Chapter 24: ID III - Antifungals & Antivirals Flashcards
1
Q
What are the 3 types of fungal classification
A
Yeasts, molds, or dimorphic
2
Q
Invasive disease with Zygomycetes (Mucor species and Rhizopus species) is commonly referred to as
A
Mucormycosis
3
Q
Which fungi are yeasts
A
The candida species:
- C. albicans
- C. tropicalis
- C. parapsilosis
- C. glabrata
- C. krusei
- Crypotococcus neoformans
4
Q
Which fungi are molds
A
Aspergillus species
Zygomycetes (Mucor and Rhizopus species)
5
Q
Which fungi are dimorphic
A
Histoplasma capsulatum
Blastomyces dermatitidis
Coccidioides immitis
6
Q
What is the conventional form of Amphotericin B
A
Amphotericin B deoxycholate (many toxicities)
7
Q
The lipid formulations of Amphotericin B are used clinically because
A
they have fewer toxicities (decreased infusion reactions, decreased nephrotoxicity)
8
Q
Amphotericin B is active against
A
Yeasts: Cryptococcus neoformans
Mold: Aspergillus spp
Dimorphic fungi
9
Q
Amphotericin B deoxycholate and liposomal Amphotericin B formulation
A
Injection
10
Q
Conventional Amphotericin B for injection doses should not exceed ___ mg/kg/day d/t risk of ____
A
1.5 mg/kg/day
Cardiopulmonary arrest
11
Q
Amphotericin B SE
A
Infusion-related: fever, chills, HA, malaise, rigors
Other: ↓ K & Mg, nephrotoxicity
12
Q
Amphotericin B must be diluted in ___ only, & lipid formulations must be ___ during preparation
A
D5W
filtered
13
Q
Amphotericin B deoxycholate (conventional formulation) requires ___ to reduce infusion-related reactions
A
Premedication with APAP or NSAID + Benadryl and/or hydrocortisone
14
Q
Liposomal Amphotericin B brand name
A
AmBisome
15
Q
Flucytosine penetrates fungal cells and is converted to
A
Fluorouracil
16
Q
Flucytosine should not be
A
Used alone due to development of resistance
17
Q
Flucytosine is recommended for use in combination with ____ for treatment of
A
Amphotericin B Invasive Cryptococcal (meningitis)
18
Q
Flucytosine side effects
A
Myelosuppression
19
Q
MOA of azole antifungals
A
Decreases ergosterol synthesis and cell membrane formation
20
Q
Azoles are ___ of the CYP450 system
A
inhibitors
21
Q
Fluconazole has limited efficacy against _____ due to resistance and ____ is considered fluconazole-resistant
A
C. glabrata
C. krusei
22
Q
Fluconazole can be used for yeast infections and ____ infections
A
nail bed (onychomycosis)
23
Q
Primary use of itraconazole
A
nail bed infections (onychomycosis)
24
Q
What is the treatment of choice for Aspergillus
A
Voriconazole
Remember: V looks like upside down A
25
All azole antifungals can cause
Increased LFTs
Risk for QT prolongation
Many drug interactions
26
What is the only azole that requires renal dose adjustment
Fluconazole
27
Hepatotoxicity with this azole has led to liver transplantation
Ketoconazole
28
Which azole can cause HF
Itraconazole
29
Which azole can cause visual changes and phototoxicity
Voriconazole
| Remember: Visual & Vori
30
Which azole should be taken with food
Posaconazole & itraconazole tablets and capsule
31
What is the IV:PO ratio for all azoles
1:1
32
Which azoles have SBECD vehicle
Voriconazole and posaconazole
33
What formulations does fluconazole come in
IV and PO
34
Fluconazole dose for vaginal candidiasis
150 mg PO x1
35
Ketoconazole oral tabs should only be used when
Other effective antifungal therapy is unavailable or not tolerated
36
Which 2 azoles penetrate the CNS adequately to treat fungal meningitis
Fluconazole and voriconazole
37
Voriconazole brand name
Vfend, Vfend IV
38
What should be done if a patient is going to be treated with voriconazole and CrCl < 50 mL/min
