ID III: Antifungals and Antivrals

Question 1

what does amph b cover?

Answer 1

most candida, aspergillus, zygomycetes, dimorphic histoplasmas, blastomyces, coccodioides, cryptococcal meningitis

Question 2

what formulations does amph B come in?

what is the difference btwn the formulations?

Answer 2

comes in deoxycholate and lipid formlations

deoxy formulation : infusion related rxn (fever, rigors, chills, sweating, HA), BP changes, thrombophlebitis, N/V, DEC K AND Mg, NEPHROTOXCITY, ANEMIA

Question 3

dosing of amph B formulations

Answer 3

deoxycholate: 0.1-1.5mg/kg/d
lipid formulation: 5mg/kg/d

Question 4

How should Amph B deoxycholate formulation be administered

Answer 4

pre medicate with
APAP or NSAID
benadryl +/- hydrocortisone
NS boluses to dec nephrotoxicity
+/- meperidine to dec severe rigor duration

Question 5

lipid formulations of amph B need to be _______________ prior to administration

Answer 5

filtered

Question 6

amph B interacts with ___________ due to _____________.

A. warfarin, 2D6 inhibition by amph B
B. warfarin, 3A4 induction by warfarin
C. rifampin, 3A4 induction by rifampin
D. digoxin, hyperkalemia risk

Answer 6

D. digoxin, hyperkalemia risk

Question 7

amph B has a BBW for

Answer 7

formulation mix ups
deoxycholate not to exceed 1.5mg/kg/day

Question 8

amph B formulations are

A. blue
B. yellow-orange
C. red
D. clear

Answer 8

B. yellow-orange

Question 9

what should be considered as additional management while a patient is receiving amph B

Answer 9

scheduled K and Mg repletion

Question 10

amph B can be in

A. NS only
B. NS or D5W
C. NS or LR
D. D5W only
E. NS LR or D5W

Answer 10

D. D5W only

Question 11

caspofungin can be in

A. NS only
B. NS or D5W
C. NS or LR
D. D5W only
E. NS LR or D5W

Answer 11

C. NS or LR

Question 12

flucytosine is recommended for

Answer 12

invasive cryptococcal or candida infections in combo w Amph B

Question 13

flucytosine is best as monotherapy
T or F

Answer 13

false, always an add on

Question 14

flucytosine BBWs

Answer 14

extreme caution in renal dysfunction
monitor renal fxn, liver fxn, hematologic status

Question 15

flucytosine ADE

Answer 15

nephrotox, myelosuppression, CNS effects, BG dec, dec K, aplastic anemia

Question 16

how should flucytosine be monitored

Answer 16

CNS ADE
renal fxn
liver fxn
hematologic status (CBC)
electrolytes (K)

Question 17

what does fluconazole cover

Answer 17

c. albicnas
c. parapsilosis
c. tropicalis

Question 18

what two candida species are considered resistant to azole antifungals

Answer 18

c glabrata
c krusei

Question 19

class effects/pearls of antifungals

Answer 19

QT prolongation!
all 1:1 IV:PO
typically inhibit CYPs

Question 20

fluconazole dosing

Answer 20

50-800mg IV/PO qd
dec dose if CrCl <50

Question 21

which azoles are contraindicated with many other meds including barbiturates, rifampin, alkaloids, ritonavir, carbamazepine and efavirenz

Answer 21

posaconazole, voriconazole

Question 22

ketoconazole BBW
dosing

Answer 22

BBW hepatotox, QTp, oral is last line if no other option available

200-400mg/d

Question 23

itraconazole can cause ____________ which is a BBW

Answer 23

HF

Question 24

all azoles inhibit CYP______, and increase plasma concentrations of ___________ and ___________

Answer 24

3A4
rivaroxaban and apixaban

Question 25

what are the echinocandins and what do they cover

Answer 25

caspofungin and micafungin

cover candida species including c glabrata and c krusei that the azoles do not cover!

Question 26

AE of the echinocandins caspofungin and micafungin

Answer 26

histamine related
anaphylaxis

Question 27

caspofungin dosing

Answer 27

70mg IV day 1, then 50mg IV daily (35mg IV daily if hepatic imp)

Question 28

micafungin dosing

Answer 28

candida: 100mg IV daily
esophageal candida: 150 IV daily

Question 29

caspofungin and micafungin are both administered _____

Answer 29

IV

Question 30

nystatin
dosing

Answer 30

po candida (thrush)
400,000 - 600,000 U QID x7-14d
SWISH AND SWALLOW

intestinal infection
500,000 - 1,000,000 U Q8H

Question 31

treatment for mild thrush

Answer 31

clotrimazole troches
or
miconazole
or
nystatin

Question 32

treatment for mod-severe thrush OR thrush in HIV+ patients

Answer 32

fluconazole

Question 33

esophageal c. albicans treatment

Answer 33

fluconazole
or
echinocandins (caspo or mica)

Question 34

nail bed infection (dermatophytes) treatment

Answer 34

terbinafine or itraconazole

or

fluconazole

Question 35

aspergillus treatment

Answer 35

voriconazole
or
amph B

Question 36

c. krusei or c. glabrata treatment

Answer 36

echinocandins
(resistant to azoles!)
or
amph B
or
high dose fluconazole

Question 37

cryptococcus neoformans (meningitis) treatment

Answer 37

amph B + flucytosine

Question 38

patient initiated on voriconazole for invasive aspergillus. what are possible ADE

Answer 38

phototoxicity and vision changes
QTp
DDI

Question 39

influenza first line tx

Answer 39

oseltamivir (Tamiflu)
must be started within 48 hours of sx onset
75mg PO BID x5d if > 12 yo

pediatric dosing is based on TBW

Question 40

when is it reasonable to initiate Tamiflu after 48 hours since sx onset

Answer 40

severely ill patients

Question 41

possible ADE of Tamiflu

Answer 41

neuropsych, HA, N/V

Question 42

COVID-19 treatment options

Answer 42

supplemental care (APAP, O2, hydration etc.)

remdesivir, paxlovid, toclizumab

if patient is on oxygen, add dexamethasone (sterod equivalent 0.75mg)

Question 43

acyclovir and valacyclovir dosing in oral/genital herpes vs shingles

Answer 43

——————-oral genital shingles
acyclovir 400mg TID 400mg TID 800mg
x 7-10d x 7-10d 5x/dx7-10d

valacyclovir 1g BID 1g BID 1g TID x7d

Question 44

cytomegalovirus
treatment

Answer 44

gangciclovir or valgangciclovir