EXAM 5 antifungal TIEMAN Flashcards
aspergillus
causes disease in immunocompromised hosts (neutropenia)
histo location
midwestern states mainly
blastomyces location
occurs in southeastern and midwestern states
Cryptococcus species
neoformans is common
affects CNS
Spectrum of activity for amphothericin
1st line for:
cryptococcus
blastomyces
histoplasma
mucor
Amphothericin adverse effects
Nephrotoxicity!!! dose dependent
cause increase in Scr and BUN
electrolyte abnormalities
Flucytosine penetration
penetrates CSF - used for cryptococcal meningitis
Flucytosine spectrum
cryptococcus
flucytosine adverse effects
hematologic – bone marrow suppression
monitor: CBC, platelets, Scr, BUN
fluconazole clinical use and spectrum
1st line: invasive candidiasis
use for most candida species
fluconazole adverse effects
QTc prolongation
itraconazole facts
metabolized by CYP 3A4
active metabolite - hydroxyitraconazole
1st line: histoplasmosis
Adverse effects: hepatotoxicity, QTc, CHF (boxed warning)
posaconazole facts
absorption affected by gastric pH
AVOID if CrCl <50
QTc and increased AST/ALT/bilirubin
voriconazole facts
metabolized by P450 isoenzymes (2C19, 2C9, 3A4)
NO DOSE ADJUST FOR ORAL
AVOID IF CRCL < 50 ML/MIN
voriconazole clinical use
invasive aspergilosis
voriconazole adverse effects
visual disturbances
elevated liver function tests
QTc
Phototoxic skin reactions
Periosititis
isavuconazole facts
does not cause QTc prolongation - can shorten it
micafungin facts
not orally absorbed - give IV
no dose adjustments for renal dysfunction
drug interactions - not metabolized via CYP450
ibrexafungerp clinical use
VVC
verify pregnancy status prior to initiating - contraindicated
use effective contraception during and for 4 days after treatment
candida spectrum of activity
fluconazole: albicans, parapsilosis, tropicalis, lusitaniae
echino: glabrata, krusei, lusitaniae, auris
Misc. spectrum of activity
fluconazole: cryptococcus, coccidiodes
itraconazole: blastomyces, histoplasma
voriconazole: aspergillus
amphothericin: cryptococcus, mucor
flucytosine: cryptococcus
oropharyngeal + esophageal candidiasis primary line of host defenses against superficial candida
cell-mediated immunity
vulvovaginal candidiasis causes - most common
antibiotic use
