Fungal Infections and malaria Flashcards
Is Fluconazole or Itraconazole more readily absorbed?
Fluconazole
What is amphotericin B used for?
Aspergillosis, blastomycosis, candidiasis, cryptococcosis
Does amphotericin B need to be prescribed by brand?
Yes
Name 7 antifungal drugs?
Fluconazole Ketoconazole Itraconazole Amphotericin B Nystatin Voriconazole Miconazole
What is the mechanism of action of antifungal drugs?
Fungal cells contain ergosterol (not found in human/animal cells), antifungals bind to ergosterol creating pores as well as inhibiting ergosterol synthesis.
What are the main side effects of fluconazole? (3)
1) Prolonged QT interval
2) Hepatotoxicity
3) Renal impairment
What patient groups should avoid fluconazole? (2)
1) liver disease
2) pregnancy (teratogenic)
Which antifungal’s are CYP450 inhibitors?
Fluconazole
Ketoconazole
Itraconazole
What drugs do antifungals interact with?
1) CYP450 substrates
2) QT prolonging drugs e.g amiodarone, antipsychotics, quinolones etc
What are the main side effects of Voriconazole?
Hepatotoxicity
Photosensitivity (check for malignancy and seek medical attention if sunburnt)
What must you carry if you are taking voriconazole?
An alert card
What is nystatin normally used for? what are the typical dosage instructions?
Oral thrush-100,000 units QD for 7 days
What age group can fluconazole 150mg be sold to the public OTC?
16-60 for candidiasis
What must you monitor in patients taking LT treatment of fluconazole?
Liver enzymes before and during treatment
What must you monitor when taking LT treatment of voriconazole?
Renal and hepatic function before starting and then at least weekly for one month and then monthly.
Check for malignancy and avoid sunlight.
Hepatotoxicity is also associated with another antifungal, please name it?
Ketoconazole
What are the general monitoring requirements for antifungals?
1) ECG
2) Adrenal function (can cause adrenal insufficiency)
3) Hepatic function
What is the most common cause of fungal meningitis?
Cryptococcal meningitis
Can you use Itraconazole in heart failure or history of heart failure?
AVOID
How would you treat fungal meningitis?
IV amphotericin followed by oral fluconazole
What are the 1st and 2nd line treatments for aspergillosis?
1) Voriconazole
2) Liposomal amphotericin (alternatives are itraconazole or caspofungin)
What is tinea capitis?
Fungal infection of the scalp
What antifungal can you use to treat tinea capitis?
Griseofulvin
What is tinea pedis?
athletes foot
Is topical or systemic therapy more effective for fungal nail infections?
Systemic
What is a helminth infection?
Parasitic infection
What are the symptoms of thread worm?
itching around the anus and vagina, weight loss
What are the symptoms of whip worm?
Gi disturbance, colitis, bloody diarrhoea
What are the symptoms of hookworm?
Very few symptoms except weight loss and anemia (rare)
What are the symptoms of round worm?
High temperature, dry cough, worms in the stools
What is the main treatment for helminth infection? and what are the criteria for sale OTC?
What are the side effects?
Mebendazole, can be sold OTC to >2 years old if package is labelled 100mg as a single dose.
Side effects: GI effects, SJS (rare)
What is the treatment duration for malarone in malaria prophylaxis?
Start 1-2 days before and 1 week after
What is the treatment duration for doxycyline in malaria prophylaxis?
Start 1-2 days before and for 4 weeks after
What is the treatment duration for mefloquine in malaria prophylaxis?
Start 2-3 weeks before and for 4 weeks after
What is the treatment duration for chloroquine and quinine and proguanil in malaria prophylaxis?
Start 1 week before and for 4 weeks after
Which antimalarials cannot be used in epilepsy? (2)
Chloroquine and mefloquine
Which antimalarials cannot be used in renal impairment? (2)
Proguanil (AVOID)
Malarone (AVOID in eGFR <30)
Which antimalarials should you avoid in pregnancy? (3)
Doxycycline
Malarone
Proguanil (must take folic acid until 1st trimester)
Which antimalarial is associated with occular toxicity?
Chloroquine
What is the safest antimalarial in pregnancy?
Quinine
Which antimalarial is CI in patients with history of psychiatric disorders?
Mefloquine (Stop seek medical attention if experience insomnia, depression, anxiety etc)
Name two antiviral drugs used for influenza?
Oseltamivir and zanamivir
Which antiviral drug is licensed for use within 48 hours of influenza onset?
Oseltamivir
Which antiviral drug is licensed for use within 36 hours of influenza onset?
Zanamivir
What is tinea cruris?
Fungal groin infection, itchy inflammation with a visible patch of dry scaly skin
What is impetigo?
Red sores that quickly burst leaving a thick golden crust typically around 2cm across
What are the symptoms of measles/rubella?
rash for 3 days and cold-like symptoms with red blotchy rash and kopilks spots in the mouth
What are the symptoms of molloscum contagiousum?
small, firm, raised flesh coloured spots on the skin; thick yellowy-white substance released if popped
What are the symptoms of tinea corporis?
(ring worm)- affects the arms and legs, round silvery patch of skin that may be scaly inflamed and itchy.
What are the symptoms of scarlet fever?
Sore throat, headache, swollen glands, red rash that feels like sandpaper, red cheeks, white or red tongue
What are the symptoms of mumps?
Swollen, salivary glands, fever, headache and joint pain (in adults)
What are the symptoms of scabies?
Intense itching, rashes with tiny red spots, burrow marks can be seen as silvery coloured lines on the skin
What are the symptoms of hand, foot and mouth disease?
Mouth ulcers after one or two days, soon after a rash made up of small raised red spots on the skin appear, the spots may turn in to grey blisters
What are the symptoms of slapped cheek syndrome?
Bright red rash on the cheeks, temperature, sore throat, runny nose and headache
What is the treatment for ACUTE non-complicated falciparum malaria?
Artemether with lumefantime
