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NAPLEX 2023 > Chapter 24: ID III - Antifungals & Antivirals > Flashcards

Chapter 24: ID III - Antifungals & Antivirals Flashcards

1
Q

What are the 3 types of fungal classification

A

Yeasts, molds, or dimorphic

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2
Q

Invasive disease with Zygomycetes (Mucor species and Rhizopus species) is commonly referred to as

A

Mucormycosis

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3
Q

Which fungi are yeasts

A

The candida species:

  • C. albicans
  • C. tropicalis
  • C. parapsilosis
  • C. glabrata
  • C. krusei
  • Crypotococcus neoformans
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4
Q

Which fungi are molds

A

Aspergillus species

Zygomycetes (Mucor and Rhizopus species)

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5
Q

Which fungi are dimorphic

A

Histoplasma capsulatum
Blastomyces dermatitidis
Coccidioides immitis

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6
Q

What is the conventional form of Amphotericin B

A

Amphotericin B deoxycholate (many toxicities)

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7
Q

The lipid formulations of Amphotericin B are used clinically because

A

they have fewer toxicities (decreased infusion reactions, decreased nephrotoxicity)

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8
Q

Amphotericin B is active against

A

Yeasts: Cryptococcus neoformans
Mold: Aspergillus spp
Dimorphic fungi

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9
Q

Amphotericin B deoxycholate and liposomal Amphotericin B formulation

A

Injection

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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

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11
Q

Amphotericin B SE

A

Infusion-related: fever, chills, HA, malaise, rigors

Other: ↓ K & Mg, nephrotoxicity

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12
Q

Amphotericin B must be diluted in ___ only, & lipid formulations must be ___ during preparation

A

D5W

filtered

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13
Q

Amphotericin B deoxycholate (conventional formulation) requires ___ to reduce infusion-related reactions

A

Premedication with APAP or NSAID + Benadryl and/or hydrocortisone

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14
Q

Liposomal Amphotericin B brand name

A

AmBisome

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15
Q

Flucytosine penetrates fungal cells and is converted to

A

Fluorouracil

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16
Q

Flucytosine should not be

A

Used alone due to development of resistance

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17
Q

Flucytosine is recommended for use in combination with ____ for treatment of

A 
Amphotericin B
Invasive Cryptococcal (meningitis)
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18
Q

Flucytosine side effects

A

Myelosuppression

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19
Q

MOA of azole antifungals

A

Decreases ergosterol synthesis and cell membrane formation

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20
Q

Azoles are ___ of the CYP450 system

A

inhibitors

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21
Q

Fluconazole has limited efficacy against _____ due to resistance and ____ is considered fluconazole-resistant

A

C. glabrata

C. krusei

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22
Q

Fluconazole can be used for yeast infections and ____ infections

A

nail bed (onychomycosis)

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23
Q

Primary use of itraconazole

A

nail bed infections (onychomycosis)

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24
Q

What is the treatment of choice for Aspergillus

A

Voriconazole

Remember: V looks like upside down A

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25
Q

All azole antifungals can cause

A

Increased LFTs
Risk for QT prolongation
Many drug interactions

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26
Q

What is the only azole that requires renal dose adjustment

A

Fluconazole

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27
Q

Hepatotoxicity with this azole has led to liver transplantation

A

Ketoconazole

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28
Q

Which azole can cause HF

A

Itraconazole

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29
Q

Which azole can cause visual changes and phototoxicity

A

Voriconazole

Remember: Visual & Vori

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30
Q

Which azole should be taken with food

A

Posaconazole & itraconazole tablets and capsule

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31
Q

What is the IV:PO ratio for all azoles

A

1:1

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32
Q

Which azoles have SBECD vehicle

A

Voriconazole and posaconazole

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33
Q

What formulations does fluconazole come in

A

IV and PO

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34
Q

Fluconazole dose for vaginal candidiasis

A

150 mg PO x1

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35
Q

Ketoconazole oral tabs should only be used when

A

Other effective antifungal therapy is unavailable or not tolerated

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36
Q

Which 2 azoles penetrate the CNS adequately to treat fungal meningitis

A

Fluconazole and voriconazole

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37
Q

Voriconazole brand name

A

Vfend, Vfend IV

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38
Q

What should be done if a patient is going to be treated with voriconazole and CrCl < 50 mL/min

