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NAPLEX Review > ID Fungal and Viral > Flashcards

ID Fungal and Viral Flashcards

1
Q

Organisms from the candida species and cryptococcus neoformans are from what fungal class?

A

Yeasts

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2
Q

Aspergillus adn zygomycetes species are from what fungal class?

A

Molds

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3
Q

Histoplasma capsulatum, blastomyces dermatitidis, and coccidioides immitus are from what fungal class?

A

Dimorphic fungi

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4
Q

What is the difference in amphotericin B deoxycholate and amphotericing b lipid formulations?

A

Lipid formulations are bound to lipid and has fewer toxicities

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5
Q

What is amphotericin B used to treat?

A

Invasive fungal infections caused by
Candida species and cryptococcus neoformans
Aspergillus species, zygomycetes
Histoplasma capsulatum, blastomyces dermatidis, and coccidioides immitis

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6
Q

Amphotericin B MOA

A

binds to ergosterol altering cell membrane permeability and causing cell death

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7
Q

Amphotericin B BBW and SE

A

BBW: Amphotericin B max 1.5mg/kg/day, lipid complex formulation max 5mg/kg/d, liposomal formulation max 6mg/kg/d
SE: infusion-related, fever, chills, HA, malaise, rigors, low K and Mg, nephrotoxicity

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8
Q

Which formulation of amphotericin B needs to be diluted in D5W? Which need to be filtered? Which needs premedication?

A

D5W: all
Filtered: lipid formulations
Premedication: deoxycholate (non-lipid formulation)

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9
Q

What premedication should be given for amphotericin B deoxycholate?

A

APAP or NSAID
Diphenhydramien and/or hydrocortisone
NS boluses to decrease nephrotoxicity
+/- meperidine to decrease duration of severe rigors

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10
Q

Flucytosine MOA

A

Converted to fluorouracil in fungi which interferes with fungal RNA and protein synthesis

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11
Q

Invasive cryptococcal meningitis infection treatment

A

Amphotericin B + Flucytosine

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12
Q

Why should flucytosine not be used alone?

A

Developing resistance

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13
Q

Flucytosine BBW and SE

A

BBW: use with caution in renal dysfunction, monitor renal and hepatic status
SE: Dose-related myelosuppression, increase SCr and BUN, liver injury, increased bilirubin, many CNS effects, hypoglycemia, low K

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14
Q

Azole antifungals MOA

A

Decrease ergosterol synthesis and cell membrane formation

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15
Q

Azole antifungal effect on CYP enzymes

A

CYP3A4 inhibitors

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16
Q

What candida orgnaism is resistant to fluconazole?

A

C. krusei

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17
Q

What fungal infections is fluconazole used to treat?

A

yeast (vaginal, esophageal, mouth), nail bed infections

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18
Q

What fungal infections is itraconazole used to treat? Why is it’s use limited?

A

Blastomycosis and histoplasmosis

Limited by drug interactions, lack of data, and expense

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19
Q

Why is ketoconazole only used topically?

A

toxicities and many drug interactions

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20
Q

What is voriconazole DOC for?

A

Aspergillus

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21
Q

Azole antifungals Class effects and IV:PO ratio

A

Can increase LFTs
Risk for QT prolongation (except isavuconazonium)
Many drug interactions
IV:PO is 1:1

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22
Q

Which is the only azole antifungal that

requires renal dose adjustment

A

Fluconazole

If CrCl <50 decrease dose by 50%

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23
Q

Which is the only azole antifungal that

has hepatotoxicity that can lead to liver transplantation

A

Ketoconazole

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24
Q

Which is the only azole antifungal that

can cause HF

A

Itraconazole

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25
Q

Which is the only azole antifungal that

can cause visual changes and phototoxicity

A

Voriconazole

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26
Q

Fluconazole dosing for vaginal candidiasis

A

150mg x 1

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27
Q

Itraconazole BBW

A

Can worsen HF

Can increase plasma concentrations and cause QT prolongation, ventricular tachycardia, and torsades

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28
Q

Ketoconazole BBW

A

Hepatotoxicity (liver transplant), QT prolongation

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29
Q

Voriconazole CI

A

Coadministration with barbiturates, carbamazapine, efavirenz, ergot alkaloids, pimozide, quinidine, rifabutin, rifampin, ritonavir, sirolimus, or st johns wort

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30
Q

Posaconazole CI

A

Coadministration with sirolimus, ergot alkaloids, pimozide, quinidine, atorvastatin, lovastatin, and simvastatin

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31
Q

Isavuconazonium CI

A

Use with strong CYP3A4 inhibitors or inducers, familial short QT syndrome

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32
Q

Which azole antifungal is not hepatically cleared?

