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NAPLEX > ID III: Antifungals and Antivirals > Flashcards

ID III: Antifungals and Antivirals Flashcards

1
Q

Amphotericin B spectrum of activity: yeasts

A

Candida, Cryptococcus

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2
Q

Amphotericin B spectrum of activity: molds

A

Aspergillus, Zygomycetes

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3
Q

Amphotericin B spectrum of activity: dimorphic fungi

A

Histoplasma, Blastomyces, Coccidioides

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4
Q

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

A

Conventional

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5
Q

Amphotericin B BBW

A

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

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6
Q

Max daily dose of conventional amphotericin B

A

1.5mg/kg/day

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7
Q

Amphotericin B preparation: what is it compatible in?

A

D5W only

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8
Q

Which amphotericin B formulation requires premedication before infusion?

A

Conventional

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

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9
Q

Amphotericin B monitoring

A

Renal function, LFTs, electrolytes, CBC

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10
Q

Amphotericin B side effects

A

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

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11
Q

When do you use flucytosine?

A

In combination with amphotericin B. Never use it alone!

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12
Q

BBW for flucytosine

A

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

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13
Q

Flucytosine side effects

A

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

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14
Q

Class effects of azole antifungals

A

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

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15
Q

Only azole that requires renal dose adjustment

A

fluconazole

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16
Q

Ketoconazole BBW

A

Hepatotoxicity has lead to liver transplant

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17
Q

Itraconazole BBW

A

can worsen or cause heart failure

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18
Q

Voriconazole warning

A

Can cause visual changes, phototoxicity

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19
Q

Which azole HAS to be taken with food?

A

Posaconazole

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20
Q

IV:PO ratio for azole antifungals

A

1:1

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21
Q

Azoles with SBECD vehicle

A

voriconazole, posaconazole

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22
Q

Echinocandin drugs

A

micafungin, caspofungin, anidulafungin

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23
Q

Warnings for echinocandins

A

Histamine-mediated symptoms

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24
Q

Which ecinocandin requires to be protected from light?

A

Micafungin

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25
Q

Griseofulvin CI

A

pregnancy

26
Q

Terbinafine CI

A

chronic or active liver disease

27
Q

Miconazole CI

A

hypersensitivity to milk protein concentrate

28
Q

Griseofulvin counseling points

A

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

29
Q

Griseofulvin may cross-react with what allergy?

A

PCN

30
Q

Candida oropharyngeal empiric treatment: mild

A

topical antifungals (clotrimazole, miconazole)

31
Q

Candida oropharyngeal empiric treatment: moderate/severe or HIV+

A

fluconazole

32
Q

Candida oropharyngeal empiric alternate treatment

A

Nystatin

33
Q

Candida esophageal empiric treatment

A

Fluconazole

34
Q

Candida esophageal alternate empiric treatment

A

an echinocandin

35
Q

Candida kruse and glabrata empiric treatment

A

an echinocandin

36
Q

Candida krusei and glabrata alternate empiric treatment

A

Amphotericin B, high-dose fluconazole

37
Q

Invasive aspergillus empiric treatment

A

voriconazole

38
Q

Invasive aspergillus alternate treatment

A

Amphotericin B, isavuconazonium

39
Q

Cryptococcus meningitis empiric treatment

A

amphotericin B and flucytosine

40
Q

Cryptococcus meningitis alternative empiric treatment

A

high-dose fluconazole and flucytosine

41
Q

Dematophytes empiric treatment

A

terbinafine or itraconazole

42
Q

Dermatophytes alternate empiric treatment

A

fluconazole

43
Q

Single-dose regimen for influenza

A

baloxavir marboxil, start within 48 hours of symptom onset

44
Q

Tamiflu warnings

A

Neuropsychiatric events

45
Q

Tamiflu dosing: treatment for >12 years

A

75mg BID x5 days

46
Q

Tamiflu dosing: prophy for >12 years

A

75mg QD x10 days

47
Q

Inhaled influenza treatment

A

zanamivir

48
Q

Zanamivir warnings

A

Don’t use in asthma/COPD, neuropsychiatric events

49
Q

Antivirals for HSV and VZV

A

acyclovir (Zovirax)
valacyclovir (Valtrex)
famiciclovir

50
Q

Dosing acyclovir in obese patients

A

Use IBW

51
Q

warnings about HSV and VZV antivirals

A

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

52
Q

Antivirals for cold sores

A

docosanol (Abreva)
acyclovir (Zovirax)

53
Q

Antivirals for genital herpes

A

acyclovir
valacyclovir
famiciclovir

treat for 10 days for initial outbreak

54
Q

When to give the Shingrix vaccine for shingles

A

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

55
Q

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

A

YES!

56
Q

Treating invasive HSV infections

A

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

57
Q

Herpes zoster treatment options

A

acyclovir x7-10 days
valacyclovir x7 days
famiciclovir x7 days

58
Q

CMV treatment options

A

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

59
Q

BBW for ganiciclovir and valganciclovir

A

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

60
Q

BBW for foscarnet

A

Renal impairment

NAPLEX (18 decks)

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