Fungal Infections Flashcards
AMPHOTERICIN B BOXED WARNING
MEDICATION ERRORS WITH LIPOSOMAL ALTERNATIVE
CARDIOPULMONARY ARREST
CONVENTIONAL AMPHO DOSE SHOULD NOT EXCEED 1.5 MG/KG/DAY
AMPHOTERICIN B COVERAGE
BROAD SPECTRUM
MOST CANDIDAS AND CRYPTOCOCCAL NEROFORMANS
ASPERGILLUS
OTHER DIMORPHIC FUNGI
AMPHOTERICIN B SIDE EFFECTS
(WHAT PREMEDICATION IS USED TO REDUCE REACTIONS?)
INFUSION RELATED: FEVERE, CHILLS, HA, MALAISE, RIGORS
OTHER: ↓K, ↓MG, NEPHROTOXICITY
(APAP OR NSAID, DIPHENHYDRAMINE OR HC)
AMPHOTERICIN B PREPARATION NOTES
COMPATIBLE WITH D5 W ONLY
LIPID FORMULATIONS MUST BE FILTERED
FLUCYTOSINE (5-FC) COVERAGE
DUE TO DEVELOPMENT OF RESISTANCE, CAN NOT BE USED ALONE
COMBO WITH AMPHO B FOR INVASIVE CRYPTOCOCCAL MENINGITIS AND CANDIDA INFECTIONS
FLUCYTOSINE SIDE EFFECTS
MYELOSUPPRESSION
FLUCONAZOLE VAGINAL CANDIDA DOSE
150 MG PO X1
FLUCONAZOLE IV:PO RATIO
1:1
ITRACONAZOLE BOXED WARNING
CAN WORSEN OR CAUSE HF, DO NOT USE IF HX OF HF
CAN ↑ RISK OF QT AND TDP
WHICH AZOLE REQUIRES AN ACIDIC ENVIRONMENT FOR ABSORPTION?
FLUCONAZOLE
KETOCONAZOLE BOXED WARNING
HEPATOTOXICITY LEADING TO TRANSPLANT OR DEATH
QT PROLONGATIONS
ORAL TABS ONLY IF OTHER OPTIONS UNAVAILALE OR INEFFECTIVE AND BENEFITS > RISK
AZOLE CLASS EFFECTS
↑LFT
RISK OF QT PROLONGATION
MANY DRUG INTERACTIONS
WHICH IS THE ONLY AZOLE THAT REQUIRES RENAL DOSE ADJUSTMENT?
FLUCONAZOLE
WHICH IS THE ONLY AZOLE WITH RISK OF HEPATOTOXICITY THAT CAN LEAD TO TRANSPLANT OR DEATH
KETOCONAZOLE
WHICH AZOLE CAN LEAD TO HF
ITRACONAZOLE
WHICH AZOLE CAN CAUSE VISUAL CHANGES AND PHOTOTOXICITY
VORICONAZOLE
WHICH AZOLE DOES NOT HAVE EQUIVALENT DOSE BETWEEN PO TABS AND PO SUSPENSIONS
POSACONAZOLE
BIOAVAILABILITY OF AZOLES
ALL HAVE 1:1 IV:PO
WHICH AZOLES CAN PENETRATE THE CNS TO ADEQUATELY TREAT FUNGAL MENINGITIS?
FLUCONAZOLE
VORICONAZOLE
VORICONAZOLE: WHAT SHOULD BE DONE AT CRCL<50
THE SBECD IV VEHICLE BUILDS UP
ORAL SHOULD BE USED IF POSSIBLE
SHOULD VORICONAZOLE BE TAKEN WITH OR WITHOUT FOOD?
EMPTY STOMACH
POSACONAZOLE WITH OR WITHOUT FOOD
WITH FOOD
WHICH AZOLE CAN ACTUALLY CAUSE QT SHORTENING
ISAVUCONAZONIUM SULFATE
ECHINOCANDIN AGENTS
CASPOFUNGIN
MICAFUNGIN
ECHINOCANDIN MOA
INHIBIT SYNTHESIS OF BETA-D-GLUCAN
AZOLE COVERAGE
VARY BETWEEN AGENTS
- FLUCONAZOLE = YEAST AND ONCHOMYCOSIS
- ITRACONAZOLE = DIMORPHIC FUNGI AND ONCHOMYCOSIS
- VORICONAZOLE = ASPERIGILLUS
- KETOCONAZOLE = TOPICAL INFECTIONS
ECHINOCANDIN COVERAGE
MOST CANDIDA SPECIES
ALSO COVERS ASPERGILLUS, BUT OTHER CLASSES ARE TYPICALLY PREFERRED
ECHINOCANDIN CLASS WARNING
HISTAMINE-MEDIATED SYMPTOMS CAN OCCUR RESULTING IN ANAPHYLAXIS
ECHINOCANDIN DOSING
ALL ONCE DAILY AND DO NOT REQUIRE DOSE ADJUSTMENT IN RENAL IMPAIRMENT
NYSTATIN COMMON USES
ORAL CANDIDIASIS
INTESTINAL INFECTIONS
GRISEOFULVIN COMMON USE
FUNGAL INFECTIONS OF SKIN, HAIR AND NAIL
GRISEOFULVIN CONTRAINDICATION
PREGNANCY
GRISEOFULVIN SIDE EFFECTS
PHOTOSENSITIVITY
↑LFT
GRISEOFULVIN ADMINISTRATION
WITH FATTY MEAL TO ↑ ABSORPTION OR
FOOD/MILK TO AVOID GI UPSET
CLOTRIAZOLE COMMON USE
OROPHARYNGEAL CANDIDIASIS
MICONAZOLE COMMON USE
OROPHARYNGEAL CANDIDIASIS
EMPIRIC TREATMENT FOR OROPHAYNGEAL CANDIDA ALBICANS
MILD: TOPICAL SUCH AS CLOTRIMAZOLE OR MICONAZOLE
MOD-SEV OR HIV+: FLUCONAZOLE
EMPIRIC TREATMENT FOR CANDIDA ALBICANS ESOPHAGEAL
FLUCONAZOLE
ALT: ECHINOCANDIN
EMPIRIC TREATMENT FOR ALL CANDIDA BLOODSTREAM INFECTIONS
ECHINOCANDIN
ALT: AMPHO B
EMPIRIC TREATMENT FOR INVASIVE ASPERGILLUS
VORICONAZOLE
ALT: AMPHO, ISAVUCONAZONIUM
EMPIRIC TREATMENT FOR CRYPTOCOCCUS MENINGITIS
AMPHO + FLUCYTOSINE
EMPIRIC TREATMENT FOR NAIL BED INFECTIONS
TERBINAFINE OR ITRACONAZOLE
ALF: FLUCONAZOLE
