antifungals and antivirals III Flashcards by Krupa Bhakta

conventional formulation of amphotericin B deoxycholate

0.1-1.5 mg/kg /day

SE infusion-related fever, chills, headache, malaise, rigors

prepare in D5W only

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Lipid formulation
Amphotericin B Lipid complex

Abelcet
injection
5mg/kg/day

prepare in D5W only

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lipid formulation
liposomal amphotericin B

AmBisome
injection
3-6mg/kg/day

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amphotericin facts

decrease K and Mg
nephrotoxic

can give NS bolus to decrease nephrotoxicity and meperidine to decrease duration of severe rigors

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flucytosine

ancobon

resistance common so use with amphotericin B
- flucytosine (in fungal cell covered to fluorouracil)

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fluconazole class info

decrease ergosterol synthesis and cell membrane formation
cyp3A4 inhibitor
- increase LFTs
- QT prolongation except isavuconazonium
- many DDI

all azole IV to PO 1:1

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fluconazole

Diflucan PO/IV 1:1

only azole that requires renal dose adjustment
- azole

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itraconazole

Sporanox, Tolsura
can cause heart failure
Sporanox brand requires acidic gut
- azole

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ketoconazole topical

Nizoral A-D, Extina, Ketozole, Xolegel

Nizoral A-D is OTC

hepatotoxic
QT prolongation
for these reasons avoid PO (requires acidic gut), last resort
- azole

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Voriconazole

Vfend, Vfend IV
can cause visual changes and phototoxicity
avoid sunlight and take on empty stomach (1hr gap)

SBECD Vehicle
- azole

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Posaconazole

Noxafil- delayed-release tablets, suspension, and injection
with food

tablet dose does not equal the suspension dose due to different bioavailability
SBECD vehicle
-azole

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Isavuconazonium sulfate

Cresemba
QT shortening not prolonging
requires filter
prodrug of isavuconazole
- azole

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Caspofungin

Cancidas
- echinocandins

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Micafungin

Mycamine
light protect during admin
-echinocandins

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Anidulafungin

Eraxis
echinocandins

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echinocandins

only injectables
once daily and no renal dose adjustments
inhibit synthesis of beta-D-glucan an essential part of the fungal cell wall

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Nystatin

suspension, tablet
typical forms (Nyamyc, Nystop)
suspension, swish in the mouth retain for as long as possible, several min before swallowing

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Griseofulvin

indicated for skin, hair, and nails fungal infection
take with fatty meal or food/milk
can increase metabolism of hormonal contraceptives

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Terbinafine

Lamisil AT
(Rx, OTC)
hepatotoxic
SJS/TEN/DRESS

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Clotrimazole

10mg troche /lozenge
topical and vaginal brands
monitor LFTs

Miconazole

buccal tablets Oravig

Candida albicans
oropharyngeal infection (thrush)

mild: topical- clotrimazole, miconazole
moderate-severe or HIV +: fluconazole
alternative: nystatin

Candida albicans
Esophageal infection

fluconazole
alternative: echinocandin

Candida krusei and glabrata
all candida species bloodstream infections

Echinocandin
alternative: Amphotericin B, high dose fluconazole (susceptible isolates only)

Aspergillus invasive

Voriconazole alternative: Amphotericin B, Isavuconazonium

Cryptococcus neoformans meningitis

Amphotericin B + flucytosine (5-FC) alternative: High-dose fluconazole + flucytonsine (5-FC)

Dermatophytes nail bed infections

terbinafine or itraconazole alternate: Fluconazole

neuraminidase inhibitors

reduce the amount of virus in the body by inhibiting the enzyme which enables the release of new viral particles from infected cells

endonuclease inhibitors

post-exposure prevention, within 48 hours of exposure

Oseltamivir

tamiflu 75mg BIDx 5 days capsule and suspension warning neuropsych event SJS/TEN renal adjust after CrCl<60 store reconstituted suspension at room temp for 10 days or fridge for 17 days - neuraminidase inhibitor

Zanamivir

Relenza Diskhaler bronchospasms (do not use on asthma, COPD, or breathing issue pt) - neuraminidase inhibitor

Peramivir

Rapivab injection renal adjust after CrCl<50 - neuraminidase inhibitor

Baloxavir marboxil

Xofluza single-dose, withing 48 hr of exposure - endonuclease inhibitor

Acyclovir

Zovirax, Sitavig nephrotoxic avoid in renal impairment dosing based on IBW even in obese pts

Valacyclovir

Valtrex prodrug of acyclovir

Famciclovir

prodrug of penciclovir

topical Herpes Labialis Docosanol

Abreva OTC apply 5x daily of first sign of outbreak

topical Herpes Labialis Acyclovir cream

Zovirax- Rx Apply 5x daily for 5 days

topical Herpes Labialis acyclovir buccal

sitavig- rx apply 50mg tab as a sing dose to upper gum region

topical Herpes Labialis penciclovir cream

denavir- rx apply every 2hr during waking hours for 4 days

systemic oral tx of herpes labialis acyclovir

initial tx for 7-10 days: 200mg 5x daily or 400mg TID recurrence: 400mg TID x 5-10 days chronic suppression: 400mg BID

systemic oral tx of herpes labialis Valacyclovir

initial tx for 7-10 days: 1g BID recurrence: 2g BIDx 1 day chronic suppression: 500,g or 1g daily

systemic oral tx of herpes labialis famciclovir

initial tx for 7-10 days: 250mg 3x daily or 500mg BID recurrence: 1.5 g x 1 dose chronic suppression:

shingles

herpes zoster Zovirax 800mg 5x daily for 7 days Valtrex 1g TID for 7 days famciclovir 500mg TID for 7 days

Ganciclovir

injection Zirgan- ophtalmic gel myelosuppression

Valganciclovir

Valcyte tablet and solution prodrug of ganciclovir better bioavailability solution: refrigerate, discard after 49 days

Cidofovir

injection CMV retinitis in HIV pts only nephrotoxic, contra in SCr >1.5

Foscarnet

Foscavir injection, CMV retinits ressitant HSV boxed warning, renal impairment

nail bed infection first line

terbinafine, intraconazole, fluconazole