A

Fluconazole

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33
Q

Which azole antifungals penetrate CNS?

A

Fluconazole and voriconazole

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34
Q

Which azole antifungal causes QT shortening rather than prolongation?

A

Isavuconazonium

35
Q

Azole antifungals interaction with apixiban and rivaroxaban

A

Increase concentration of DOAC - monitor for s/sx of bleeding

36
Q

Azole antifungals interaction with warfarin

A

Increase effects of warfarin and INR

37
Q

Absorption of which azole antifungals is pH dependent?

A

Itraconazole and ketoconazole
Higher pH will decrease absorption
Can take with non-diet cola or orange juice to provide acidic environment for absorption

38
Q

Echinocandin MOA

A

Inhibit synthesis of beta (1,3)-D-glucan, an essential component of the fungal cell wall

39
Q

What medications are echinocandins

A

Caspofungin and micofungin

40
Q

What do echinocandins cover?

A

Most candida species and some aspergillus species (not preferred for aspergillus as monotherapy)

41
Q

Echinocandin warnings and SE

A

Warnings: histamine-mediated symptoms (rash, flushing, hypotension), anaphylaxis
SE: increased LFTs, HA, hypotension, low Mg, fever, N/V/D, hyperglycemia, anemia, increased SCr, rash

42
Q

How often are echinocandins administered and what are their renal adjustments?

A

Once daily

No renal adjustments

43
Q

What dosage form is preferred for topical fungal infections?

A 
Topical products (gel, cream, solution, etc)
Oral are second line
44
Q

Griseofulvin indication, CI, SE

A

Indication: Fungal infections of skin, hair, nails
CI: Pregnancy, severe liver disease, porphyria
SE: Photosensitivity, increased LFTs, HA, rash, urticaria, dizziness, leukopenia, severe skin reactions

45
Q

Terbinafine CI, warnings, SE

A

CI: Chronic or acute liver disease
Warnings: hepatotoxicity, taste/smell disturbance, hematologic abnormalities, hemolytic uremia syndrome, SJS
SE: HA, increased LFTs, skin rashes

46
Q

Which antifungal agent can increase metabolism of hormonal contraceptives? What should be used instead?

A

Griseofulvin

Use non-hormonal methods

47
Q

Preferred and alternative regimens for

candida albicans - oropharyngeal infection (thrush)

A

Preferred: topical clotrimazole or miconazole (mild), fluconazole (mod/severe or HIV+)
Alternative: nystatin

48
Q

Preferred and alternative regimens for

candida albicans - esophageal infection

A

Preferred: fluconazole
Alternative: echinocandin

49
Q

Preferred and alternative regimens for

candida krusei and glabrata - bloodstream infection

A

Preferred: echinocandin
Alternative: amphotericin B

50
Q

Preferred and alternative regimens for

Aspergillus - invasive

A

Preferred: voriconazole
Alternative: Amphotericin B, isavuconazonium

51
Q

Preferred and alternative regimens for

cryptococcus neoformans - meningitis

A

Preferred: amphotericin B + flucytosine
Alternative: none

52
Q

Preferred and alternative regimens for

Dermatophytes - nail bed infection

A

Preferred: terbinafine or itraconazole
Alternative: fluconazole

53
Q

Which antifungals should be taken with food?

A

With food: itraconazole tablets and capsules, posaconazole

Without food: itraconazole solution, voriconazole

54
Q

Neuraminidase inhibitors indication and MOA

A

Indicated for influenza

MOA: inhibit the enzyme that enables release of new viral particles from infected cells

55
Q

When should neuraminidase inhibitors be started

A

<48 hours of illness onset in mild cases

Anytime if hospitalized for severe illness

56
Q

What drugs are neuaminidase inhibitors?

A

Oseltamivir (Tamiflu)
Zanamivir (Relenza diskhaler)
Peramivir (Rapivab)

57
Q

Oseltamivir treatment and prophylaxis doses

A

Treatment >12 years: 75mg BID x 5 days

Prophylaxis >12 years: 75mg BID x 10 days

58
Q

Oseltamivir renal adjustment

A

CrCl < 60 reduce dose

59
Q

Oseltamivir warnings and SE

A

Warnings: neuropsychiatric events, serious skin reaction, anaphylaxis
SE: HA, N/V/D, abdominal pain, delirium

60
Q

Which neuroaminidase inhibitor is preferred over the others in pregnancy

A

Oseltamivir

61
Q

What drugs are endonuclease inhibitors?

