ID Antifungals

Question 1

What should you be pre medicated with if you are taking Ampho B coonventional? 4 drugs but 2 sets

Answer 1

1. Acetaminophen or NSAID
2. Diphenhydramine and or hydrocortisone

Question 2

3 side effects of Ampho B

Answer 2

1. Decreased K, Mg, nephrotoxicity

Question 3

Ampho can increase risk of what drug and why?

Answer 3

1. Increase risk of digoxin due to hypokalemia

Question 4

What does flucytosine treat? Two main things

Answer 4

Cryptococcal Men

and

Candida Infections

Question 5

What main side effect of flucytosine?

Answer 5

DOse related myelosuppression

Question 6

Azole anti fungals key persons

Class effects

Answer 6

All can cause increased LFTs

All have risk for QT prolongation

Question 7

Flconazole key things

4

Answer 7

1. Only azole that requires renal dose adjustments
2. Narrow spectrum covers C. Albicans
3. Useful for vaginal candidiasis (non pregnant)
4. C. Glabrata and C. Krusei can be resistant

Question 8

Voriconazole

DOC for?

One other thing

Answer 8

1. DOC for Aspergillus
2. Monitor for visual changes and phototoxicity

Question 9

Posaconazole and Isavuconazonium

Answer 9

1. Active against molds including aspergillus and Zygomysetes
2. Posaconazole tablet dose does not equal suspension

Question 10

Diflucan

Answer 10

FLuconazole

Question 11

Vfend

Answer 11

Voriconazole

Question 12

Noxafil

Answer 12

Posaconazole

Question 13

Itraconazole Contraindicated in? 2 things

Answer 13

Pts with ventricular dysfunction or hx of HF

Coadmin with other QT prolonging drugs can

Question 14

CrCl cut off for Fluconazole?

Answer 14

CrCl <= 50 decrease dose by 50

Question 15

Diflucan dosing for vaginal candiasis?

Answer 15

150 mg PO x 1

Question 16

What drugs penetrate the CNS enough to treat cryptococcal men

Answer 16

Voriconazole and FLuconazole

Question 17

Vfend Warnings? 3

Answer 17

1. Liver damage
2. Visual disturbances
3. Phototox

Question 18

Naxafil

What should you do before starting therapy?

Answer 18

Posaconazole

Correct electrolyte abnormalitites

due to QT prolongation

Question 19

Vfend rec for CrCl?

Answer 19

CrCl< 50 oral dose is preferred

Question 20

Noxafil

Admin counseling?

Answer 20

Take with food

Question 21

What azole needs a filter

Answer 21

Isavuconazium

Question 22

All azoles are inhibitors of?

Answer 22

CYP3A4

Question 23

Itraconazole DI? 1

Answer 23

Inhibitor of P-gp

Question 24

Ketoconazole DIs 5 total

Answer 24

1. Inhibitors of
   
   1. P-gP
   2. 1A2
   3. 2C9
   4. 2C19
   5. 2D6

Question 25

FLuconazole DIs?

Answer 25

2C9 and 2C19

Question 26

Isavuconium is an inducer of? 2

Answer 26

• 2C8/9
• 3A4

Question 27

Echinocandin acitivty includes?

Answer 27

Aspergillus

Question 28

Echinocandins are what formulation?

Answer 28

Injections

Question 29

Warnings for Echinocandins

Answer 29

Histamine mediated symptoms

Question 30

Cancidas?

Answer 30

Caspofungin

Question 31

Mycamine?

Answer 31

Micafungin

Question 32

Echinocandins are all given?

Answer 32

once daily and dont need renal adjustments

Question 33

Micafungin dosing for Candidemia and Esophageal candidiasis?

Answer 33

Candid: 100 mg daily

Esopha: 150

Question 34

How should griseofulvin be taken?

Answer 34

With a fatty meal or milk to increase absorption

Question 35

Griseofulvin SEs? 2

Answer 35

Photosens, Increase LFTs

Question 36

Nystatin admin instructions?

Answer 36

Swish in mouth and retain for as long as possible before swallowing

Question 37

What drug can increase the metabolism of hormonal contraceptives and cause failure?

Answer 37

Griseofulvin

Question 38

First line treatment for C. Albicans?

Answer 38

1. Thrush: Oropharyngeal: Mild topical antifungals (clortrimazole, nystatin)
2. If HIVL mod to severe Dx fluconazole PO preferred

Esophageal infection: Fluconazole or echinocandin

Blood stream: not neutropenic: enchinocandins preferred, flucon alt

NeutropenicL echinocandins preferred, or amphoB and flu

Question 39

Candida glabrata or Krusei tx?

Answer 39

Echinocandins

Question 40

Aspergillus 3

Answer 40

1. Voriconazole preferred
2. Lipo AMp B
3. Isavuconazium

Question 41

Cryptoneoformans serious versus consolidated?

Answer 41

1. Ampo B + flu for inductions
2. Consolidated: flucon long

Question 42

Dermatophytes: Nail bed 3

Answer 42

1. Itra, terbinafine, fluconazole

Question 43

Noxafil generic?

Counseling?

Answer 43

Posaconazole

Take with food

Question 44

When should neuraminidase inhibitors be used?

Answer 44

within 48 hours of onset

Question 45

Warnings for Oseltamivir?

Answer 45

Neuropsychiatric events

Question 46

Zanamavir Warniings

Answer 46

Inhalation so bronchospasm is a concern dont use with asthma or COPD

Question 47

HSV-1 is commonly assoicated with?

Answer 47

Oropharyngeal disease

Question 48

HSV 2 is associated with?

Answer 48

genital warts

Question 49

Varicella virus is commonly associated with?

Answer 49

Chicken pox

Question 50

After an occurance of zoster what can happen?

Answer 50

Shingles

Question 51

Acyclovir dosing?

Answer 51

based on IBW no matter what

Question 52

Caution in acyclovir?

Answer 52

renal impairment and elderly and or those getting nephro drugs

Question 53

Tx of Herpes Labialis? OTC and Rx?

Answer 53

Docosanol Abreva

Acyclovir (Zovirax)

Question 54

For genital herpes when does therapy need to be initiated and with what?

Answer 54

Acyclovir during prodrome phase within 1 day of lesion onset

Question 55

Shingles Treatment?

Answer 55

Get the vaccine shingrix > 20

Zovirax 800 mg PO 5x daily for 7 or 10 days

Question 56

Valcyte

Answer 56

Valgancyclovir

Question 57

Valgan Boxed warning?

Answer 57

Myelosuppression

Question 58

Foscarnet Boxed warning?

Answer 58

Renal impairment