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PT3 ID 2 > antifungal therapeutics > Flashcards

antifungal therapeutics Flashcards

1
Q

drugs to use for thrush

A
  • nystatin
  • clotrimazole
  • fluconazole
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2
Q

nystatin regimen for thrush

A

swish/swallow qid for 5-10 days

-avoid at meal times

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3
Q

clotrimazole regimen for thrush

A

dissolve 1 troche 5xday for 5-10 days

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4
Q

fluconazole regimen for thrush

A

200 mg once
or
100 mg qd for 7-14 days for mod-severe

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5
Q

options for fluconazole refractory thrush

A 
itraconazole
posoconazole
voriconazole
caspofungin
AMB
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6
Q

chronic suppression for thrush regimen

A

fluconazole 100 mg 3 times per week

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7
Q

what to use for candidal esophagitis

A

systemic only

fluconazole 200-400 mg 7-10 days

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8
Q

what to use for relapse of candida esophagitis

A

fluconazole 400-800 mg for 14-21 days

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9
Q

main problem with AMB

A

nephrotoxicity

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10
Q

AMB covers what fungi

A
  • candida
  • aspergillus
  • cryptococcus
  • coccidioides
  • histoplasma
  • sporothrix
  • mucor
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11
Q

AMB lipid formulations

A
  • complexed with 2 lipid bilayer ribbons

- complexed with lipid vesicles

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12
Q

AMB dosing technique

A
  • first do test does of 1 mg

- taper up to test the kidneys

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13
Q

AMB infusion reactions

A 
bronchospasm
dyspnea
tachycardia
fever
chills
rigors
myalgia
N/V
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14
Q

pretreat rigors with what

A

demerol

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15
Q

how does AMB cause renal failure

A

direct damage of distal tubules leading to waste of Na, K, and Mg, causing tubular acidosis

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16
Q

ways to reduce AMB renal toxicity

A
  • monitor renal fxn
  • avoid AMB if CrCl < 30
  • QoD dosing
  • lipid formulations
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17
Q

flucytosine use

A

only in combinations in serious infections to avoid resistance

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18
Q

flucytosine serious adverse effects

A

leukopenia

thrombocytopenia

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19
Q

flucytosine target concentration

A

under 100 mcg/ml

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20
Q

why isn’t ketoconazole used as much

A

many drug interactions

liver toxicity

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21
Q

fluconazole adverse effects

A

well tolerated

maybe n/v, LFTs

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22
Q

fluconazole spectrum

A

candida

crptococcus

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23
Q

itraconazole adverse effects

A

GI
headache
minor LFT elevation
hypokalemia

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24
Q

preferred dosage form for itraconazole

A

PO solution over the capsule

25
Q

itraconazole solution counseling

A

take on an empty stomach for max absorption

26
Q

itraconazole capsule counseling

A

take with food and acidic drink

27
Q

voriconazole adverse effects

A 
visual changes
LFTs
rash
hallucinations
QTc prolongation
28
Q

screening before using voriconazole

A

EKG

CrCl

29
Q

why don’t we give IV voriconazole or posaconazole when CrCl <50

A

solubilization agent (SBECD) can accumulate

30
Q

voriconazole drug interactions

A

extensive, inhibiting metabolism

31
Q

voriconazole dosing for invasive aspergillosis

A

6 mg/kg iv q12h for a day, then 4 mg/kg IV q12h

32
Q

voriconazole IV dosing for candidemia

A

6 mg/kg iv q12h for a day, then 3 mg/kg IV q12h

33
Q

voriconazole oral dosing for pt over 40 kg with candidemia

A

400 mg q12h for 1 day then 200 mg q 12h

34
Q

voriconazole oral dosing for pt under 40 kg with candidemia

A

200 mg q12h for one day then 100 mg q12h

35
Q

only azole with reliable activity vs zygomycetes

A

posaconazole

36
Q

posaconazole indication

A

prophylaxis of invasive aspergillus and candida infections of immunocompromised pts

37
Q

posaconazole dosage forms and their use

A

IV - prophylaxis of invasive infections
oral - prophylaxis of invasive infection
suspension - thrush

38
Q

posaconazole adverse effects

A

n/v/d
rash
potential QT prolongation

39
Q

posaconazole tablet dosing for prophylaxis

A

300 mg bid with fatty meal

40
Q

isavuconazole indications

A

invasive aspergillosis and mucormycosis

41
Q

isavuconazole dosing

A

372 mg q8h for 6 doses

42
Q

isavuconazole side effects

A 
LFT elevations
skin reactions
SJS
n/v/d
headache
hypokalemia
43
Q

caspofungin dosing

A

70 mg IV day 1, then 50 mg IV qd

44
Q

caspofungin notable drug interactions

A

phenytoin, dexamethasone, carbamazepine, rifampin

45
Q

caspofungin adverse effects

A 
*uncommon*
chills
fever
thrombophlebitis
n/v
46
Q

caspofungin main use

A
  • febrile neutropenia when fluconazole can’t be used
  • candidemia
  • esophageal candidiasis when fluconazole can’t be used
47
Q

assay that diagnoses aspergillosis

A

galactomannan assay

48
Q

test that detects invasive fungal disease

A

B-D-glucan assay (Fungitell)

49
Q

things that can cause Fungitell false positives

A
  • hemodialysis w/ cellulose membranes
  • platelet infusions with filters
  • immune globulin infusion
  • serious bacterial infection
  • augmentin
  • zosyn
50
Q

when to treat asymptomatic cadiduria (UTI)

A
  • patient is neutropenic

- patient is undergoing urologic procedure

51
Q

drug to treat candiduria (UTI)

A

fluconazole (both asymptomatic and symptomatic)

52
Q

symptoms of candiduria

A

dysuria
frequency
urgency

53
Q

empiric therapy for candidemia

A

caspofungin 70 mg load, then 50 mg per day

54
Q

fungus resistant to fluconazole

A

candida glabrata, candida krusei

55
Q

alternate options for candidemia

A

micafungin
fluconazole
voriconazole
AMB

56
Q

options for candidemia in a neutropenic host

A

caspofungin
lipid based AMB
fluconazole
voriconazole

57
Q

how long to treat for candidemia in neutropenic host

A

2 weeks after last positive culture

58
Q

what else to test for in candidemia

A

eye exam

59
Q

how long to treat candidemia in non-neutropenic host

A

2 weeks after first negative blood culture

PT3 ID 2 (6 decks)

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