Fungal Infections Flashcards
Which patients are at high risk of fungal infections and may receive prophylactic antifungals?
Immunocompromised patients.
Which antifungal drugs are commonly used for prophylaxis?
Oral triazole antifungals. Fluconazole is more readily absorbed than itraconazole. Itraconazole is preferred in patients at risk of invasive aspergillosis.
As anaphylaxis is possible with amphotericin B use, what should be done before the first dose?
A test dose should be administered and the patient observed for at least 30 minutes.
When should prophylactic antipyretics and hydrocortisone be used alongside amphotericin B?
When the patient has previously experienced acute adverse reactions.
How do different preparations of IV amphotericin B vary?
In pharmacokinetics, pharmacodynamics, dosage and administration.
Are different brands of IV amphotericin B be interchanged? How should they be prescribed?
No, they should be prescribed by brand name.
What are the two important MHRA alerts issued for itraconazole?
Increased risk of heart failure and hepatotoxicity.
Caution is advised when prescribing itraconazole to patients at high risk of heart failure. What are these risks?
Patients receiving high doses or longer courses. Older patients and those with cardiac disease. Patients with chronic lung disease associated with pulmonary hypertension. Patients receiving treatment with negative ionotropic drugs such as CCBs.
In which patients should itraconazole be avoided?
Patients with ventricular dysfunction or a history of heart failure, unless the infection is serious.
There is a rare risk of life-threatening hepatotoxicity developing with the use of itraconazole. In what patients should caution be taken or use be avoided all together?
History of hepatotoxicity with other drugs or in hepatic impairment.
When using itraconazole, when should liver function be monitored?
If using for longer than one month, if receiving other hepatotoxic drugs, if history of hepatotoxicity with other drugs, in hepatic impairment.
How should oral preparations of itraconazole be taken?
On an empty stomach.
What signs and symptoms of hepatotoxicity should a patient look out for and report to their doctor?
Anorexia, nausea, vomiting, fatigue, abdominal pain, dark urine.
When on voriconazole, what should patients have on them at all times?
A patient warning card.
There is a risk of hepatitis and cholestasis, especially in patients with haematological malignancy, when taking voriconazole. What should be considered if abnormalities are detected in liver function tests?
Treatment cessation.
If patients on voriconazole develop persistent nausea, vomiting, malaise or jaundice, what course of action should be taken?
They should seek medical attention right away.
Phototoxicity is a common side effect of voriconazole use. If it develops, what course of action should be taken?
Consider treatment cessation.
Phototoxicity is a common side effect of voriconazole use. What should be specifically monitored for and what should be done if this occurs?
Monitor for pre-malignant skin lesions and squamous cell carcinomas. Discontinue of these occur.
Renal and hepatic function should both be monitored during treatment with voriconazole, when should this be carried out?
Before treatment starts, at least weekly for one month, then monthly during treatment.
What CHM alert regarding ketoconazole has recently been issues?
Suspension of marketing authority for the use of ketoconazole in the treatment of fungal infections as risk of hepatotoxicity is greater than benefit.
What monitoring is required when a patient is on ketoconazole?
ECG, adrenal function, (adrenal insufficiency), hepatotoxicity.
What are the symptoms of adrenal insufficiency, occasionally seen with the use of ketoconazole?
Fatigue, anorexia, vomiting, hypotension, hyponatraemia, hypoglycaemia.