The IV vehicle accumulates, so treat with oral voriconazole
39
Voriconazole SE
Visual changes, ↑ LFTs, ↑ SCr, CNS toxicity (hallucinations)
40
T/F: Vfend should be taken on an empty stomach
True
41
Posaconazole brand name
Noxafil
42
T/F: Posaconazole should not be taken with food
False- take with food daily
43
Which azole causes QT shortening instead of prolongation
Isavuconazonium sulfate
44
Which azole requires a filter
Isavuconazonium sulfate
45
Azoles can increase the effects of which drug
Warfarin (monitor INR)
46
Absorption of which two azoles is pH-dependent
Itraconazole and Ketoconazole (↑ pH will ↓ absorption)
47
If PPIs or H2RAs must be used while on ketoconazole, what should be done
An acidic beverage (such as non-diet cola) to provide an acidic environment for absorption
48
Echinocandins MOA
Inhibit synthesis of beta (1,3) D-glucan, an essential component of the fungal cell wall
49
Echinocandins are effective against most ____ species
Candida
| the word candin is in the name
50
Activity of Echinocandins includes
Aspergillus spp
51
Echinocandins formulation
Injection only
52
Caspofungin brand name
Cancidas
53
Micafungin brand name
Mycamine
54
Which drugs are Echinocandins
Caspofungin
| Micafungin
55
Echinocandins warning
Histamine-mediated symptoms
56
All Echinocandins are given how many times a day
Once daily
57
T/F: Echinocandins do not require renal dose adjustment
True
58
Nystatin formulations
Suspension, tablet
59
How should nystatin suspension be used for oral candidiasis
Swish in the mouth and retain for as long as possible (several minutes) before swallowing
60
Terbinafine brand name
Lamisil AT
61
Griseofulvin is indicated for fungal infections of
hair, skin and nails
62
Terbinafine comes in which formulations
Topical (Rx and OTC)
63
Clotrimazole comes in a 10 mg ___
troche/lozenge
64
Clotrimazole topical and vaginal forms brand name
Mycelex
65
Griseofulvin CI
pregnancy
66
Griseofulvin SE
Photosensitivity, ↑ LFTs
67
Griseofulvin should be taken with
a fatty meal to increase absorption or with food/milk to avoid GI upset
68
Terbinafine warning
Hepatotoxicity
69
Terbinafine SE
HA, ↑ LFTs
70
Griseofulvin can ↑ metabolism of
hormonal contraceptives which can lead to contraceptive failure
71
Preferred antifungal regimen for mild disease of Candida albicans (thrush)
Topical antifungals (clotrimazole, miconazole)
72
Preferred antifungal regimen for moderate-severe disease or HIV+ of Candida albicans (thrush)
Fluconazole
73
Preferred antifungal regimen for Candida albicans (esophageal infection) & the alternative
Fluconazole
| Alt: Echinocandin
74
Preferred antifungal regimen for Candida krusei & glabrata (bloodstream infection) & the alternative
Echinocandin
| Alt: Amphotericin B
75
Preferred antifungal regimen for invasive Aspergillus spp & the alternative
Voriconazole
| Alt: Amphotericin B, isavuconazonium
76
Preferred antifungal treatment for Cryptococcus neoformans (Meningitis)
Amphotericin B + flucytosine (5-FC)
77
Preferred antifungal treatment for dermatophytes (nail bed infection) & the alternative
Terbinafine or itraconazole
| Alt: Fluconazole
78
Which antivirals are used for influenza
Neuramidase inhibitors: oseltamivir, zanamivir
| Endonuclease inhibitor: Baloxavir
79
Neuramidase inhibitors MOA
reduces the amount of virus in the body by inhibiting the enzyme which enables release of new viral particles from infected cells
80
Neuramidase inhibitors decrease the duration of influenza symptoms by about how many days, while also reducing complications from influenza
