Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Infectious Disease > Antifungals > Flashcards

Antifungals Flashcards

1
Q

Yeasts

A

Candida

Cryptococcus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Dimorphic fungi

A

Coccidioides
Blastomyces
Histoplasma
Paracoccidiodes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Moulds

A

Aspergillus
Zygomycetes
Fusarium
Scedosporium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Polyenes

A

Amphotericin B

Topical nystatin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Main toxicity of amphotericin B

A

Nephrotoxicity

Infusion-related Rxns

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Ampho. B MOA

A

Polyenes bind to the ergosterol in the cell membrane of fungi, disrupting its membrane

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

ABCD

A

Ampho. B colloidal dispersion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

ABLC

A

Ampho. B lipid complex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

LAmB, Ambisome

A

Liposomal amphotericin B

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Spectrum for Polyenes

A

Good for everything except candida lusitaniae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Polyene AEs

A

Nephrotoxicity
Infusion-related reactions (use APAP or benadryl)
Electrolyte disturbances (decreased Mg/Ca, increase/decrease K)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Amphotericin dosing problems

A

-Many formulations can lead to dosing confusion

Ampho. B deoxycholate is 0.5-1.5mg/kg/d and lipid formulations are 3-6mg/kg/d

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is given to treat rigors with amphotericin B

A

Meperidine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Utility of Polyenes

A

DOC for cryptococcal meningitis (and serious forms of other fungal infections, such as dimorphic fungi and some mould infections)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Drug interactions with amphotericin

A

Increased nephrotoxicity with other nephrotoxic agents (aminoglycosides, CsA, etc)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Antimetabolits

A

Flucytosine (5-FC) is the only drug in this class

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

5-FC spectrum

A

in combination with amphotericin B: cryptococcus neoformans, most species of candida

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

5-FC MOA

A

Antimetabolite that interferes with DNA synthesis; enters fungal cell -> converts to floururacil -> competes with uracil -> interferes with fungal RNA and protein synthesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

5-FC AEs

A

Relatively selective for fungi
Can cause bone marrow suppression, esp in high doses for long periods of time
Can cause GI disturbances and CNS effects (HA, confusion, atacia, hallucinations)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

5-FC important facts

A

Drug concentration monitoring usually done off site.
Check peak about 2 hours after a dose is given
Do not rely on concentrations alone
Dose adjustments need for renal insufficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Drug interactions for 5-FC

A

Increased effect with amphotericin B

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

5-FC utility

A

Tx of cryptococcal disease in combo with Ampho. B

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

5-FC Don’t Forget

A

Follow CBC closely

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Azoles

A 
Itraconazole
Fluconazole
Voriconazole
Posaconazole
Isavuconazole
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Azole MOA

A

Inhibit fungal CYP450, decreasing ergosterol production

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Itraconazole good spectrum

A 
C. albicans
C. tropicalis
C. parasilosis
C. lusitaniae
Cryptococcus neoformans
Aspergillus
Many dimorphic fungi
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Itraconazole Moderate spectrum

A

C. glabrata

C. Krusei

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Itraconazole Poor spectrum

A

Mucorales (zygomycetes spp.), other moulds

29
Q

Fluconazole Good spectrum

A 
C. albicans
C. tropicalis
C. parasilosis
Cryptococcus neoformans
Coccidiodes immitis
30
Q

Voriconazole Good spectrum

A 
C. albicans
C. tropicalis
C. parasilosis
C. lusitaniae
C. krusei
Aspergillus spp.**
Many other moulds
31
Q

Fluconazole moderate spectrum

A

C. glabrata

32
Q

Fluconazole poor spectrum

A

Moulds
Dimorphic fungi
C. krusei

33
Q

Voriconazole Moderate spectrum

A

C. glabrata & C. albicans (that are fluconazole resistant)
Fusarium spp.

34
Q

Voriconazole poor spectrum

A

Mucorales (zygomycetes spp.)

35
Q

Posaconazole good spectrum

A 
C. albicans
C. tropicalis
C. parasilosis
C. lusitaniae
C. krusei
Aspergillus**
Mucorales (Zygomycetes spp)***
Many moulds
Dimorphic fungi***
36
Q

Posaconazole moderate spectrum

A

C. glabrata

Fusarium spp.