A

The IV vehicle accumulates, so treat with oral voriconazole

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39
Q

Voriconazole SE

A

Visual changes, ↑ LFTs, ↑ SCr, CNS toxicity (hallucinations)

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40
Q

T/F: Vfend should be taken on an empty stomach

A

True
(Very empty before taking vori)

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41
Q

Posaconazole brand name

A

Noxafil

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42
Q

T/F: Posaconazole should not be taken with food

A

False- take with food daily (post meal)

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43
Q

Which azole causes QT shortening instead of prolongation

A

Isavuconazonium sulfate

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44
Q

Which azole requires a filter

A

Isavuconazonium sulfate

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45
Q

Azoles can increase the effects of which drug

A

Warfarin (monitor INR)

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46
Q

Absorption of which two azoles is pH-dependent

A

Itraconazole and Ketoconazole (↑ pH will ↓ absorption)

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47
Q

If PPIs or H2RAs must be used while on ketoconazole, what should be done

A

An acidic beverage (such as non-diet cola) to provide an acidic environment for absorption

K for Cola

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48
Q

Echinocandins MOA

A

Inhibit synthesis of beta (1,3) D-glucan, an essential component of the fungal cell wall

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49
Q

Echinocandins are effective against most ____ species

A

Candida

the word candin is in the name

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50
Q

Activity of Echinocandins includes

A

Aspergillus spp

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51
Q

Echinocandins formulation

A

Injection only

52
Q

Caspofungin brand name

A

Cancidas

53
Q

Micafungin brand name

A

Mycamine

54
Q

Which drugs are Echinocandins

A

Caspofungin

Micafungin

55
Q

Echinocandins warning

A

Histamine-mediated symptoms

56
Q

All Echinocandins are given how many times a day

A

Once daily

57
Q

T/F: Echinocandins do not require renal dose adjustment

A

True

58
Q

Nystatin formulations

A

Suspension, tablet

59
Q

How should nystatin suspension be used for oral candidiasis

A

Swish in the mouth and retain for as long as possible (several minutes) before swallowing

60
Q

Terbinafine brand name

A

Lamisil AT

61
Q

Griseofulvin is indicated for fungal infections of

A

hair, skin and nails

62
Q

Terbinafine comes in which formulations

A

Topical (Rx and OTC)

63
Q

Clotrimazole comes in a 10 mg ___

A

troche/lozenge

64
Q

Clotrimazole topical and vaginal forms brand name

A

Mycelex

65
Q

Griseofulvin CI

A

pregnancy

66
Q

Griseofulvin SE

A

Photosensitivity, ↑ LFTs

67
Q

Griseofulvin should be taken with

A

a fatty meal to increase absorption or with food/milk to avoid GI upset

68
Q

Terbinafine warning

A

Hepatotoxicity

69
Q

Terbinafine SE

A

HA, ↑ LFTs

70
Q

Griseofulvin can ↑ metabolism of

A

hormonal contraceptives which can lead to contraceptive failure

71
Q

Preferred antifungal regimen for mild disease of Candida albicans (thrush)

A

Topical antifungals (clotrimazole, miconazole)

72
Q

Preferred antifungal regimen for moderate-severe disease or HIV+ of Candida albicans (thrush)

A

Fluconazole

73
Q

Preferred antifungal regimen for Candida albicans (esophageal infection) & the alternative

A

Fluconazole

Alt: Echinocandin

74
Q

Preferred antifungal regimen for Candida krusei & glabrata (bloodstream infection) & the alternative

A

Echinocandin

Alt: Amphotericin B

75
Q

Preferred antifungal regimen for invasive Aspergillus spp & the alternative

A

Voriconazole

Alt: Amphotericin B, isavuconazonium

76
Q

Preferred antifungal treatment for Cryptococcus neoformans (Meningitis)

A

Amphotericin B + flucytosine (5-FC)

77
Q

Preferred antifungal treatment for dermatophytes (nail bed infection) & the alternative

A

Terbinafine or itraconazole

Alt: Fluconazole

78
Q

Which antivirals are used for influenza

A

Neuramidase inhibitors: oseltamivir, zanamivir

Endonuclease inhibitor: Baloxavir

79
Q

Neuramidase inhibitors MOA

A

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

80
Q

Neuramidase inhibitors decrease the duration of influenza symptoms by about how many days, while also reducing complications from influenza