1 day
81
Neuramidase inhibitor should be started within how many hours of illness onset
48 hrs
82
What is an advantage of the Endonuclease inhibitor, Baloxavir
It is a single dose regimen
83
Baloxavir should be started within how many hours of symptom onset
48 hours
84
Oseltamivir comes in which formulations
Capsules and suspension
85
Oseltamivir dosing for age > 12 years
75 mg BID x 5 days
86
Oseltamivir ppx dosing for age > 12 years
75 mg daily x 10 days
87
Oseltamivir warning
Neuropsychiatric events
88
Zanamivir comes in which formulation
Inhalation
89
Zanamivir warning
Bronchospasm; do not use in asthma/COPD or with any breathing problems
90
HSV-1 is most commonly associated with ___ disease
oropharyngeal
91
HSV-2 is most commonly associated with ___ disease
Genital
92
Acyclovir brand name
Zovirax
93
Valacyclovir brand name
Valtrex
94
Valacyclovir is a prodrug of
acyclovir
95
What drug is used for cold sores (herpes simplex labialis)
Zovirax cream
96
Famciclovir is a prodrug of
penciclovir
97
Antivirals for herpes simplex virus and varicella zoster virus warnings
Caution in patients with renal impairment, the elderly and those receiving nephrotoxic agents
98
Acyclovir dose is based on which weight
IBW, even in obese pts
99
When is the best time to use medication for cold sores
during prodromal symptoms (tingling, itching, soreness)
100
Docosanol brand name
Abreva
101
Which drugs are used for cold sore
Docosanol & acyclovir
102
Dosing for Docosanol for Cold sores
Apply 5x daily at first sign of outbreak
103
Dosing for acyclovir for cold sores
Apply 5x per day for 4 days
104
Treatment for genital herpes must be initiated during the prodrome or within how many days of lesion onset
1 day
105
What is the least expensive med to treat genital herpes
Acyclovir (but must be dosed up to 5 x per day)
106
Which medications can be used to treat genital herpes
Acyclovir
Valacyclovir (good for pts with adherence issues)
Famciclovir
107
What is the most commonly identified cause of viral encephalitis
HSV
108
How is HSV encephalitis treated
IV acyclovir
109
Shingles rash symptoms
itchy, tingly, very painful, unilateral rash
| Cluster of fluid-filled blisters, often in a band
110
Antiviral therapy for shingles is most effective when started within __ hours of the onset of rash
72 hours
111
How can shingles pain be treated
- topical medications (lidoderm patch)
- Neuropathic pain: pregabalin, gabapentin, duloxetine, and TCAs
- NSAIDs or opioids
112
What is chronic pain after recovery from shingles called
postherpetic neuralgia
113
How long should antiviral therapy be used for in Shingles treatment
7 days
114
Cytomegalovirus occurs in which pt populations
severely immunicompromised states (e.g., AIDS, transplant recipients)
115
Cytomegalovirus commonly causes what symptoms
Retinitis, colitis, esophagitis
116
What are the treatments of choice for CMV
Ganciclovir and valganciclovir
117
Which drugs should be used for refractory cases of CMV
Foscarnet and cidofovir
118
Ganciclovir brand name
Cytovene
119
Valganciclovir brand name
Valcyte
120
What is the prodrug of ganciclovir
Valganciclovir
121
Which drug can be used for CMV retinitis
Foscarnet
122
Ganciclovir must be prepared in which kind of water
sterile, NOT bacteriostatic
123
Ganciclovir & valganciclovir BW
Myelosuppression
124
Ganciclovir & valganciclovir suspension must be
refrigerated
125
Foscarnet BW
Renal impairment
126
What is another name for infectious EBV
mononucleosis or "mono"
127
How is EBV spread/transmitted
Bodily fluids, primarily saliva, and can spread by kissing
