ID III: Antifungals, Antivirals, & Antiparasiticals

Question 1

Name the most common Candida sp.

Answer 1

c. albicans, c. tropicalis, c. glabrata, c. krusei

Question 2

Name the most common yeast species

Answer 2

candida sp. and Cryptococcus neoformans

Question 3

What is a dimorphic fungi?

Answer 3

Fungi that exists as a mold at lower temperatures and a yeast at higher temperatures.

“Mold in the cold, yeast in the heat”

Question 4

Name the most common types of mold

Answer 4

Aspergillus sp. and zygomycetes (includes mucor sp. & rhizopus sp.)

Question 5

Name the dimorphic fungi

Answer 5

histoplasma capsulatum, blastomuyces dermatitidis, and coccidiodes immitis

Question 6

MOA of amphotericin B

Answer 6

Binds to ergosterol, altering the cell membrane permeability and causing cell death

*fungicidal

Question 7

BBW and SE of ampho B

Answer 7

BBW: dosing based on specific product name and lipid-based form of ampho - use caution

SE: infusion related (fever, chills, HA, malaise, rigors, decreased K & Mg), nephrotoxicity
*Lipid formulations have decreased SE

Question 8

Coverage of ampho B

Answer 8

yeasts, molds, and dimorphic fungi

Initial tx for INVASIVE fungal infxns - cryptococcal meningitis, histoplasmosis, and mucormycosis

Question 9

MOA of flucytosine

Answer 9

penetrates fungal cells, converted to flurouracil - competes w/uracil and interferes w/fungal RNA and protein synthesis

*fungicidal

Question 10

Coverage of flucytosine

Answer 10

Used with ampho B for invasive cryptococcal meningitis or candida infections

Question 11

MOA of azole antifungals

Answer 11

Decrease ergosterol synthesis and inhibit cell membrane formation; also inhibitors fungal CYP450 system

*fungistatic, but can be fungicidal for some fungal pathogens

Question 12

Coverage of fluconazole

Answer 12

yeasts: c. albicans, c. tropicalis, Cryptococcus

dimorphic fungi: coccidiodes

• limited efficacy against c. glabrata d/t resistance
• c. krusei is considered fluconazole-resistant

Question 13

Brand name of fluconazole

Answer 13

Diflucan

Question 14

Coverage of itraconazole

Answer 14

yeasts: c. albicans, c. tropicalis

dimorphic fungi

molds: Aspergillus

Question 15

Brand name of itraconazole

Answer 15

Sporanox (capsule/tab), Onmel (solution)

Question 16

SE of azole antifungals

Answer 16

increased LFTs, QT prolongation

CYP450 - especially CYP3A4 DDIs

Question 17

Renal dosing of fluconazole

Answer 17

Requires dose adjustment

Question 18

Counseling for itraconazole oral caps/tab vs. solution

Answer 18

Caps/tab: take with food

Solution: take without food

Question 19

Coverage of voriconazole

Answer 19

Broad spectrum w/ better coverage of aspergillus sp., c. glabrata, and c. kruesi than itra/fluconazole.

• DOC for aspergillosis
• NO coverage against zygomycetes

Question 20

Storage of voriconazole solution

Answer 20

Do NOT refrigerate

Question 21

Brand name of voriconazole

Answer 21

Vfend

Question 22

SE of voriconazole

Answer 22

Visual disturbances, increased LFTs and SCr, CNS toxicity (hallucinations, HA, dizziness), teratogen, QT prolongation (correct K, Ca, and Mg prior to initiating tx)

Question 23

Monitoring of voriconazole

Answer 23

trough levels (1-5mcg/mL), visual fxn, LFTs, electrolytes

Question 24

Renal dosing of voriconazole

Answer 24

Requires adjustment w/ IV d/t containing sulfobutyl either beta-cyclodextrin - which can accumulate in worsen renal fxn

Question 25

Coverage of posaconazole

Answer 25

covers more resistant yeasts, and molds w/ activity against zygomycetes

Question 26

Brand name of posaconazole

Answer 26

Noxafil

Question 27

SE of posaconazole

Answer 27

QT prolongation (correct K, Ca, and Mg prior to initiating tx), increased LFTs, decreased K and Mg

Question 28

Counseling with posaconazole

Answer 28

Suspension and tabs should be taken with food

Question 29

Coverage of isavuconazonium

Answer 29

covers more resistant yeasts, and molds w/activity against zygomycetes

Question 30

Brand name of isavuconazonium

Answer 30

Cresemba

Question 31

Special administrations considerations with isavuconazonium

Answer 31

Requires a filter (0.2-1.2 microns) during administration

Question 32

MOA of echinocandins

Answer 32

Inhibit the synthesis of beta(1,3)-D-glucan, an essential component of the cell wall *fungicidal

Question 33

Name the echinocandins

Answer 33

Caspofungin (Cancidas), Micafungin (Mycamine), Anidulafungin (Eraxis)

Question 34

Renal dosing of echinocandins

Answer 34

Do not required dose adjustment

Question 35

SE of echinocandins

Answer 35

increased LFTs, hypotension, fever, N/V/D, and decreased K and Mg

Question 36

Coverage of echinocandins

Answer 36

Candida sp. including c. glabrata and c. krusei and non-albicans strains resistant to azole antifungals. Activity against aspergillus, but should be used in combo

Question 37

Hepatic impairment dosing of echinocandins

Answer 37

Caspofungin requires adjustment in moderate hepatic impairment

Question 38

MOA of griseofulvin

Answer 38

Bind to the keratin precursor cells which prevents fungal invasion Indications: dermatomycosis and tinea infections of skin, hair, and nails

Question 39

Brand name of griseofulvin

Answer 39

Grifulvin V, Gris-PEG