Brainscape's Knowledge GenomeTM

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


See full index

Therapeutics 3 > Fungal Infections > Flashcards

Fungal Infections Flashcards

1
Q

What organisms can cause primary disease?

A
  • histoplasma capsulatam
  • blastomyces dermatitdis
  • coccidiodes immitis

endemic fungi, found in the soil

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

What organisms can cause secondary disease?

oppurtunistic infection, found in immunocompromised patients

A
  • candida spp.
  • aspergillus spp.
  • zygomycetes
  • fusarium spp.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the most common fungal pathogen found in tyhe ICU setting?

A

candida albicans

followed by candida glabrata

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

What is unique about the transmission of candida auris?

A

person to person transmission can occur

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

What is the preferred treatment for candida auris?

A

echinocandins

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

What is the diagnostic test for fungal infections?

A

1, 3 beta-D-glucan (BDG), primary component of most fungal cell walls

not specific, but negatives can rule out fungal infection

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

What is the candida score?

A

assists in diagnostic, candida score > 3 along with postive BDG suggests fungal infection
score is based on points:
- miltifocal colonization= 1 point
- surgery= 1 point
- parenteral nutrition= 1 point
- severe sepsis= 2 points

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

What is the primary treatment for invasive candida infection?

A

AZOLE ANTIFUNGALS
- imidazole= ketoconazole
- triazoles= fluconazole, itraconazole, voriconazole, posaconazole
- tetrazoles= oteseconazole

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

Which antifungals cause QTc prolongation?

A

azole antifungals

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

Which azole antifungal has the largest interaction with 2C9?

A

fluconazole

interacts with warfarin

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

What are the dosage forms of ketoconazole?

A

ketoconazole

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

What is the indication of fluconazole?

A
  • any candida infection, except C. auris, C. krusei, and C. glabrata
  • cryptococcal meningitis
  • prophylaxis of candida infection in high risk patients
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Describe the absorption of fluconazole:

A

> 90% bioavaliability

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

Descibe the distribution of fluconazole:

A

good CNS penetration

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

How is fluconazole metabolized?

A

significant inhibitor of CYP2C9 (warfarin is highly affected), but 70% is excreted unchanged renally (renal adjustments required)

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

What is dosing of fluconazole?

A

systemic infection= 400mg+ IV/PO daily, therapeutic drug monitoring (TDM) needed, but TDM not needed for topical/local infections with dosing < 400mg

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

What drugs are echinocandins?

A
  • caspofungin
  • micafungin
  • anidulafungin
  • rezafungin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Describe the distribution of echinocandins:

A

large molecules, do NOT penetrate the CNS

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

What are the dosage forms of Echinocandins?

A

IV only

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the dosing of Caspofungin?

A

loading dose of 70mg, MD of 50mg daily

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the dosing of Micafungin?

A

100mg daily for candida or 150mg daily for aspergillus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the dosing of Anidulafungin?

A

loading dose of 200mg, MD of 100mg daily

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the dosing of Rezafungin?

A

loading dose of 400mg, MD 200mg weekly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Which enchiocandin is associated with infusion-related reactions?

A

rezafungin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Which echinocandin can only be infused in the central line?

A

caspofungin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is the indication of echinocandins?

A

all candida, including C. glabrata, C. krusei, and C. auris (drug of choice) and aspergillus (in combo with azoles)

no activity against cryptococcus or endemic fungi

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What are echinocandins place in therapy?

A
  • candidemia and ivasive candida infection
  • preferred empiric treatment in immunocompromised patients
  • C. auris infections
  • esophageal candiditis
  • invasive aspergillosis in combo with azoles, monotherapy ok if intolerant to all other treatments
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

When may echinocandins be preferred over fluconazole for empiric treatment?

A
  • immunosuppressed patients
  • clinically unstable, ICU, or septic patients
  • history of C. glabrata, C. krusei, or C. auris
  • concurrent or extensive history of fluconazole use
  • high rate of C. glabrata at your site
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

At what site would you not treat a fungal infection?

A

urine/pneumonia

30
Q

Describe how aspergillus can take hold?

A

immunocompromised patients that have t-cell and b-cell dysfunction contributes to active disease which can be triggered by drugs such as: alemtuzumab, TNF-alpha inhibitors and more

31
Q

How is aspergillus diagnosed?

A

BOTH
- compatible host factors (immunocompromised)
- clincal and/or radiographic findings
PLUS
- proven culture
- probable bug through antigen
- possible infection (no direct testing results)

32
Q

What is the antigen test for aspergillus?

A

galactomannan (GM)

33
Q

What is the primary treatment for aspergillus?

A
  1. voriconazole, isavuconazole or posaconazole
  2. azole + echinocandins
  3. amphotericin B
34
Q

What is the place in therapy of voriconazole?

A

invasive aspergillus

35
Q

Describe the absorption of voriconazole:

A

food decrease bioavaliability, seperate dosing with meals

36
Q

Describe the distribution of voriconazole:

A

~ 50% CNS penetration and good ocular penetration

37
Q

Describe the metabolism of voriconazole:

A

inhibit CYP2C19, 3A4, and 2C9- interactions with warfarin, phenytoin, and sulfonylureas

38
Q

What are the adverse effects of voriconazole?

