Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NAPLEX > Chapter 24: Infectious Diseases III > Flashcards

Chapter 24: Infectious Diseases III Flashcards

1
Q

Amphotericin B MOA

A

Binds to ergosterol, altering cell membrane permeability and causing cell death.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Amphotericin B deoxycholate

A

Conventional form has many toxicities. Lipid formulations have active medication and lipid components and have fewer toxicities (decreased infusion rxns and nephrotoxicity)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Amp B active against

A
  • Yeasts: most candida (cryptococcus neoformans)
  • Molds: Aspergillus species
  • Dimorphic fungi
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Amp B boxed warning

A

Med errors confusing the lipid formula and conventional have resulted in cardiopulmonary arrest and death.
Conventional doses should not exceed 1.5mg/kg/day (verify product and dose)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Amp B SE and notes

A

SE: infusion related fever, chills, headache, nausea, malaise, rigors. Decreased K, Mg, and nephrotoxicity
Notes: D5W only! lipid formulas must be filtered. Conventional requires pre-medication to reduce infusion related rxns (apap, nsaid, diphenhydramine and/or hydrocortisone)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Flucytosine MOA

A

Penetrates fungal cells and is converted to fluorouracil, which competes with uracil, interfering with fungal RNA and protein synthesis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Flucytosine Uses

A

Should NOT be used alone!

Recommended in combination with Amp B for treatment of invasive cryptococcal meningitis or candida infections

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Flucytosine SE

A

Dose related myelosuppression (anemia, neutropenia, thrombocytopenia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Azole Antifungals MOA

A

Decrease ergosterol synthesis and cell membrane formation. Azoles are inhibitors of CYP450 (mainly 3A4) and have significant drug interactions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Fluconazole Activity Against

A

C. albicans, C. parapsilosis and C. tropicalis.

Limited efficacy against C. galbrata and C. krusei is considered fluconazole resistant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Itraconazole Uses

A

Dimorphic fungi Blastomycosis and Histoplasmosis and nail bed infections

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Voriconazole Uses

A

Drug of choice for Aspergillus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Fluconazole Dosing

A

50-800mg PO/IV daily
Vaginal Candidiasis 150mg po once
IV/PO ratio is 1:1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Itraconazole Boxed Warnings

A

Can worsen or cause HF; do NOT use to treat pts with onychomycosis in pts with ventricular dysfunction of HF
Can increase plasma concentrations of certain drugs and can lead to QT prolongation and ventricular tachyarrhythmias

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Ketoconazole Boxed Warnings

A

Hepatotoxicity, QT prolongation
Use of oral tablets ONLY when other effective antifungal therapy is unavailable or not tolerated and benefit outweighs risks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Azole Antifungal Notes

A

All azoles are cleared hepatically except fluconazole which requires renal dose adjustment.
Fluconazole and Voriconazole penetrate CNS adequately to treat fungal meningitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Voriconazole Warnings

A

CrCl <50ml/min the IV vehicle SBECD accumulates and oral is preferred. Monitor SCr
Hepatotoxicity, visual disturbances, (optic neuritis), phototoxicity, QT prolongation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Voriconazole Side Effects

A

Visual changes, increased LFTs and SCr, CNS toxicity (hallucinations)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Voriconazole Notes

A

Vfend: take on an empty stomach at least 1 hour before or after a meal. hold tube feedings for 1hr before and after doses
Caution while driving at night
Avoid direct sunlight

20
Q

Posaconazole Dosing, Warnings

A

Noxafil

  • given daily with food
  • eGFR<50ml/min IV vehicle SBECD can accumulate
  • QT prolongation
21
Q

Isavuconazonium sulfate CI, Notes

A

Cresemba (prodrug of isavuconazole)
QT shortening
Requires a filter

22
Q

Echinocandin MOA

A

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

23
Q

Echinocandin Uses

A

Effective against most candida species, including non-albicans strains resistant to azoles (c. glabrata, C. krusei). Used in combination against aspergillus.
Available ONLY as injections

24
Q

Echinocandin Drugs

A
  • Caspofungin (cancidas)