37
Q

Isavuconazole good spectrum

A

Candida spp.
Aspergillus spp. ***
Mucorales (Zygomycetes spp.)
Other moulds, dimorphic fungi

38
Q

Isavuconazole moderate spectrum

A

C. glabrata

39
Q

Isavuconazole poor spectrum

A

Fusarium

40
Q

Itraconazole AEs

A

Hepatotoxicity
QTc prolongation
Contraindicated with HF

41
Q

Itraconazole DDIs

A

Strong CYP3A4 inhibitor

42
Q

Itraconazole important facts

A

Lower F than the solution and are less preferred for systemic fungal infections
Capsules always be taken with food
Solution taken on empty stomach
Absorption inhibited by PPIs

43
Q

Itraconazole utility

A

DOC for some dimorphic infxns, such as histoplasmosis

44
Q

Fluconazole AEs

A

Can cause hepatotoxicity or rash

QTc prolongation

45
Q

Fluconazole DDIs

A

Lower propensity for drug interactions
Strong inhibitor of CYP 2C9 and 2C19
Moderate inhibitor of CYP 3A4

46
Q

Fluconazole Important facts

A

Adjust dose based on renal function
Poorly active against C. krusei and C. glabrata, it is best to check for susceptibilities and give 800mg/d
High F

47
Q

Fluconazole utility

A

DOC for many susceptible fungal infections

48
Q

Voriconazole AEs

A

Hepatotoxicity, rash, QT prolongation
Visual effects; tend to go away with continued use
Visual and auditory hallucinations
Sun sensitivity
Drug interactions (moderate inhibitor CYP2C9 and CYP 3A4)

49
Q

Voriconazole important facts

A

Contraindicated in CrCl < 50 in IV; can use oral

Eliminated hepatically and not useful for treatment of candiduria

50
Q

Utility of Voriconazole

A

DOC for invasive aspergillosis

51
Q

Posaconazole AEs

A

Hepatotoxicity, rash
GI disturbances
QT prolongation

52
Q

Posaconazole DDIs

A

Strong inhibitor of CYP3A4

53
Q

Posaconazole important facts

A

Delayed release tablets and oral suspension dosing is not interchangedable
Oral: take with food to increase absorption

54
Q

Posaconazole utility

A

PO tabs, suspension and IV: prophylaxis of candida and aspergillus in high risk patients
PO suspension: oropharyngeal candidiasis refractory or ristant to fluconazole/itraconazole

55
Q

Isavuconazole AEs

A

Hepatotoxicity

56
Q

Isavuconazole DDIs

A

Substrate of CYP3A4, inhibitor of CYP 4A4, P-gp, and organic cation transporter 2 (OCT 2)

57
Q

Isavuconazole important facts

A

Supplied as a prodrug
Available as IV injection and PO capsules
Can be taken w/ or w/out food
Very broad spectrum
Very long t1/2; extensive loading dose regimen

58
Q

Isavuconazole utility

A

treatment of invasive mold infections

59
Q

Isavuconazole loading dose regimen

A

q8h x 48h then q24h

60
Q

Echinocandins MOA

A

inhibit the synthesis of beta-1,3-glucan, a component of the fungal cell wall

61
Q

Echinocandins

A

Capsofungin
Micafungin
Anidulafungin

62
Q

Echinocandin good spectrum

A 
C. albicans
C. tropicalis
C. lusitaniae
C. galbrata***
C. krusei***
Aspergillus spp.***
C. parasilosis
63
Q

Echinocandin moderate spectrum

A

Mucorales, in combo with ampho b

64
Q

Echinocandin poor spectrum

A

Most non-aspergillus moulds

Cryptococcus neoformans

65
Q

Echinocandin AEs

A

Mild histamine-mediated infusion-related reactions (not common; just slow down infusion rate)
Hepatotoxicity (rare)

66
Q

Echinocandin important facts

A

No oral formulation yet
Differences among the echinocandins are minor and mostly PK
Capsofungin and micafungin are eliminated by non-CYP450 metabolism
Anidulafungin degrades in the plasma and avoids hepatic metabolism

67
Q

Echinocandin DDIs

A

Minor

Be cautious when using caspofungin with CsA or rifampin and micafungin with sirolimus

68
Q

Echinocandin utility

A

Becoming the DOC for invasive candidiasis
Useful for treatment of invasive aspergillosis but do not have the level of evidence that voriconazole and amphotericin do

Infectious Disease (19 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions