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NAPLEX 21 > ID III: Antifungals & Antivirals > Flashcards

ID III: Antifungals & Antivirals Flashcards

1
Q

Fungi are classified as either:

A

yeasts, molds, or dimorphic

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2
Q

Candida species:

C. albicans, C. krusei, C. tropicalis, Cryptococcus neoformans are examples of

A

Yeasts (exist in the heat)

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3
Q

Aspergillus species, Zygomycetes (Nucor and rhizopus species) are examples of:

A

Molds (exist in the cold)

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4
Q

Histoplasma capsulatum, Blastomyces dermatitidis, and coccidiodes immitis are examples of

A

dimorphic fungi

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5
Q

Zygomyctes refers to a class of fungi which includes Mucor species and Rhizopus species; invasive disease with this group is commonly called

A

mucormycosis

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6
Q

The most susceptible Candida species:

More difficult to treat due to resistance:

A

Easy: C.albicans
Harder: C. glabrata and C. Krusei

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7
Q

MOA: binds to ergosterol, alternating cell membrane permeability and causes cell death

A

Amphotericin B

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8
Q

Which form of Amphotericin B has few toxicities? (dec infusion reactions, dec nephrotoxicity)

A

The lipid formulations

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9
Q

Which drug is active against:
Yeast - most Candida species, Cryptococcus neoformans
Molds - Aspergillus species, Zygomycetes
Dimorphic fungi - Histoplasma capsulate, Blastomyces dermatittidis and Coccidiodes immitis

A

Amphotericin B

Broad-spectrum!

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10
Q

Brand: AmBisome

A

Generic: Liposomal Amphotericin B (INJ)

3-6mg/kg/day

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11
Q

Brand: Abelcet

A

Generic: Amphotericin B Lipid Complex

5mg/kg/day

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12
Q

Conventional amphotericin B for injection doses should not exceed 1.5mg/kg/day; verify product name and dosage. Overdose can result in:

BOXED WARNING.

A

Cardiopulmonary arrest

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13
Q

Common side effects of this drug can result in infusion-related fever, chills, headache, malaise, rigors; as well as dec K & Mg, nephrotocixicity

A

Amphotericin B

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14
Q

Preparation of Amphotericin B should be diluted in ____ ONLY.

A

D5W; lipid formulation must be filtered during preparation

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15
Q

Which formulation of Amphotericin B requires premedication to reduce infusion-related reactions? (30-60 mins prior to infusion administer Tylenol or NSAID, Benadryl and/or hydrocortison

A

Conventional formulation (ampho B deoxycholate)

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16
Q

This drug penetrates fungal cells and is converted to fluorouracil, which competes with uracil, interfering with fungal RNA and protein synthesis

A

Flucytosine

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17
Q

Brand: Ancobon

A

Generic: Flucytosine, 5-FC

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18
Q

Due to development of resistance, flucytosine should not be used alone, but is recommended for use in combination with:

A

amphotericin B

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19
Q

Flucytosine + Amphotericin B are used to treat:

A

invasive Cryptococcal (meningitis) or Candida infections

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20
Q

These drugs decrease ergosterol synthesis and cell membrane formation

A

Azole antifungals

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21
Q

This azole has activity against C. albicans, C. parapilosis and C. tropicalis; but limited efficacy against C. glabrata due to resistance & C. Krusei is completely resistant.

A

Fluconazole

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22
Q

This drug can be used for many infections including yeast (vaginal and esophageal, mouth), and nail bed infections (onychomycosis)

A

Fluconazole

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23
Q

The primary uses for this drug are for dimorphic fungi Blastomycosis and Histoplasmosis and for nail bed infections

A

Itraconazole

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24
Q

Treatment of choice for Aspergillus

A

Voriconazole

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25
Q

Key issues with Azole antifungals:

  • All can cause inc ______
  • All have a risk for ________; except isavuconazonium
  • MANY drug interactions - CYP 3A4
A

inc LFTs

QT Prolongation

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26
Q

Only azole that requires renal dose adjustment

A

Fluconazole

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27
Q

Hepatoxicity has led to liver transplantation

A

Ketoconazole

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28
Q

Can cause HF

A

Itraconazole

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29
Q

Can cause visual changes and phototoxicity

A

Voriconazole

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30
Q

Tablet dose does not equal suspension dose (due to different bioavailability) and take w food

