antifungals and antivirals III Flashcards
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
Lipid formulation
Amphotericin B Lipid complex
Abelcet
injection
5mg/kg/day
prepare in D5W only
lipid formulation
liposomal amphotericin B
AmBisome
injection
3-6mg/kg/day
amphotericin facts
decrease K and Mg
nephrotoxic
can give NS bolus to decrease nephrotoxicity and meperidine to decrease duration of severe rigors
flucytosine
ancobon
resistance common so use with amphotericin B
- flucytosine (in fungal cell covered to fluorouracil)
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
fluconazole
Diflucan PO/IV 1:1
only azole that requires renal dose adjustment
- azole
itraconazole
Sporanox, Tolsura
can cause heart failure
Sporanox brand requires acidic gut
- azole
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
Voriconazole
Vfend, Vfend IV
can cause visual changes and phototoxicity
avoid sunlight and take on empty stomach (1hr gap)
SBECD Vehicle
- azole
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
Isavuconazonium sulfate
Cresemba
QT shortening not prolonging
requires filter
prodrug of isavuconazole
- azole
Caspofungin
Cancidas
- echinocandins
Micafungin
Mycamine
light protect during admin
-echinocandins
Anidulafungin
Eraxis
echinocandins
echinocandins
only injectables
once daily and no renal dose adjustments
inhibit synthesis of beta-D-glucan an essential part of the fungal cell wall
Nystatin
suspension, tablet
typical forms (Nyamyc, Nystop)
suspension, swish in the mouth retain for as long as possible, several min before swallowing
Griseofulvin
indicated for skin, hair, and nails fungal infection
take with fatty meal or food/milk
can increase metabolism of hormonal contraceptives
Terbinafine
Lamisil AT
(Rx, OTC)
hepatotoxic
SJS/TEN/DRESS
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
