- first do test does of 1 mg - taper up to test the kidneys

antifungal therapeutics Flashcards by Tim Pulleyn

drugs to use for thrush

nystatin
clotrimazole
fluconazole

How well did you know this?

Not at all

Perfectly

nystatin regimen for thrush

swish/swallow qid for 5-10 days

-avoid at meal times

How well did you know this?

Not at all

Perfectly

clotrimazole regimen for thrush

dissolve 1 troche 5xday for 5-10 days

How well did you know this?

Not at all

Perfectly

fluconazole regimen for thrush

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

How well did you know this?

Not at all

Perfectly

options for fluconazole refractory thrush

itraconazole
posoconazole
voriconazole
caspofungin
AMB

How well did you know this?

Not at all

Perfectly

chronic suppression for thrush regimen

fluconazole 100 mg 3 times per week

How well did you know this?

Not at all

Perfectly

what to use for candidal esophagitis

systemic only

fluconazole 200-400 mg 7-10 days

How well did you know this?

Not at all

Perfectly

what to use for relapse of candida esophagitis

fluconazole 400-800 mg for 14-21 days

How well did you know this?

Not at all

Perfectly

main problem with AMB

nephrotoxicity

How well did you know this?

Not at all

Perfectly

AMB covers what fungi

candida
aspergillus
cryptococcus
coccidioides
histoplasma
sporothrix
mucor

How well did you know this?

Not at all

Perfectly

AMB lipid formulations

complexed with 2 lipid bilayer ribbons

- complexed with lipid vesicles

How well did you know this?

Not at all

Perfectly

AMB dosing technique

first do test does of 1 mg

- taper up to test the kidneys

How well did you know this?

Not at all

Perfectly

AMB infusion reactions

bronchospasm
dyspnea
tachycardia
fever
chills
rigors
myalgia
N/V

How well did you know this?

Not at all

Perfectly

pretreat rigors with what

demerol

How well did you know this?

Not at all

Perfectly

how does AMB cause renal failure

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

How well did you know this?

Not at all

Perfectly

ways to reduce AMB renal toxicity

monitor renal fxn
avoid AMB if CrCl < 30
QoD dosing
lipid formulations

How well did you know this?

Not at all

Perfectly

flucytosine use

only in combinations in serious infections to avoid resistance

How well did you know this?

Not at all

Perfectly

flucytosine serious adverse effects

leukopenia

thrombocytopenia

How well did you know this?

Not at all

Perfectly

flucytosine target concentration

under 100 mcg/ml

How well did you know this?

Not at all

Perfectly

why isn’t ketoconazole used as much

many drug interactions

liver toxicity

How well did you know this?

Not at all

Perfectly

fluconazole adverse effects

well tolerated

maybe n/v, LFTs

How well did you know this?

Not at all

Perfectly

fluconazole spectrum

candida

crptococcus

How well did you know this?

Not at all

Perfectly

itraconazole adverse effects

GI
headache
minor LFT elevation
hypokalemia

How well did you know this?

Not at all

Perfectly

preferred dosage form for itraconazole

Study These Flashcards

PO solution over the capsule

itraconazole solution counseling

take on an empty stomach for max absorption

itraconazole capsule counseling

take with food and acidic drink

voriconazole adverse effects

``` visual changes LFTs rash hallucinations QTc prolongation ```

screening before using voriconazole

EKG | CrCl

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

solubilization agent (SBECD) can accumulate

voriconazole drug interactions

extensive, inhibiting metabolism

voriconazole dosing for invasive aspergillosis

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

voriconazole IV dosing for candidemia

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

voriconazole oral dosing for pt over 40 kg with candidemia

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

voriconazole oral dosing for pt under 40 kg with candidemia

200 mg q12h for one day then 100 mg q12h

only azole with reliable activity vs zygomycetes

posaconazole

posaconazole indication

prophylaxis of invasive aspergillus and candida infections of immunocompromised pts

posaconazole dosage forms and their use

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

posaconazole adverse effects

n/v/d rash potential QT prolongation

posaconazole tablet dosing for prophylaxis

300 mg bid with fatty meal

isavuconazole indications

invasive aspergillosis and mucormycosis

isavuconazole dosing

372 mg q8h for 6 doses

isavuconazole side effects

``` LFT elevations skin reactions SJS n/v/d headache hypokalemia ```

caspofungin dosing

70 mg IV day 1, then 50 mg IV qd

caspofungin notable drug interactions

phenytoin, dexamethasone, carbamazepine, rifampin

caspofungin adverse effects

``` *uncommon* chills fever thrombophlebitis n/v ```

caspofungin main use

- febrile neutropenia when fluconazole can't be used - candidemia - esophageal candidiasis when fluconazole can't be used

assay that diagnoses aspergillosis

galactomannan assay

test that detects invasive fungal disease

B-D-glucan assay (Fungitell)

things that can cause Fungitell false positives

- hemodialysis w/ cellulose membranes - platelet infusions with filters - immune globulin infusion - serious bacterial infection - augmentin - zosyn

when to treat asymptomatic cadiduria (UTI)

- patient is neutropenic | - patient is undergoing urologic procedure

drug to treat candiduria (UTI)

fluconazole (both asymptomatic and symptomatic)

symptoms of candiduria

dysuria frequency urgency

empiric therapy for candidemia

caspofungin 70 mg load, then 50 mg per day

fungus resistant to fluconazole

candida glabrata, candida krusei

alternate options for candidemia

micafungin fluconazole voriconazole AMB

options for candidemia in a neutropenic host

caspofungin lipid based AMB fluconazole voriconazole

how long to treat for candidemia in neutropenic host

2 weeks after last positive culture

what else to test for in candidemia

eye exam

how long to treat candidemia in non-neutropenic host

2 weeks after first negative blood culture

antifungal therapeutics Flashcards

(59 cards)