ID III: Antifungals and Antivirals

Question 1

Amphotericin B spectrum of activity: yeasts

Answer 1

Candida, Cryptococcus

Question 2

Amphotericin B spectrum of activity: molds

Answer 2

Aspergillus, Zygomycetes

Question 3

Amphotericin B spectrum of activity: dimorphic fungi

Answer 3

Histoplasma, Blastomyces, Coccidioides

Question 4

Which formulation of amphotericin B has more toxicities: the conventional or lipid formulation?

Answer 4

Conventional

Question 5

Amphotericin B BBW

Answer 5

Med errors between the conventional and lipid formulations have resulted in cardiopulmonary arrest and death

Question 6

Max daily dose of conventional amphotericin B

Answer 6

1.5mg/kg/day

Question 7

Amphotericin B preparation: what is it compatible in?

Answer 7

D5W only

Question 8

Which amphotericin B formulation requires premedication before infusion?

Answer 8

Conventional

premeditate with APAP or NSAID, diphenhydramine or hydrocortisone, NS boluses, and +/- meperidine to decrease the duration of rigors

Question 9

Amphotericin B monitoring

Answer 9

Renal function, LFTs, electrolytes, CBC

Question 10

Amphotericin B side effects

Answer 10

Infusion-related reactions, hypokalemia, hypomagnesemia, nephrotoxicity, anemia

Question 11

When do you use flucytosine?

Answer 11

In combination with amphotericin B. Never use it alone!

Question 12

BBW for flucytosine

Answer 12

Use extreme caution in patients with renal dysfunction; monitor hematologic, renal, and hepatic status

Question 13

Flucytosine side effects

Answer 13

dose-related myelosuppression, increased SCr and BUN, liver injury, increased bilirubin, CNS effects, hypoglycemia, HYPOkalemia, aplastic anemia

Question 14

Class effects of azole antifungals

Answer 14

Increased LFTs, QT prolongation (except for isavuconazonium), many drug interactions

Question 15

Only azole that requires renal dose adjustment

Answer 15

fluconazole

Question 16

Ketoconazole BBW

Answer 16

Hepatotoxicity has lead to liver transplant

Question 17

Itraconazole BBW

Answer 17

can worsen or cause heart failure

Question 18

Voriconazole warning

Answer 18

Can cause visual changes, phototoxicity

Question 19

Which azole HAS to be taken with food?

Answer 19

Posaconazole

Question 20

IV:PO ratio for azole antifungals

Answer 20

1:1

Question 21

Azoles with SBECD vehicle

Answer 21

voriconazole, posaconazole

Question 22

Echinocandin drugs

Answer 22

micafungin, caspofungin, anidulafungin

Question 23

Warnings for echinocandins

Answer 23

Histamine-mediated symptoms

Question 24

Which ecinocandin requires to be protected from light?

Answer 24

Micafungin

Question 25

Griseofulvin CI

Answer 25

pregnancy

Question 26

Terbinafine CI

Answer 26

chronic or active liver disease

Question 27

Miconazole CI

Answer 27

hypersensitivity to milk protein concentrate

Question 28

Griseofulvin counseling points

Answer 28

Take with a fatty meal to increase absorption or with food/milk to avoid GI upset

Question 29

Griseofulvin may cross-react with what allergy?

Answer 29

PCN

Question 30

Candida oropharyngeal empiric treatment: mild

Answer 30

topical antifungals (clotrimazole, miconazole)

Question 31

Candida oropharyngeal empiric treatment: moderate/severe or HIV+

Answer 31

fluconazole

Question 32

Candida oropharyngeal empiric alternate treatment

Answer 32

Nystatin

Question 33

Candida esophageal empiric treatment

Answer 33

Fluconazole

Question 34

Candida esophageal alternate empiric treatment

Answer 34

an echinocandin

Question 35

Candida kruse and glabrata empiric treatment

Answer 35

an echinocandin

Question 36

Candida krusei and glabrata alternate empiric treatment

Answer 36

Amphotericin B, high-dose fluconazole

Question 37

Invasive aspergillus empiric treatment

Answer 37

voriconazole

Question 38

Invasive aspergillus alternate treatment

Answer 38

Amphotericin B, isavuconazonium

Question 39

Cryptococcus meningitis empiric treatment

Answer 39

amphotericin B and flucytosine

Question 40

Cryptococcus meningitis alternative empiric treatment

Answer 40

high-dose fluconazole and flucytosine

Question 41

Dematophytes empiric treatment

Answer 41

terbinafine or itraconazole

Question 42

Dermatophytes alternate empiric treatment

Answer 42

fluconazole

Question 43

Single-dose regimen for influenza

Answer 43

baloxavir marboxil, start within 48 hours of symptom onset

Question 44

Tamiflu warnings

Answer 44

Neuropsychiatric events

Question 45

Tamiflu dosing: treatment for >12 years

Answer 45

75mg BID x5 days

Question 46

Tamiflu dosing: prophy for >12 years

Answer 46

75mg QD x10 days

Question 47

Inhaled influenza treatment

Answer 47

zanamivir

Question 48

Zanamivir warnings

Answer 48

Don't use in asthma/COPD, neuropsychiatric events

Question 49

Antivirals for HSV and VZV

Answer 49

acyclovir (Zovirax) valacyclovir (Valtrex) famiciclovir

Question 50

Dosing acyclovir in obese patients

Answer 50

Use IBW

Question 51

warnings about HSV and VZV antivirals

Answer 51

Caution in the elderly, renal impairment, and/or those receiving nephrotoxic drugs

Question 52

Antivirals for cold sores

Answer 52

docosanol (Abreva) acyclovir (Zovirax)

Question 53

Antivirals for genital herpes

Answer 53

acyclovir valacyclovir famiciclovir treat for 10 days for initial outbreak

Question 54

When to give the Shingrix vaccine for shingles

Answer 54

In adults ≥50 years or patients ≥19 years who are immunocompromised

Question 55

Can you vaccinate a person with the Shingrix vaccine after an acute outbreak?

Answer 55

YES!

Question 56

Treating invasive HSV infections

Answer 56

10mg/kg of IV acyclovir q8h x14-21 days

Question 57

Herpes zoster treatment options

Answer 57

acyclovir x7-10 days valacyclovir x7 days famiciclovir x7 days

Question 58

CMV treatment options

Answer 58

ganiciclovir valganciclovir cidofovir (alternate treatment) foscarnet (alternate treatment)

Question 59

BBW for ganiciclovir and valganciclovir

Answer 59

Myelosuppression, carcinogenic and teratogenic effects and inhibition of spermatogenesis in animals

Question 60

BBW for foscarnet

Answer 60

Renal impairment