Antifungals

Question 1

Amphotericin B
Amphoterrible
SE

Answer 1

1. infusion related: f&c (1-3hrs after infusion;
   mgt: subside with repeated infusion or slow infusion (for 3hr), thrombophlebitis
2. Hypotension
   - hypotension is accompanied by hypoK –> need K+ supp & extra care for pt taking digoxin or other drugs causing K+ fluctuations
3. Nephrotoxicity Mgt: - can use liposomal but more costly; when conventional Na deoxycholate causes renal dysfunction, decrease total OD dose by 50%
   - hydrate pt adequately
   - C/I for pt w renal impairment
4. Ototoxicity
5. Bone marror suppression

Question 2

Pregnancy

Answer 2

Suitable: amp B (B, well tolerate in neonates)
Terbinafine: vaginal A, oral B (BUT NOT FOR NURSING MOTHERS bc it accumulates in breast milk)

Not suitable:
5-FC: C
echinocandins: C

ALL TRIAZOLE: TERATOGENIC, C/I FOR PREGNANCY
Fluco/Itraconazole: C
Voriconazole: D

Question 3

Different PK PD of triazoles

Answer 3

Flu: Oral/IV
PO: well A bc of low MW

Itra: Oral
Capsules: better A in acidic condition so take itra with food and coke (NOT WITH ANTACID)
Solution: better A than capsules & take on empty stomach

Vori: Oral/IV

Flu: long t1/2, well D to body fluids (breastmilk, CSF) cos of low MW

itra: well D to tissues but poor CSF

Vori: high oral F, well D to tissue and CSF

Question 4

invasive aspergillosis

1st line, 2nd line (how to qualify for 2nd line)

Answer 4

1st line: vori > amp B

2nd line: echinocandins (pt who cannot tolerate amp B & azoles: maybe renally impaired/ cannot tolerate the hypotension

or have ddi with azoles, like warfarin/DM med)

Question 5

common SE of topical imidazole

Answer 5

contact dermatitis
vulvar irritation
edema

Question 6

SE of 5-fc

Answer 6

GI
serious bone marrow (monitor weekly wbc and plt)
hepatotoxicity (mild reversible , monitor weekly ALT, AST
Renal impaired need to dose adj

Question 7

renal patient having fungal infection

hepatic pt

Answer 7

C/I for amp b
but if conventional ampb is causing renal problem, decrease by 50%

dose adj for 5-fc, fluco

[hepatic]
Dose adj for echinocandins

Question 8

SE of echinocandins

Answer 8

GI
F&C
Rashes, skin flushng
Thrombocytopenia

Question 9

DDI of echinocandins

Answer 9

with rifampicin: need to increase dose of rifampicin

with cyclosporin: bc pt will have increase ALT and AST

Question 10

amp B + 5FC

Answer 10

to increase penetration of 5FC

to treat candidiasis and cryptococcal meningitis and pulmonary

Question 11

SE of triazoles

Answer 11

GI, hepatotoxicity, qt prolongation

need to dose adj for renal pt for fluco as it is excreted unchanged

cardiac toxicity for itra

neurotoxicity for vori (visual disturbances, see ghosts, delirium, hallucinations)