A
  • CNS/visual disturbances (associated with trough/Cmin > 5.5 mg/L
  • liver enzyme elevations
  • bone pain (periostitis) with prolonged therapy
  • rash and photopsia
39
Q

Describe the dosing of voriconazole:

A

weight based IV dosing using adjBW

40
Q

What is the goal trough for voriconazole?

A

1-5.5 mg/L

41
Q

What is unique about the IV formulation of voriconazole?

A

contains beta-cyclodextrin solubilizer (SCEBD) which accumulates in the kidneys, caution in patients with CrCl < 50mL/min and is not recommended for CrCl < 30, but is removed in HD

42
Q

What is the primary use of isavuconazole?

A

invasive aspirgillus and zygomycosis

43
Q

What are the adverse drug effects of isavuconazole?

A
  • N/V/D, rash, headache, and peripheral edema
  • AST/ALT elevations
  • infusion related reactions (respiratory distress, dyspnea, and hypotension)
  • QT shortening (unlike other azoles which prolong)
44
Q

What is the dosing of isavuconazole?

A

loading dose 200mg IV/PO q8h for 2 days then 200mg IV/PO daily

IV formulation needs in-line filter

45
Q

What is the primary role of posaconazole?

A
  • prophylaxis to decrease risk of candida and aspergillus
  • invasive aspergillosis
  • zygomycoses infections
46
Q

Describe the distribution of posaconazole:

A

large Vd but limited CNS penetration due to P-gp substrate which becomes pumped out of the CNS

47
Q

Describe the metabolism of Posaconazole:

A

primarly metabolized by UGT and to a lesser extent CYP3A4 (strong inhibitor)

48
Q

When is therapeutic drug monitoring (TDM) be recommended for posaconazole?

A

oral suspension due to low and variable bioavaliability, but not commonly used for delayed release or IV formulations

49
Q

How is the oral suspension of posaconazole dosed?

A

200mg TID or 400mg BID, doses > 800mg do not produce any greater effect due to “ceiling effect”, must be administered with food (high fat meal) to increase AUC

50
Q

What are the dosage forms of amphotericin B?

A
  • conventional amphotericin B= amphotericin B deoxycholate (CAmB)
  • lipid formulations= amphotericin B lipid complex (ABLC), liposomal amphotericin B (L-AMB)
51
Q

What is the place in therapy of amphotericin B?

A

aspergillosis and zygomycetes, not recommended for candida

52
Q

What is the dosing of amphotericin B?

A
  • CAmB: 1-1.5 mg/kg/day (rarely exceeds 100mg/dose)
  • LF-AmB: 3-5mg/kg/day (doses almost always exceed 200mg/dose)
53
Q

Which dosage form of amphotericin B is safer?

A

LF-AmB

54
Q

What are the adverse effects of conventional amphotericin B (CAmB)?

A
  • infusion related= fevers, chills, rigors, hypotension, arrhythmias, thrombophlebitis, headache
  • nephrotoxicity
  • hypokalemia
  • hypomagnesium
  • hypophosphatemia
  • hyponatremia
  • anemia
  • LFT elevation
55
Q

What drugs can be given prophylatically for infusion related reactions due to conventional amphotericin B (CAmB)?

A
  • fever= acetominophen
  • rigors= meperidine
  • hypotension= corticosteroids

all given 30 minutes prior to infusion

56
Q

What can be given prophylactically for nephrotoxicity due to coventional amphotericin B (CAmB)?

A

hydration and electrolyte replacement

57
Q

What are the monitoring parameters for coventional amphotericin B (CAmB)?

A
  • blood pressure, HR/rythmn, vitals, infusion rate
  • SCr
  • electrolytes (K, Mg, PO3)
  • liver function tests
  • hemoglobin and hematocrit
58
Q

How is histoplasmosis diagnosed?

A

antibody detection or urinary antigen

59
Q

What is the treatment for mild histoplasmosis?

A

itracontrole standard 2x/day for 6-12 weeks

60
Q

What is the treatment for moderate histoplasmosis?

A

itraconazole loading dose 3x for day one then standard dosing 2x/day dosing

TDM

61
Q

What is the treatment for severe histoplasmosis?

A

-LF-AmB daily for 1-2 weeks then itraconazole loading dose 3x day for 3 days then standard 2x/day dosing for 6-18 months

TDM

62
Q

What is the treatment for mild coccidioidomycosis?

A

fluconazole 400mg daily for 3-12 months

63
Q

What is the treatment for moderate coccidioidomycosis?

A

fluconazole > 400mg/day

64
Q

What is the treatment for severe coccidoioidomycosis?

A

LF-AmB for 1-2 weeks then fluconazole 800-1200mg daily for at least 12 months

65
Q

How must itraconazole capsules be dosed?

A

with food or with acidic pH- caution with pt on PPIs or H2 blockers

66
Q

How must Itraconazole solution be dosed?

A

on an empty stomach

67
Q

Which formulation of itraconazole has the best bioavaliability?

A

SUBA

68
Q

What are the treatment options for zygomycetes (mucormycosis)?

A

amphotericin or isavuconazole

69
Q

What is the treatment for cryptococcal meningitis?

A

flucytosine (5-FC) in combination with AmB

70
Q

What are the adverse drug effects of flucytosine?

A
  • GI intolerance
  • myelosuppression

Therapeutics 3 (19 decks)

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