fungal infections (mycoses) Flashcards
What are the two types of fungal infections (mycoses)?
Systemic and Superficial.
Which type of mycoses is less frequent but more serious?
Systemic mycoses.
How are systemic mycoses classified?
Opportunistic and Non-opportunistic.
What is the drug of choice (DOC) for systemic mycoses?
Amphotericin B.
Why is Amphotericin B considered highly toxic?
Causes infusion reactions, nephrotoxicity, electrolyte imbalances, and bone marrow suppression.
How is Amphotericin B administered?
IV only.
What are the adverse effects of Amphotericin B?
Infusion reactions, nephrotoxicity, hypokalemia, phlebitis, bone marrow suppression, delirium, hypotension, hypertension, wheezing, hypoxia, and rare cases of seizure, anaphylaxis, dysrhythmias, acute liver failure, nephrogenic diabetes insipidus.
How can infusion reactions from Amphotericin B be prevented?
Pretreat with IV diphenhydramine & acetaminophen; may also give IV meperidine & dantrolene.
How is nephrotoxicity minimized with Amphotericin B?
Administer 1L of normal saline (NS).
What should be monitored when using Amphotericin B?
CBC, hematocrit (Hct), and electrolytes.
What conditions require caution when using Amphotericin B?
Pregnancy/lactation, impaired renal function, anemia, electrolyte imbalances, bone marrow suppression.
What drugs interact with Amphotericin B?
Other nephrotoxic drugs, Flucytosine.
What class of antifungals is used for systemic mycoses and is less toxic than Amphotericin B?
Azoles.
How do azoles work?
Inhibit CYP450 enzymes.
How are azoles administered?
Some are oral (po), some are IV, and some can be both.
What are the adverse effects of azoles?
GI effects, headache, hepatotoxicity, cardiac effects (QT prolongation or shortening, CHF).
What are the common types of superficial mycoses?
Candida infections (vulvovaginal, oral/thrush), dermatophytic infections (ringworm), and onychomycosis (nail infections).
How are superficial mycoses usually treated?
Topical or oral antifungals.
How is vulvovaginal candidiasis treated?
1-3 days of topical antifungals or a one-dose fluconazole (oral).
What are the treatment options for oral candidiasis (thrush)?
Topical or oral antifungals: Clotrimazole, Miconazole, Nystatin; severe cases may require Fluconazole, Posaconazole, Itraconazole.
What are the treatment options for tinea infections?
Topical or oral antifungals.
Which antifungal agents are used for tinea capitis?
Oral, Topical, Ketoconazole (shampoo).
Which takes longer to treat: toenail or fingernail onychomycosis?
Toenail infections take longer.
What are the main adverse effects of topical azoles?
Local irritation.
What are the adverse effects of oral azoles?
Systemic effects including hepatotoxicity, GI effects, HA , and cardiac issues (QT pronlongation, CHF, QT shortening)
How is Nystatin used for fungal infections?
for superficial
po or topical
AE: po-N/V/D; topical-local irritation
What are the adverse effects of oral Nystatin?
Nausea, vomiting, diarrhea (N/V/D).
What are the adverse effects of topical Nystatin?
Local irritation.
How is Griseofulvin best absorbed?
When taken with a fatty meal.
What are the adverse effects of Griseofulvin?
Transient headache, rash, GI effects.
What are the adverse effects of oral Terbinafine, Naftifine, and Butenafine?
Headache, diarrhea, dyspepsia, abdominal pain, skin reactions, taste disturbances, liver failure.
What is the class of antifungal drugs that includes Caspofungin, Micafungin, and Anidulafungin?
Echinocandins.
How are echinocandins administered?
IV only.
What infections do echinocandins treat?
Narrow-spectrum activity for systemic Aspergillus and Candida infections.
How do echinocandins interact with the CYP450 system?
They act as substrates, meaning they can be affected by other CYP450 drugs.
What are the adverse effects of echinocandins?
Fever, phlebitis, headache, rash, nausea/vomiting, flushing, pruritis.