A

Posaconazole

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31
Q

IV to PO Ratio is what for all azoles

A

1:1

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32
Q

Drugs with sulfobutyl ether beta-cyclodextrin (SBECD) vehicle

A

voriconazole, posaconazole

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33
Q

Brand: Diflucan

A

Generic: Fluconazole

NOT for preggos

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34
Q

Fluconazole dosing for vaginal candidasis

A

150mg PO x1

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35
Q

Brand: Spranox, Tolsura

A

Itraconazole

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36
Q

Brand: Nizoral, Nizoral A-D, Extina, Xolegel

A

Generic: Ketoconazole

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37
Q

Which azoles can penetrate the CNS adequately to treat fungal meningitis

A

Fluconazole and voriconazole

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38
Q

Brand: Vfend, Vfend IV

A

Voriconazole

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39
Q

When CrCl <50ml/min, which formulation of voriconazole and posaconazole is preferred?

A

PO, due to the SBECD accumulation

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40
Q

While taking this drug, avoid direct sunlight, take on an empty stomach

A

Voriconazole

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41
Q

Brand: Noxafil

A

Generic: Posaconazole

Take with food

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42
Q

Brand: Cresemba

A

Generic: Isavuconazonium sulfate

43
Q

Which azole drug can cause QT shortening?

A

Cresemba/Isavuconazonium

*requires a filter during administration

44
Q

Itraconazole and ketoconazole inhibit

A

P-gp

45
Q

Fluconazole and voriconazle inhibit CYP…

A

CYP2C9 and 2C19

46
Q

Absorption of these azoles are pH dependent

A

Itraconazole and ketoconazole

inc pH will dec absorption

47
Q

This drug inhibits synthesis of beta (1,3) D glucan, an essential component of the fungal cell wall

A

Echinocandins

48
Q

These drugs are most effective against most Candida species, including non-albicans strains that are resistant to azoles (C. glabrata and C. Krusei)

A

Echinocandins

49
Q

Brand: Cancidas

A

Generic: Caspofungin

50
Q

Brand: Mycamine

A

Generic: Micafungin

51
Q

Brand: Eraxis

A

Generic: Anidulafungin

52
Q

Warnings of these drugs include a histamine-mediated symptoms
& all are given ONCE daily and do NOT require dose adjustment in renal impairment

A

Echinocandins

53
Q

These two drugs are useful for treating mild, localized Candida infections like thrush

A

Nystatin suspension and clotrimazole troches/lozenges

54
Q

Nystatin is available in what drug formulations

A

Suspension and tablet, topical forms

Yes- you swallow for oral candidasis

55
Q

This drug is indicated for fungal infections of the skin, hair, and nails BUT has photosensitivity and can inc LFTs. Take with a fatty meal to inc absorption
C/I in preg

A

Griseofulvin

56
Q

Brand: Lamisil AT

A

Generic: Terbinafine

57
Q

This drug has warnings for hepatoxicity; side effects include headache and inc LFTs. The topical forms come in Rx and OTC

A

Terbinafine

58
Q

This drug comes in troche/lozenge and topical and vaginal forms (Mycelex)

A

Clotrimazole

59
Q

This drug can increase metabolism of hormonal contraceptives which can lead to OC failure

A

Griseofulvin

60
Q

What is the preferred regimen for:

Pathogen: Candida albicans

oropharyngeal infection (thrush), mild disease

A

Topical antifungals (clotrimazole, miconazole)

Alt: nystatin

61
Q

What is the preferred regimen for:

Pathogen: Candida albicans -

oropharyngeal infection (thrush), mod-severe or HIV+ disease

A

fluconazole

Alt: nystatin

62
Q

What is the preferred regimen for:

Pathogen: Candida albicans

esophageal infection

A

Fluconazole

Alt: Echinocandin

63
Q

What is the preferred regimen for:

Pathogen: Candida Krusei and glabrata

Bloodstream infection

A

Echinocandin

Alt: Ampho B

64
Q

What is the preferred regimen for:

Pathogen: aspergillus, invasive

A

Voriconazole

Alt: Ampho B or isavuconazonium

65
Q

What is the preferred regimen for:

Pathogen: Cryptococcus neoformans

Meningitis

A

Amphotericin B + flucytosine (5-FC_

66
Q

What is the preferred regimen for:

Pathogen: dermatophytes

Nail bed infection

A

Terbinafine or itraconazole

Alt: fluconazole

67
Q

These antifunals can cause liver damage and QT prolongation, and have many drug interactions

A

AZOLE antifungals

no QT prolongation with isavuconazonium

68
Q 
Which azole?
Tablets and capsules: take with food
Solution: take on an empty stomach
Can cause HF
Drug interactions due to high gastric pH
A

Itraconazole

69
Q

Which azole?

