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Roomies Collab Deck 1: Infectious Disease and CV > Antifungals: systemic use > Flashcards

Antifungals: systemic use Flashcards

1
Q

What is the first-line drug for aspergillosis? (2 options)

A

Voriconazole (treatment of choice)
OR
Liposomal amphotericin B

Second line: Caspofungin OR itraconzaole

Third line: Posaconazole

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2
Q

What are the indications for voriconazole?

A
  1. Invasive aspergillosis
  2. Scedosporium spp. (serious infection)
  3. Fusarium spp. (serious infection)
  4. Invasive fluconazole-resistant Candida spp. (including C. krusei)

https://bnf.nice.org.uk/drug/voriconazole.html

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3
Q

What is the dose of oral voriconazole for the treatment of invasive aspergillosis for a patient with bodyweight < 40 kg?

A

Initially 200 mg every 12 hours for 2 doses, then 100 mg every 12 hours, increased if necessary to 150 mg every 12 hours

Bodyweight 40 kg or above:
- Initially 400 mg every 12 hours for 2 doses, then 200 mg every 12 hours, increased to 300 mg every 12 hours

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4
Q

What is the dose of oral voriconazole for the treatment of invasive aspergillosis for a patient with bodyweight of 40 kg or above?

A

Initially 400 mg every 12 hours for 2 doses, then 200 mg every 12 hours, increased to 300 mg every 12 hours

Bodyweight < 40 kg:
- Initially 200 mg every 12 hours for 2 doses, then 100 mg every 12 hours, increased if necessary to 150 mg every 12 hours

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5
Q

What is the dose of IV infusion of voriconazole for the treatment of invasive aspergillosis?

A

Initially 6 mg/kg every 12 hours for 2 doses, then 4 mg/kg every 12 hours; reduced if not tolerated to 3 mg/kg every 12 hours

For max. 6 months

Can also be given orally

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6
Q

Which antifungal drug can be used as an adjunct to glucocorticoids in the treatment of allergic bronchopulmonary aspergillosis?

A

Itraconazole

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7
Q

Which oral medications can be used to treat vaginal candidiasis? (2 - first and second line)

A

First line**: Fluconazole
- 150 mg for 1 dose

Second line: Itraconazole (for resistant organisms in adults)
- 200 mg twice daily for 1 day

**The other first line is a locally acting antifungal (e.g. clotrimazole pessary)

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8
Q

Which oral medications can be used to treat oropharyngeal candidiasis if unresponsive to topical therapy? (2 - first and second line)

A

First line: Fluconazole
- 50 mg daily for 7-14 days

Second line: Itraconazole
- 100-200 mg twice daily for 2 weeks

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9
Q

Which class of oral medications are used to treat oropharyngeal candidiasis in immunocompromised patients?

A

Triazole (fluconazole, itraconazole)

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10
Q

What are the two first-line options for invasive or disseminated candidiasis?

A

Echinocandin
OR
Fluconazole (only in clinically stable patients who have not received an azole antifungal recently)

Second line:
Amphotericin B

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11
Q

What is the first-line treatment for CNS candidiasis?

A

Amphotericin B

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12
Q

What is the treatment of choice for cryptococcal meningitis? (2 drugs initially, followed by 1)

A

Amphotericin B (IV) and Flucytosine (IV) for 2 weeks

Followed by fluconazole (oral) for 8 weeks (or until cultures are negative)

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13
Q

Which antifungal treatment can be used as prophylaxis following successful treatment of cryptococcal meningitis in HIV-infected patients?

A

Fluconazole

- 200 mg daily

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14
Q

What is the first-line treatment of indolent non-meningeal histoplasmosis infection (e.g. chronic pulmonary histoplasmosis) in an immunocompetent patient?

A

Itraconazole

  • 200 mg 3 times a day for 3 days, then 200 mg 1-2 times a day (oral) OR
  • 200 mg every 12 hours for 2 days, then 200 mg once daily for max. 12 days (IV)
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15
Q

For the treatment of histoplasmosis, what are the routes of administration for itraconazole? (2)

A

Oral
- 200mg 3 times a day for 3 days, then 200 mg 1-2 times a day

OR
IV
- 200 mg every 12 hours 2 days, then 200 mg once daily for max. 12 days

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16
Q

What drug is used in the initial treatment of fulminant or severe histoplasmosis infections?

A

Amphotericin B (IV)

Followed by itraconazole (oral)

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17
Q

What drug is used as prophylaxis against a relapse of histoplasmosis infection in immunosuppressed patients?

A

Itraconazole (oral)

- 200 mg once daily, then increased to 200 mg twice daily

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18
Q

Mild localised fungal infections of the skin usually respond to topical therapy. What are the indications for systemic therapy used fungal skin infections?

A
  1. Topical therapy fails
  2. Many areas are affected
  3. Site of infection is difficult to treat (nails, scalp)

Frequently used options: oral imidazole, triazole antifungals (e.g. itraconazole), terbinafine

Less commonly used: griseofulvin

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19
Q

In which two anatomical locations do localised fungal infections of the skin require systemic therapy?

A
  1. Nail (onychomycosis)
  2. Scalp (tinea capitis)

Frequently used options: oral imidazole, triazole antifungals (e.g. itraconazole), terbinafine

Less commonly used: griseofulvin

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20
Q

Which oral antifungal is NOT effective against pityriasis versicolour?

A

Terbinafine

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21
Q

Topical therapy (ketaconazole shampoo) has been ineffective for a patient with pityriasis versicolour, which two oral antifungals can be used?

A

Itraconazole
- 200 mg once daily for 7 days

OR

Fluconazole
- 50 mg daily for 2-4 weeks (max. 6 weeks)

22
Q

What is the first-line drug for the systemic treatment of skin and nail infections?

