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Bugs & Drugs > Antifungals > Flashcards

Antifungals Flashcards

1
Q

amphoB MOA

A

binds to ergosterol

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2
Q

spectrum (CACEZ)

A

BROAD

Candida, Aspergillus, cryptococcus, endemics, zygomycetes

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3
Q

amphoB adjust for organ dysfxn?

A

no

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4
Q

amphoB toxicity

A

Nephrotoxicity (TG feedback –> constriction; RTA –> spill electrolytes) loss of H/K/Mg
Anemia
Infusion fever/rigors

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5
Q

lipid amphoB

A

gentler - reduces SE’s by 20x

but less potent

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6
Q

indications for amphoB

A

1st line for:
Crypt. Meningitis
Endemics
Initial tx for Zygomycoses

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7
Q

Tx of zygomycetes?

A

AmB

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8
Q

Cryptococcal meningitis 1st line?

A

AmB

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9
Q

Azole MOA

A

block an enzyme in the ergosterol synth pathway
static for candida
cidal for aspergillus

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10
Q

Azole spectrum

A

Candida (not glabrata/krusei)
Cryptococcus
Endemics

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11
Q

big candida problem in the hospital

A

Glabrata

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12
Q

Azoles NOT good for

A

Aspergillus

Zygomycetes

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13
Q

Fluconazole kinetics

A

Gets where we want it to get
renal elimination
drug interactions: CYP450 inhibitor

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14
Q

Fluconazole toxicity

A

teratogenicity limits in pregnancy

QT prolongation

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15
Q

Fluconazole indications

A

1st line: mucosal candidiasis
1st line: step-down for invasive candidiasis and cryptococcal meningitis
1st line for candida cystitis

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16
Q

mucosal candidiasis tx

A

fluconazole

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17
Q

Itraconazole spectrum

A

More potent against endemic fungi
Candida/Crypto/aspergillus/dermatophytes
Not zygomycetes

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18
Q

Itraconazole kinetics

A 
VARIABLE absorption (not sure how much pt will actually get)
depends on acid/food status of stomach
poor CNS/urine distribution
no change for renal dysfunction
BIG TIME CYP450 inhibitor
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19
Q

Itraconazole toxicity

A

more GI than fluconazole
QT prolong
same teratogenicity problem

20
Q

Itraconazole indications

A

1st line for dermatophytes

1st line step down for endemics

21
Q

Voriconazole spectrum

A

closer to itra than flu
Aspergillus terreus (not gotten by amphora)
endemics/crypto
not zygomycetes

22
Q

Voriconazole kinetics

A 
Does not get in urine
Yes CNS
No need for food or acid
SHORT half-life
**liver metabolism: CYP2C19 (thus need TDM)
CYP450 inhibitor
23
Q

voriconazole toxicity

A

most toxic among triazoles
VISUAL photopsia, photosensitivity –> sunburns
more hepatotoxicity

24
Q

Voriconazole indications

A

1st line: BEST for invasive aspergillosis, fusarium, scedosporium
endemics/cryptococcal meningitis

25
Q

Posaconazole

A

ZYGOMYCETES + the rest

26
Q

Posaconazole kinetics

A

need lipids
acid needed, better w/food
poor CNS, no urine
TDM

27
Q

Posaconazole toxicity

A

OK

…but less information than other triazoles

28
Q

Posaconazole indications

A

1st line prophylaxis in HEME malignancy/BMT
1st line ZYGOMYCETES (only other option is AmphoB)
2nd line for other infections (endemics e.g.)

29
Q

Isavuconazole

A

Same is posaconazole

30
Q

Isavuconazole advantages

A 
kinetics: well-absorbed, IV formulation
no need for acid or food
no need for TDM
no change for renal/hepatic dysfunction
few drug interactions CYP3A4
31
Q

Isavuconazole SE’s

A

minimal

32
Q

Isavuconazole indications

A

1st line for aspergillus/zygomycestes, fusarium, scedosporum

2nd line for candidiasis and endemics

33
Q

flucytosine

A

inhibits DNA/protein synthesis
candida (all) and crypto
Nothing else

34
Q

Flucytosine kinetics

A

oral only
CNS and urine excellent
no drug interactions
change dose for renal dysfxn

35
Q

Flucytosine toxicity

A 
life-threatening toxicity with amphoB --> nephrotoxicity
Bone marrow suppression
Hepatitis
*due to accumulation of 5-FC in blood
So use TDM
36
Q

Flucytosine primary use

A

cryptococcal meningitis (w/AmphoB)

candida cystitis

37
Q

Echinocandin MOA

A

inhibit B-D-glucan synthase

38
Q

Echinocandin kinetics

A

IV only
Poor CNS/eye/urine
minimal toxicity

39
Q

Echinocandin spectrum

A

CIDAL for all candida (except parapsilosis)
Static for Aspergillosis
NO cryptococcus/endemics/zygo/dermatophytes

40
Q

Echinocandin indications

A

1st line for invasive candidiasis (not CNS/eye)
Combo w/voriconazole for aspergillosis
Prophylaxis for heme malig/BMT

41
Q

Candidiasis

A

mucosal: topical azoles, oral flucon
systemic: AmB, flucon

42
Q

Aspergillosis

A

Voriconazole
AmB
Itraconazole (for mild)

43
Q

Cryptococcosis

A

GOLD STD: AmB + 5-FC

Flucon for mild & suppression

44
Q

Histoplasmosis/Blastomycosis

A

AmB for severe
Itracon for non-life threatening/non-CNS
Voricon/Posacon

45
Q

Coccidioidomycosis

A

AmB for severe
Flucon/itracon less effective
Flucon for meningitis due to kinetics
Voricon/Posacon

46
Q

Dermatophytes

A

Terbinafine&raquo_space; Itracon

Terb: fewer SE’s and no interactions

Bugs & Drugs (15 decks)

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