Tablets- take with food
Suspension- take with full meal or oral liquid nutritional supplement

A

Posaconazole (Noxafil)

70
Q

Which azole?
Take on an empty stomach at least 1 hour before or one hour after meals
Can cause: photosensitivity, vision changes
Store reconstituted oral suspension at room temp

A

Voriconazole

71
Q

These antivirals reduce the amount of virus in the body by inhibiting the enzyme which enables release of new viral particles from infected cells

A

Neuraminidase inhibitors (oseltamivir, zanamivir, peramivir)

72
Q

Neuraminidase inhibitors are active against both influenza A and B and decrease the duration of symptoms by about:

A

one day; should be started within 48h of onset

73
Q

Baloxavir marboxil (Xofluza) is what type of antiviral

A

Endonuclease inhibitor - single dose regimen

74
Q

Brand: Tamiflu

A

Generic: Oseltamivir

Capsules, suspension

75
Q

Warnings regarding Tamiflu

A

Neuropsychotic events

76
Q

Tamiflu treatment in ages >12y

A

75mg BID x 5 days

77
Q

Tamiflu prophylaxis in age >12

A

75mg daily x 10 days

78
Q

Brand: Relenza, Diskhaler

A

Generic: Zanamivir

Inhalation

79
Q

This antiviral has bronchospasm warnings, do not use in COPD/asthma

A

Zanamivir

80
Q

Brand: Rapivab

A

Generic: Peramivir

81
Q

Brand: Zovirax, Sitavig

A

Generic: Acyclovir

82
Q

Brand: Valtrex

A

Generic: Valacyclovir

Prodrug of alcyclovir

83
Q

These antivirals have a warning regarding using caution in patients with renal impairment, the elderly, and/or those receiving nephrotoxic agents.

A

Acyclovir, Valacyclovir, Famciclovir

84
Q

Cold Sores-

Sore eruption is preceded by prodromal symptoms (tingling, itching, soreness), which is optimal time for:

A

apply topical or take oral meds to reduce blister duration

85
Q

What is an OTC option for Herpes Labialis treatment?

A

Docosanol (Abreva)

Apply 5x daily at first sign of outbreak

86
Q

Acyclovir topical cream for Herpes Labialis treatment

A

Apply 5x daily x 4 days

87
Q

Genital Herpes-

Treatment must be initiated during the prodrome or within one day of lesion onset. What are the options?

A

Acyclovir - least expensive, but dose 5x day

Valacyclovir (prodrug), higher concentrations and less freq dosing

88
Q

What is the most commonly identified cause of viral encephalitis?

A

HSV

89
Q

How is HSV encephalitis treated?

A

IV acyclovir x 14-21 days

90
Q

Shingles pain can be treated with:

A

Pregabalin, gabapentin, duloxetine, tricyclic antidepressants, NSAIDs, opioids

91
Q

5-10% of people have chronic pain after shingles, called

A

Postherpetic neuralgia (PHN)

92
Q

Herpes Zoster treatment

A

Acyclovir, Valacyclovir, Famciclovir x 7 days

93
Q

This virus is a double stranded DNA virus within the herpes virus family (HHV-5) and occurs in severely immunocompromised states (AIDS, transplant patients) and can cause retinitis, colitis or esophagitis

A

CMV

94
Q

What is the treatment of choice in CMV?

A

Ganciclovir or valganciclovir

95
Q

What meds should be reserved for refractory cases of CMV?

A

Foscarnet and cidofovir

96
Q

What is an FDA-approved prophylaxis treatment for CMV in patients receiving a hematopoietic stem cell transplant

A

Letermovir (Prevymis)

97
Q

Brand: Cytovene

A

Generic: Ganciclovir

98
Q

This antiviral should be prepared in sterile water, NOT bacteriostatic

A

ganciclovir

99
Q

Brand: Valcyte

A

Generic: Valganciclovir

*prodrug of ganciclovir

100
Q

These antivirals have a boxed warning for myleosuppression and the suspension must be refrigerated

A

Ganciclovir, valganciclovir

101
Q

This antiviral is used in CMV retinitis and resistant HSV

A

Foscarnet (Foscavir), INJ

102
Q

The boxed warning for Foscarnet

A

Renal impairment

Vesicant! – central line

103
Q

What virus is spread via kissing?

A

Epstein-Barr Virus / “mononucleosis”

NAPLEX 21 (60 decks)

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