A

Terbinafine
- 250mg once daily (varying length of treatment depending on location of fungal infection)

Second line: itraconazole

Less commonly used: griseofulvin

23
Q

For the treatment of onychomycosis, 200 mg of itraconazole can either be givenonce daily for 3 months or as intermittent ‘pulse’ therapy. What is intermittent ‘pulse’ therapy?

A

200 mg twice daily for 7 days, subsequent courses repeated after 21-day intervals
(fingernails 2 courses, toenails, 3 courses)

BUT treatment of choice (first-line) is terbinafine

24
Q

What class of antifungal drugs are preferred as prophylaxis for immunocompromised patients?

A 
Triazole antifungals (oral)
e.g. Fluconazole, itraconazole
25
Q

When choosing an antifungal drug for prophylaxis in immunocompromised patients, it is important to take into consideration:

(Fluconazole/itraconazole) is more reliable absorbed than (fluconazole/itraconazole), but (fluconazole/itraconazole) is NOT effective against Aspergillus spp.

A

Fluconazole is more reliable absorbed than itraconazole, but fluconazole is NOT effective against Aspergillus spp.

Itraconazole is preferred in patients at risk of invasive aspergillosis

26
Q

Which antifungal is preferred in immunocompromised patients at risk of invasive aspergillosis?

A

Itraconazole

Because fluconazole is not effective against Asperigllus spp.

27
Q

Which antifungal drug can be given as prophylaxis in patients undergoing haematopoietic stem cell transplantation or receiving chemotherapy for acute myeloid leukaemia or myelodysplastic syndrome and expected to develop prolonged neutropenia?

A

Posaconazole
- 200 mg three times a day, start several days before the expected onset of neutropenia and continue for 7 dyas after neutrophil count rises above 500 cells/mm3

28
Q

Which drug can be be used as prophylaxis of candidiasis in patients undergoing haematopoietic stem cell transplantation when fluconazole, itraconazole or posaconazole cannot be used?

A

Micafungin

  • 1 mg/kg once daily continue for at least 7 days after neutrophil count is desirable (bodyweight up to 40 kg)
  • 50 mg once daily continue for at least 7 days after neutrophil count is in desirable range (bodyweight 40 kg or above)
29
Q

Which triazole antifungal drug has good penetration into the cerebrospinal fluid to treat fungal meningitis?

A

Fluconazole

30
Q

Why can fluconazole be used to treat candiduria?

A

Excreted largely unchanged in the urine

31
Q

Itraconazole should be avoided or used with caution in patients with what disease?

A

Liver disease

Fluconazole is less frequently associated with hepatotoxicity

32
Q

Voriconazole is a broad-spectrum antifungal drug that is licensed for use in …

A

life-threatening infections

33
Q

Name 4 triazole antifungals

A

Fluconazole
Itraconazole
Posaconazole
Voriconazole

34
Q

When would you consider using posaconazole for treatment of invasive fungal infections?

A

If the infection is unresponsive to conventional treatment

e.g. unresponsive to itraconazole, amphotericin B, fluconazole

35
Q

Name 4 imidazole antifungals that can be used for local treatment of vaginal candidiasis and for dermatophyte infections

A

Clotrimazole
Econazole nitrate
Ketaconazole
Tioconazole

36
Q

Which imidazole antifungal is given in oral gel form for the treatment for oral and intestinal candidiasis?

A

Miconazole

37
Q

Name 2 polyene antifungals

A

Amphotericin B

Nystatin

38
Q

What are the indications for the use of nystatin? (2)

A 
Oral candidiasis (oral)
Oral and perioral fungal infections (oral)
39
Q

What is the mode of administration of nystatin?

A

Local application in the mouth

40
Q

AmBisome is the trade name for which antifungal drug?

A

Liposomal amphotericin B

[Abelcet = amphotericin B (lipid complex)]

41
Q

Abelcet is the trade name for which antifungal drug?

A

Amphotericin B (lipid complex)

42
Q

Which 2 organs are commonly damaged by amphotericin B?

A
  1. Kidneys
    - nephrotoxicity
    - nephrocalcinosis
    - renal impairment
    - renal tubular acidosis
    - hyposthenuria
  2. Liver
    - hepatic function abnormal (discontinue use)
43
Q

Name 3 echinocandin antifungal drugs?

A

Anidulafungin
Caspofungin
Micafungin

44
Q

Which two fungal species can caspofungin be used to treat?

A

Aspergillus spp.
Candida spp.

Caspofungin is an echinocandin antifungal

45
Q

Which fungal species can both anidulafungin and micafungin be used to treat?

A

Candida spp.

Anidulafungin and micafungin are both echinocandin antifungals

46
Q

Are the echinocandins, anidulafungin and micafungin, used in the treatment of aspergillosis?

A

NO

Caspofungin is the only echinocandin that is used in the treatment of aspergillosis

47
Q

Are echinocandins effective against fungal infections of the CNS?

A

NO

48
Q

Which echinocandin antifungal is used in the treatment of both Aspergillus spp. and Candida spp.?

A

Caspofungin

49
Q

What drug can be used in combination with flucytosine due to the synergistic effect?

A

Amphotericin B

50
Q

What needs to be monitored weekly when taking flucytosine? (2)

A

Kidney function tests

Blood counts

51
Q

What are the indications for the use of flucytosine? (3)

A
  1. Systemic yeast and fungal infections
  2. Adjunct to amphotericin B in severe systemic candidiasis and other severe or long-standing infections
  3. Cryptococcal meningitis (adjunct to amphotericin B)
52
Q

Griseofulvin is the drug of choice for which infection in children?

A

Trichophyton infections in children

Roomies Collab Deck 1: Infectious Disease and CV (84 decks)

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