GYN/Final: drugs & tx Flashcards
Severe life threatening infections
IV amphotericin B–>DOC
Leishmaniasis
IV amphotericin B
PO and IV Fluconazole
Pentamidine –alternative
systemic mycoses infection
Amphotericin B
Candida Albicans
**Amphotericin B– severe infections only
*fluconazole (PO, IV) esp good if candidemia
IV caspofungin
Aspergillus
- doc
- second line
*Amphotericin B– severe infections only
DOC: Voriconazole
IV Caspofungin SECOND line after failing or intolerant to azole or amphotericin B
Blastomyces
-doc?
*Amphotericin B– severe infections only
**DOC=Itraconazole
Cryptococcus
- initial tx
- maintenance tx
Amphoterin B (+/-) flucytosine (5-FC) THEN change to fluconazole
Maintenance: fluconazole 6-12 MO in pt with or without AIDS
*Amphotericin B– severe infections only
Histoplasmosis
- DOC
- others
DOC for severe requiring hospitalization=Amphotericin B IV–>then switch to itraconazole once stable and afebrile
FOR EXAM: ALWAYS ANSWER ITRACONAZOLE
Candidiasis-
- first line for invasive?
- cutaneous?
- esophageal–DOC?
- thrush/oral
- systemic/invasive
oral, esophageal and cutaneous— **Nystatin (oral suspension, cream, ointment, powder)
*clotrimazole=PO, cutaneous and vaginal
**DOC for esophageal=FLuconazole
*Miconazole=oral and vaginal
INVASIVE INFECTION IN IMMUNO COMP PT=IV caspofungin–DOC **
esophageal in immuno comp use IV caspofungin first line
Cutaneous=Ciclopirox–cream, gel, suspension
thrush
DOC
others
DOC= Nystatin swish and spit— if not compliant than PO
- Fluconazole PO
- Fenoconazole PO
- Clotrimazole pouches
Nystatin-swish and spit/swallow
Coccoides
*fluconazole PO or IV
Candida glabrata
Voriconazole
IV caspofungin
Candida Krusei
Voriconazole
IV caspofungin
Tinea spp.
Clotrimazole
Miconazole
Trichophyton rubrum
Efinaconazole x48 weeks
PO terbinafine X3MO
Trichophyton mentagrophytes
Eficonazole x48 weeks
PO terbinafine x30MO
Dermatophyte onychomycoses
- doc
- other options
DOC=PO terbinafine*******
Ciclopirox nail lacquer formation
PO Griseofulvin for 6-12MO
topical Tavaborole
Tinea Capitis
PO terbinafine
Topical terbinafine
Ciclopirox–cream, gel, suspension
Tinea cruris
Topical terbinafine
Ciclopirox–cream, gel, suspension
topical Tavaborole
Tinea versicolor
topical terbinafine
Ciclopirox–cream, gel, suspension
tinea pedis
topical terbinafine
Ciclopirox–cream, gel, suspension
topical Tavaborole
neutropenic fever
IV caspofungin
fluconazole resistant Candida glabrata and C. krusei
Echinocandins aka Caspofungin
Cryptococcal meningitis
Amphotericin B + 5-FC (Flucytosine)
INTRA-FECAL ONLY** cannot do IV because amphotericin does not cross CNS IV
*Fluconazole IV
Candiduria
- pharmacotx if persistent*
- ->fluconazole PO 7-14 days
OTHER:
5-FC/Flucytosine
chromoblastomycosis
5-FC
Flucytosine
dermatophytosis of scalp + hair
Griseofluvin
Seborrheic dermatitis
Ciclopirox shampoo
tinea corporis
topical Tavaborole
Imidazoles
- clotrimazole
- miconazole
- Efinaconazole
Esophageal candidiasis
- Fluconazole daily x14-21 days
- Fluconazole IV or Caspofungin for interolerance to PO therapy
*use PO itraconazole, PO/IV Voriconazole or Caspofungin for strains refractory to fluconazole
Vulvovaginal Cadidiasis
- Fluconazole PO
- Clotrimazole vaginally
- miconazole vaginally
PO is the same as above
Candidemia
1st line
-other
-when to discontinue tx?
1st line: Echinocandin–>Caspofungin IV
others:
* Fluconazole PO/IV for less severe disease
***tx should continue 2 weeks after last positive blood culture and s/s resolution
Bacterial vaginosis
metronidazole
Gardnerella vaginalis
metronidazole