ID III: Antifungals and Antivirals Flashcards
Amphotericin B spectrum of activity: yeasts
Candida, Cryptococcus
Amphotericin B spectrum of activity: molds
Aspergillus, Zygomycetes
Amphotericin B spectrum of activity: dimorphic fungi
Histoplasma, Blastomyces, Coccidioides
Which formulation of amphotericin B has more toxicities: the conventional or lipid formulation?
Conventional
Amphotericin B BBW
Med errors between the conventional and lipid formulations have resulted in cardiopulmonary arrest and death
Max daily dose of conventional amphotericin B
1.5mg/kg/day
Amphotericin B preparation: what is it compatible in?
D5W only
Which amphotericin B formulation requires premedication before infusion?
Conventional
premeditate with APAP or NSAID, diphenhydramine or hydrocortisone, NS boluses, and +/- meperidine to decrease the duration of rigors
Amphotericin B monitoring
Renal function, LFTs, electrolytes, CBC
Amphotericin B side effects
Infusion-related reactions, hypokalemia, hypomagnesemia, nephrotoxicity, anemia
When do you use flucytosine?
In combination with amphotericin B. Never use it alone!
BBW for flucytosine
Use extreme caution in patients with renal dysfunction; monitor hematologic, renal, and hepatic status
Flucytosine side effects
dose-related myelosuppression, increased SCr and BUN, liver injury, increased bilirubin, CNS effects, hypoglycemia, HYPOkalemia, aplastic anemia
Class effects of azole antifungals
Increased LFTs, QT prolongation (except for isavuconazonium), many drug interactions
Only azole that requires renal dose adjustment
fluconazole
Ketoconazole BBW
Hepatotoxicity has lead to liver transplant
Itraconazole BBW
can worsen or cause heart failure
Voriconazole warning
Can cause visual changes, phototoxicity
Which azole HAS to be taken with food?
Posaconazole
IV:PO ratio for azole antifungals
1:1
Azoles with SBECD vehicle
voriconazole, posaconazole
Echinocandin drugs
micafungin, caspofungin, anidulafungin
Warnings for echinocandins
Histamine-mediated symptoms
Which ecinocandin requires to be protected from light?
Micafungin
Griseofulvin CI
pregnancy
Terbinafine CI
chronic or active liver disease
Miconazole CI
hypersensitivity to milk protein concentrate
Griseofulvin counseling points
Take with a fatty meal to increase absorption or with food/milk to avoid GI upset
Griseofulvin may cross-react with what allergy?
PCN
Candida oropharyngeal empiric treatment: mild
topical antifungals (clotrimazole, miconazole)
Candida oropharyngeal empiric treatment: moderate/severe or HIV+
fluconazole
Candida oropharyngeal empiric alternate treatment
Nystatin
Candida esophageal empiric treatment
Fluconazole
Candida esophageal alternate empiric treatment
an echinocandin
Candida kruse and glabrata empiric treatment
an echinocandin
Candida krusei and glabrata alternate empiric treatment
Amphotericin B, high-dose fluconazole
Invasive aspergillus empiric treatment
voriconazole
Invasive aspergillus alternate treatment
Amphotericin B, isavuconazonium
Cryptococcus meningitis empiric treatment
amphotericin B and flucytosine
Cryptococcus meningitis alternative empiric treatment
high-dose fluconazole and flucytosine
Dematophytes empiric treatment
terbinafine or itraconazole
Dermatophytes alternate empiric treatment
fluconazole
Single-dose regimen for influenza
baloxavir marboxil, start within 48 hours of symptom onset
Tamiflu warnings
Neuropsychiatric events
Tamiflu dosing: treatment for >12 years
75mg BID x5 days
Tamiflu dosing: prophy for >12 years
75mg QD x10 days
Inhaled influenza treatment
zanamivir
Zanamivir warnings
Don’t use in asthma/COPD, neuropsychiatric events
Antivirals for HSV and VZV
acyclovir (Zovirax)
valacyclovir (Valtrex)
famiciclovir
Dosing acyclovir in obese patients
Use IBW
warnings about HSV and VZV antivirals
Caution in the elderly, renal impairment, and/or those receiving nephrotoxic drugs
Antivirals for cold sores
docosanol (Abreva)
acyclovir (Zovirax)
Antivirals for genital herpes
acyclovir
valacyclovir
famiciclovir
treat for 10 days for initial outbreak
When to give the Shingrix vaccine for shingles
In adults ≥50 years or patients ≥19 years who are immunocompromised
Can you vaccinate a person with the Shingrix vaccine after an acute outbreak?
YES!
Treating invasive HSV infections
10mg/kg of IV acyclovir q8h x14-21 days
Herpes zoster treatment options
acyclovir x7-10 days
valacyclovir x7 days
famiciclovir x7 days
CMV treatment options
ganiciclovir
valganciclovir
cidofovir (alternate treatment)
foscarnet (alternate treatment)
BBW for ganiciclovir and valganciclovir
Myelosuppression, carcinogenic and teratogenic effects and inhibition of spermatogenesis in animals
BBW for foscarnet
Renal impairment