Q

Agents cover only Candida species

A

Micafungin
Anidulafungin
Nystatin

35
Q

Agents cover both Candida and Aspergillus

A 
Amphotericin 
Itraconazole 
Voriconazole 
Posaconazole 
Caspofungin
36
Q

Be familiar with agents that have issues with resistance to some organisms

A

Fluconazole
Amphotericin
Flucytosine

37
Q

Which drugs have activity against Cryptococcus?

A

Amphotericin
Flucytosine
Fluconazole

38
Q

Which drugs have activity against mucorales species?

A

Amphotericin

Isavuconazole

39
Q

Only oral

A

Flucytosine

Itraconazole

40
Q

Only IV

A 
Caspofungin
Micafungin
anidulafungin
amphotericin B
Lipid amphotericin
41
Q

Oral and IV

A

Fluconazole
Voriconazole
Posconazole
Isavuconazole

42
Q

Only topic

A

Nystatin

43
Q

Oral and topical

A

Ketoconazole
terbinafine
tolnaftate

Pharm (3 decks)

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