- Micafungin (mycamine)

25
Q

Echinocandin Warnings, Notes

A

Warnings: histamine-mediated symptoms
Notes: all given once daily and do not require renal dose adjustment

26
Q

Griseofulvin CI, SE, Notes

A

CI: pregnancy
SE: photosensitivity, increased LFTs
Notes: take with a fatty meal to increase absorption or with food/milk to avoid GI upset

27
Q

Empiric Treatment for Fungal Pathogens: C. albicans (oropharyngeal) thrush

A

Mild disease: topical antifungals (clotrimazole, miconazole) (alternative: nystatin)

Moderate to severe or HIV+: fluconazole

28
Q

Empiric Treatment for Fungal Pathogens: C. albicans (esophageal)

A

Fluconazole

Alternative: echinocandin

29
Q

Empiric Treatment for Fungal Pathogens: C. krusei and glabrata (all candida blood stream infections)

A

Echinocandin

Alternative: Amp B, high-dose fluconazole

30
Q

Empiric Treatment for Fungal Pathogens: Aspergillus (invasive)

A

Voriconazole

Alternative: Amp B, Isavuconazonium

31
Q

Empiric Treatment for Fungal Pathogens: Cryptococcus neoformans (meningitis)

A

Amp B + Flucytosine

Alternative: high-dose fluconazole + flucytosine

32
Q

Empiric Treatment for Fungal Pathogens: Dermatophytes (nail bed infection)

A

Terbinafine or itraconazole

Alternative: Fluconazole

33
Q

Neuraminidase Inhibitors MOA

A

Oseltamivir, zanamivir and peramivir
Reduce the amount of virus in the body by inhibiting the enzyme which enables release of new viral particles from infected cells

34
Q

Oseltamivir Dosing

A

Tx age >12 years: 75mg bid for 5 days
Prophylaxis age >12 years: 75mg qd for 10 days

Warnings: neuropsychiatric events

35
Q

Zanamivir Dosing

A

Relenza Diskhaler
TX >7 years: 10mg (two 5mg inhalations) BID for 5 days
Prophylaxis age >=5 years: 10mg once daily for 10 days (household setting) or 28 days (community outbreak)

Warnings: bronchospasm (do not use in asthma, copd, or pts with breathing problems)

36
Q

Endonuclease Inhibitor

A 
Baloxavir marboxil (Xofluza) 
Approved for Tx and post-exposure prophylaxis; start within 48 hours of symptoms
37
Q

Remdesivir MOA

A

Veklury
Inhibits RNA-dependent RNA polymerase which is needed for viral replication
Indicated in hospitalized adults and children >+12 years who weigh at least 40kg

38
Q

HSV-1 Associated With

A

Oropharyngeal disease

39
Q

HSC-2 Associated With

A

Genital disease

40
Q

Antivirals for Herpes Simplex and Varicella Zoster

A

Acyclovir (Zovirax)

Valacyclovir (Valtrex)

41
Q

Acyclovir and Valacyclovir Warnings, Notes

A

Warnings: caution in patients with renal impairment, the elderly, and those receiving nephrotoxic agents
Notes: acyclovir dose is based on IDW even in obese patients

42
Q

Topical Tx for Herpes Labialis

A

Docosanol (abreva): apply 5 times daily at first sign of outbreak
Acyclovir (zovirax): apply 5 times daily for 4 days

43
Q

Invasive HSV Infections Tx

A

IV acyclovir

44
Q

Herpes Zoster Tx

A

Acyclovir: 800mg po 5 times daily for 7 days
Valacyclovir: 1 gram po tid for 7 days

45
Q

Cytomegalovirus Tx

A

Ganciclovir (cytovene injection)
Valganciclovir (valcyte) (prodrug)

Boxed warning: Myelosuppression
Solution must be stored in fridge

46
Q

Resistant CMV

A

Foscarnet (foscavir)
CMV retinitis, resistant HSV
Boxed Warning: renal impairment (pre-hydration recommended)

NAPLEX (45 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions