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Therapeutics IV > Fungal Infections - Block 3 > Flashcards

Fungal Infections - Block 3 Flashcards

1
Q

Ex of dermatophytes?

A
  1. Trichophyton
  2. Microsporum
  3. Epidermophyton
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2
Q

Types of Yeast?

A
  1. Candida
  2. Cryptococcus neoformans
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3
Q

Types of mold?

A

Aspergillus

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4
Q

Types of dimorphic?

A
  1. Histoplasma
  2. Bastomyces
  3. Coccidioides
  4. Paracoccidioides
  5. Sporothrix
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5
Q

Stypes of antimicrobial resistant fungi?

A
  1. Aspergillus (Azole)
  2. Candida (fluconazole)
  3. Candida auris (fluconazole)
  4. Ringworm
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6
Q

Can topical azoles be used for pregnancy?

A

Yes

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7
Q

Terbinafine

MOA

A

Disrupts synthesis of ergosterol and penetrates to keratin precursor cells (fungicidal)

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8
Q

Griseofulvin

MOA

A

Prevents fungal cell division and provides good penetration to superficial sites due to transfer of drug cia sweat and trans epidermal fluid loss

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9
Q

Ciclopirox

MOA

A

Topical lacquer that degrades peroxides within the fungal cells

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10
Q

Nystatin

MOA, Idication

A

MOA: Alters fungal cell membrane leading to leakage of cell -> cell death
Indication: Oral candidiasis or thrush

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11
Q

Zinc oxide

MOA

A

Provides physical barrier to water absorption

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12
Q

Selenium sulfide

MOA

A

Reduction in the turnover of epidermal cells

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13
Q

What are the presentations of Oral candidia? Diagnosis?

A

Sx: Dysphagia, abnormal odor, dry mouth, abnormal taste
Diagnosis: White plaque that leave an inflamed or bleeding base when scraped off

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14
Q

TYpes of thrush tx?

A

Acute: 7-14 days
Suppression: not recommended

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15
Q

Tx for Oral Candida?

A

Fluconazole
Nystatin
Miconazole
Clotrimazole

7-14 days

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16
Q

Presentations of esophageal candida? Diagnosis?

A
  1. Can be asymptomatic
  2. AIDS defining illness (CD4 <100)

Diagnosis: Endoscopy

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17
Q

Tx for Esophageal Candidiasis?

A

Prophylaxis: Fluconazole, itraconazole
Acute: Fluconazole for 14-21 days
Resistnat: Itraconazole oral solution

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18
Q

Vulvovaginal Candidiasis presentation and diagnosis?

A

Sx: discharge with little to no odor, pruritis, erythema
Diagnosis:
* Uncomplicated: clincal exam, pH (4-4.5), wet mount
* Complication: reccurent (>4 episodes/wr), severe VVC

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19
Q

Vulvovaginal Candida Tx? Pregnancy?

A

Uncomplicated:
* Miconazole 2% x 3 days
* Fluconazole PO 1 dose

Complicated:
* Miconazole 2% for 7-14 days
* Fluconazole PO for 3 days and 2 doses

Topical azole x 7 days for pregnancy

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20
Q

Tx for diaper dermatitis?

A

Nonpharm: Skin care, choice of diaper
Pharm:
* Topical barrier: petrolatum, zinc oxide
* Topical antifungal: nystatin, clotrimazole, miconazole, ketoconazole BID for 2 weeks

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21
Q

Presentation of Intertriginous Dermatitis (Intertrigo)?

A

Condition of skin folds causes by moisture, friction and absence of air circulation
* Burning, tenderness, prutitus, fissuring

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22
Q

Tx for Intertriginous Dermatitis (Intertrigo)?

A

Topical agents 1st line: Ketoconzale, Clotrimazole, Miconazole
PO: Fluconazole for 4 wks

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23
Q

What is the difference between tinea barbae and capitis?

A

Barbae: affects beard and mustache
Capitis: Multiple scaly and/or crusted patches and/or plaque affecting scalp or beard

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24
Q

Tx for tinea barbae/capitis?

A

Terbinafine PO for 4 wks

25
Q

Presentation of tinea corporis/cruris

A

Erythematous plaque with raised leading edge and scaling clearance at the center of a lesion with scattered nodules:
Corporis: body
Cruris: scrotum

26
Q

Tx for Tinea Corporis/Tinea Cruris?

A

Topical: Terbinafine 1% cream BID for 3-4 wk
Systemic (failure of topical): Terbinafine PO QD for 2-4 wks

27
Q

Presentation of tinea pedis

A
  1. Interdigital (in between toes)
  2. Moccasin styles (heel, soles, lateral aspects of feet)
  3. Vesiculobullous (instep)
28
Q

Tx for tinea pedis?

A

Topical (preferred): Terbinafine 1% cream QD 2-4 wks
Systemic: Terbinafine PO QD 2 wk
Nonpharm: Dry cotton socks, loose fitting shoes, drying powder, and drying feet

29
Q

Presentation and diagnosis of Tinea Unguium/Onychomycosis?

A

Separation of nail plate, thickening, discoloration, destruction of nail plate
Diagnosis: KOH prep, fungal culture, nail clippings, nail biopsy

30
Q

Presenation and diagnosis of Tinea versicolor (Pityriasis versicolor)?

A

Presentation: Superficial infection caused by yeast
* Hypopigmented and/or hyperpigmented patched with very fine scaling affecting sebum-rich areas

Diagnosis: Physical exam

31
Q

Tx for Tinea Unguium/Onychomycosis Treatment?

A

Systemic: Terbinafine PO QD for 6 wks (fingernails) or 12 wks (toenails) - avoid in liver dx
Topical: Efinaconazole 10% nail lacquer QD for 48 wks

32
Q

RF of thrush?

A

Age, IC

33
Q

RF of vulvovaginal candida?

A

IC, Uncontrolled diabetes, debilitation, pregnancy, recurrent infection

34
Q

RF of diaper rash?

A

Infrequent diaper changing, infants with diarrhea or chronic stooling, ABX use

35
Q

RF of intertriginous dermatitis?

A
  1. Bedridden
  2. Obesity
  3. Incontinence
  4. Poor hygiene
  5. Hyperhidrosis
  6. Immune def
36
Q

RF of Tinea versicolor (Pityriasis versicolor)?

A
  1. Tropical climate/warm weather
  2. Malnutrition
  3. PO contraceptives
  4. Systemic CS
  5. Immunosuppresants
  6. Hyperhidrosis
37
Q

Tinea vesicolor tx?

A

Topical (first line): Zinc pyrithione shampoo scrubbed onto the affected areas using a mildly abrasive sponge and rinsed off in 3-5 minutes QD x 1-4 wks
Systemic: FLuconazole PO QW 2-4 wks

38
Q

RF for invasive fungal infection?

A
  1. IC host
  2. CD4 count <200 cells/mm3
  3. Neutropenia (ANC 500/mm3 or less)
  4. Nosocomial infections
39
Q

Antifungals for systemic infections?

A
  1. Amphotericin B
  2. Flucytosine
  3. Azole
  4. Echinocandins
  5. Terbinafine
40
Q

What are the formulations of amphotericin B?

A
  1. Conventional/Amphotericin B deoxycholate (Fungizone IV)
  2. Liposomal (AmBisome)
41
Q

ADR of amphotericin?

A
  1. Infusion related rx
  2. Renal toxicity
  3. Electrolyte Abnormalities due to intracellular leakage and tubular defects
42
Q

Dosing of amphotericin B in obesity?

A

If using Adjusted Body Weight to dose, a max of 100 kg is suggested.
If using Actual Body Weight to dose, a max dose of 600 mg is recommended

43
Q

ADR of azoles?

A

Visual disturbance, QTc prolongation, hepatotox

Fluconazole: avoid in pregnacy

44
Q

DDI of azoles?

A

Inhibitors of CYP2D6, 2C9, 2C19, 3A4, 3A5, and 3A7

Fluconazole has the least amount of interactions

45
Q

Itraconazole counseling?

A

Absorption is dependent of gastric pH -> avoid PPI, H2RAs, antiacids

46
Q

ADR of echocandin?

A

Peripheral edema, febrile neutropenia

47
Q

DDI of echinocandiN?

A

Capsofungin and Micafungin are substrates and inhibitors of CYP3A4

Hepatic dosing: capsofungin

48
Q

CI and obesity dosing of echinocandin?

A

CI: pregancy
Obesity dosing: Micafungin: for patients weighing over 115kg, increase dose to 200 mg

49
Q

ADR of flucytosine?

A

Nephrotoxicity, hepatotoxicity, bone marrow suppression

50
Q

Dosing of flucytosine?

A

Renal dosing: based on GFR
Obesity: Use IBW
Requires therapeutic drug monitoring: 30-80mcg/mL

51
Q

Presentation and diagnosis of Disseminated Candidiasis/Candidemia?

A

Sx: fever, sx nonspecific
Diagnosis: histopathology/fungal cultures, blood cultures, serum (1,3) beta-D-glucan, T2 Candida panel

52
Q

RF of Disseminated Candidiasis/Candidemia?

A

neutropenia, prolonged hospitalization, central venous catheters, major surgery, broad-spectrum ABX, TPN

53
Q

Tx for Disseminated Candidiasis/Candidemia?

A

Preferred: Capsofungin, anidulafungin, micafungin
Azole (alternative): Fluconazole, Voriconazole
Azole and echinocandin resistance: Liposomal amphotericin B 3-5 mg/kg QD

54
Q

Presentation and diagnosis of aspergillosis?

A

Acute invasive pulmonary: cough, hemoptysis, pleuritic chest pain, shortness of breath
Chronic pulmonary: mild symptoms
Extrapulmonary invasive: skin lesions, sinusitis, or pneumonia, can disseminate and often rapidly fatal
Aspergillosis in sinuses: fever, rhinitis and headache; can have necrotic lesions, palatal or gingival ulcerations, sinus thrombosis, or pulmonary or disseminated lesions
Aspergillomas: often asymptomatic, may cause mild cough and/or hemoptysis

Diagnosis: CT chest/Xray

55
Q

Tx for aspergilosis?

A

Voriconazole PO

56
Q

Presentation and diagnosis of histoplasmosis?

A

Presentation:
* Acute primary: resembles a cold and/or pneumonia
* Chronic cavitary: pulmonary lesions and worsening respiratory status
* Progressive disseminated: hepatosplenomegaly, lymphadenopathy, bone marrow involvement, oral/gastrointestinal ulcerations

Diagnosis: Chest X-ray

57
Q

Tx for Acute primary histoplasmosis?

A

If infection does not resolve after 1 month:
* Itraconazole 200 mg PO three times daily x 3 days, then twice daily x 6-12 weeks

58
Q

Tx for chronic cavitary histoplasmosis?

A

Itraconazole 200 mg PO three times daily x 3 days, then twice daily for 12-14 months

59
Q

Tx for severe disseminated histoplasmosis?

A

Liposomal amphotericin B 3 mg/kg IV daily until clinically stable, then itraconazole 200 mg PO three times daily x 3days, then twice daily x 12 months after they become:
* Afebrile
* AIDS patients are given itraconazole indefinitely to prevent relapse or until CD4 count is > 150

Therapeutics IV (39 decks)

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