A

1 day

81
Q

Neuramidase inhibitor should be started within how many hours of illness onset

A

48 hrs

82
Q

What is an advantage of the Endonuclease inhibitor, Baloxavir

A

It is a single dose regimen

83
Q

Baloxavir should be started within how many hours of symptom onset

A

48 hours

84
Q

Oseltamivir comes in which formulations

A

Capsules and suspension

85
Q

Oseltamivir dosing for age > 12 years

A

75 mg BID x 5 days

86
Q

Oseltamivir ppx dosing for age > 12 years

A

75 mg daily x 10 days

87
Q

Oseltamivir warning

A

Neuropsychiatric events

88
Q

Zanamivir comes in which formulation

A

Inhalation

89
Q

Zanamivir warning

A

Bronchospasm; do not use in asthma/COPD or with any breathing problems

90
Q

HSV-1 is most commonly associated with ___ disease

A

oropharyngeal

91
Q

HSV-2 is most commonly associated with ___ disease

A

Genital

92
Q

Acyclovir brand name

A

Zovirax

93
Q

Valacyclovir brand name

A

Valtrex

94
Q

Valacyclovir is a prodrug of

A

acyclovir

95
Q

What drug is used for cold sores (herpes simplex labialis)

A

Zovirax cream

96
Q

Famciclovir is a prodrug of

A

penciclovir

97
Q

Antivirals for herpes simplex virus and varicella zoster virus warnings

A

Caution in patients with renal impairment, the elderly and those receiving nephrotoxic agents

98
Q

Acyclovir dose is based on which weight

A

IBW, even in obese pts

99
Q

When is the best time to use medication for cold sores

A

during prodromal symptoms (tingling, itching, soreness)

100
Q

Docosanol brand name

A

Abreva

101
Q

Which drugs are used for cold sore

A

Docosanol & acyclovir

102
Q

Dosing for Docosanol for Cold sores

A

Apply 5x daily at first sign of outbreak

103
Q

Dosing for acyclovir for cold sores

A

Apply 5x per day for 4 days

104
Q

Treatment for genital herpes must be initiated during the prodrome or within how many days of lesion onset

A

1 day

105
Q

What is the least expensive med to treat genital herpes

A

Acyclovir (but must be dosed up to 5 x per day)

106
Q

Which medications can be used to treat genital herpes

A

Acyclovir
Valacyclovir (good for pts with adherence issues)
Famciclovir

107
Q

What is the most commonly identified cause of viral encephalitis

A

HSV

108
Q

How is HSV encephalitis treated

A

IV acyclovir

109
Q

Shingles rash symptoms

A

itchy, tingly, very painful, unilateral rash

Cluster of fluid-filled blisters, often in a band

110
Q

Antiviral therapy for shingles is most effective when started within __ hours of the onset of rash

A

72 hours

111
Q

How can shingles pain be treated

A
  • topical medications (lidoderm patch)
  • Neuropathic pain: pregabalin, gabapentin, duloxetine, and TCAs
  • NSAIDs or opioids
112
Q

What is chronic pain after recovery from shingles called

A

postherpetic neuralgia

113
Q

How long should antiviral therapy be used for in Shingles treatment

A

7 days

114
Q

Cytomegalovirus occurs in which pt populations

A

severely immunicompromised states (e.g., AIDS, transplant recipients)

115
Q

Cytomegalovirus commonly causes what symptoms

A

Retinitis, colitis, esophagitis

116
Q

What are the treatments of choice for CMV

A

Ganciclovir and valganciclovir

117
Q

Which drugs should be used for refractory cases of CMV

A

Foscarnet and cidofovir

118
Q

Ganciclovir brand name

A

Cytovene

119
Q

Valganciclovir brand name

A

Valcyte

120
Q

What is the prodrug of ganciclovir

A

Valganciclovir

121
Q

Which drug can be used for CMV retinitis

A

Foscarnet

122
Q

Ganciclovir must be prepared in which kind of water

A

sterile, NOT bacteriostatic

123
Q

Ganciclovir & valganciclovir BW

A

Myelosuppression

124
Q

Ganciclovir & valganciclovir suspension must be

A

refrigerated

125
Q

Foscarnet BW

A

Renal impairment

126
Q

What is another name for infectious EBV

A

mononucleosis or “mono”

127
Q

How is EBV spread/transmitted

A

Bodily fluids, primarily saliva, and can spread by kissing

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