A

Baloxavir marboxil

62
Q

Baloxavir marboxil dosing, warnings, and SE

A 
<40kg: do not use
<80kg: 40mg PO x1
>80kg: 80mg PO x1
Use within 48 hours of symptom onset
Warnings: hypersensitivity
SE: diarrhea
63
Q

Which HSV virus is associated with oropharyngeal disease and which is associated with genital disease?

A

HSV-1: oropharyngeal

HSV-2: genital

64
Q

What virus causes chicken pox?

A

Varicella zoster virus

65
Q

What antivirals are used for HSV and varicela zoster virus?

A

Acyclovir
Valacyclovir
Famiciclovir

66
Q

What is valacyclovir a prodrug of?

A

Acyclovir

67
Q

What is famiciclovir a prodrug of?

A

penciclovir

68
Q

Acyclovir, valacyclovir, and famiciclovir warnings, SE

A

Warnings: Caution in renal impairment, elderly, and concurrent nephrotoxic medication use
SE: malaise, HA, N/V/D, rash, increased LFTs, seizures

69
Q

What antiviral can cause increased SCr and BUN with crystal nephropathy?

A

IV acyclovir

70
Q

Topical treatment for herpes labialis (cold sore)

A

OTC: Docosanol (abreva)
Rx: Acyclovir cream (Zovirax) and buccal tablet, Penciclovir

71
Q

Systemic treatment for herpes labialis (cold sore)

A

Initial episode: acyclovir 200-400mg 5x daily for 7-10 days OR 400mg TID x 7-10 days; valacyclovir 2g BID x1 day
Recurrent episode: acyclovir 200-400mg 5x daily for 5 days OR 400mg PO TID x 5 days OR 800mg PO BID x 5 days; valacyclovir 2g PO BID x 1 day
Chronic suppression: acyclovir 400mg PO BID

72
Q

If an organism is resistant to acyclovir it will also be resistant to what medication?

A

Valacyclovir because it is a prodrug of acyclovir

Will usually be resistant to famciclovir too

73
Q

Genital herpes treatment with acyclovir

A

Initial episode: 400mg TID x 7-10 days OR 200mg 5x daily for 7-10 days
Recurrent episodes: 400mg TID x 5 days OR 800mg BID x 5 days OR 800mg TID x 2 days
Chronic suppression: 400mg BID

74
Q

Genital herpes treatment with valacyclovir

A

Initial episode: 1g PO BID x 7-10 days
Recurrent episodes: 500mg BID x 3 days OR 1g daily x 5 days
Chronic suppression: 500-1000mg daily

75
Q

Treatment of invasive HSV

A

Encephalitis: Acyclovir 20mg/kg/dose q8h x 14-21 days

Esophagitis and pneumonitis: 5mg/kg/dose q8h x 14-21 days

76
Q

Treatment for shingles (herpes zoster)

A

Acyclovir 800mg 5x daily for 7-10 days
Valacyclovir 1g TID x 7 days
Famciclovir 500mg TID x 7 days

77
Q

What does cytomegalovirus (CMV) usually cause?

A

Retinitis, colitis, or esophagitis

78
Q

What medications are the treatments of choice for cytomegalovirus (CMV)? What should be reserved for refractory CMV?

A

Treatment of choice: Ganciclovir and valganciclovir

Refractory: foscarnet and cidofovir

79
Q

What is leteromovir and what is it indicated for?

A

Non-nucleoside CMV inhibitor

Indicated for prophylaxis of CMV in patients receiving a hematopoietic stem cell transplant who screen positive for CVM

80
Q

Ganciclovir and valganciclovir BBW and SE

A

myelosuppression, teratogenic effects

SE: Fever, N/V/D, hemotologic abnormalities, increased SCr, seizures, retinal detachment (valganciclovir)

81
Q

Cidofovir BBW, CI, and SE

A

BBW: dose-dependent nephrotoxicity, neutropenia, carcinogenic/teratogenic
CI: SCr > 1.5, CrCl <55 urine protein >100, sulfa allergy, nephrotoxic drugs
\SE: nephrotoxicity, lower risk of myelosuppression, metabolic acidosis

82
Q

Foscarnet indication

A

CMV retinitis and resistant HSV

83
Q

Foscarnet BBW and SE

A

BBW: renal impairment, seizures d/t electrolyte imbalances
SE: electrolyte abnormalities (low K, Ca, Mg, Phos), increased SCr/BUN, and QT prolongation

84
Q

Epstein-Barr Virus (EBV) is also known as what?

A

Mononucleosis or “mono”

NAPLEX Review (79 decks)

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