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NAPLEX Review UWorld > ID Part 1 > Flashcards

ID Part 1 Flashcards

1
Q

Which of the following statements is correct regarding ceftriaxone?

A. It should be given with IV calcium in neonates.

B. It displays concentration-dependent bactericidal activity.

C. It has better Gram-negative activity than cefotetan.

D. It is available in both oral and intravenous formulations.

E. It requires dose adjustment in renal dysfunction.

A

It has better Gram-negative activity than cefotetan.

Ceftriaxone is a 3rd generation cephalosporin that has broader Gram-negative activity than the 2nd generation cephalosporins (e.g., cefotetan).

Similar to all beta-lactams, it displays time-dependent bacterial killing.

Ceftriaxone is only available IV and does not require dose adjustment in renal dysfunction.

Ceftriaxone is contraindicated in neonates (causes biliary sludging, kernicterus) and concurrent use with IV calcium in neonates is contraindicated.

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2
Q

Cephalosporins

1st Generation

Meds & Coverage

A

IV: Cefazolin (Ancef), PO: Cephalexin (Keflex), cefadroxil (Duricef)
Staphylococci (MSSA), Streptococci, PEK, mouth anaerobes (Peptostreptococci)

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3
Q

Which generation cephalosporins is preferred for MSSA?

A

1st Gen

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4
Q

Cephalosporins

1st Generation Uses

Inpatient

A

Cefazolin (Ancef)
Surgical PPx

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5
Q

Cephalosporins

1st Generation Uses

Outpatient

A

Cephalexin (Keflex)
Strep throat, MSSA skin infections

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6
Q

Cephalosporins

2nd Generation

Meds & Coverage

A

IV/IM/PO: Cefuroxime (Ceftin, Zinacef)
Staphylococci
Better Gram-negative activity (HNPEK) than 1st gen

IV/IM Cefotetan (Cefotan) and Cefoxitin (Mefoxin)
Additional gram (-) anaerobic activity (B. fragilis)

PO: Cefaclor, Cefprozil (Cefzil)

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7
Q

Cephalosporins

2nd Generation

Inpatient

A

Cefotetan (Cefotan) and Cefoxitin (Mefoxin)
Surgical PPx (GI procedures)

Anaerobic activity (B. fragilis)

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8
Q

Which cephalosporin has a disulfiram-like reaction?

A

Cefotetan (Cefotan)

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9
Q

Cephalosporins

2nd Generation

Outpatient

A

Cefuroxime (Ceftin)
Acute OM, CAP, sinus infections

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10
Q

Cephalosporins

3rd Generation

Meds & Coverage

A

Group 1: IV Ceftriaxone, Cefotaxime
PO Cefdinir (Omnicef), Cefixime (Suprax), Cefpodoxime
Resistant Streptococci (S. pneumonaiae & viridans)
Staphylococci (MSSA)
Gram (+) anaerobes
Resistant strains of HNPEK

Group 2: IV Ceftazidime (Fortaz, Tazicef), Ceftazidime/Avibactam (Avycaz)
Lacks gram (+) activity
Pseudomonas

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11
Q

Cephalosporins

3rd Generation Uses

Outpatient

A

Cefdinir (Omnicef)
CAP, sinus infections

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12
Q

Cephalosporins

3rd Generation Uses

Inpatient

A

Ceftriaxone, Cefotaxime (Claforan)
CAP, meningitis, spontaneous bacterial perionitis (SBP), pyelonephritis

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13
Q

Which cephalosporin does not required renal adjustment?

A

Ceftriaxone

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14
Q

Which cephalosporins is not used in neonates?

A

Ceftriaxone

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15
Q

Cephalosporins

4th Generation

Meds & Coverage

A

IV: Cefepime (Maxipime)
Broad-spectrum: Gram-positives (similar to ceftriaxone), HNPEK, CAPES, Pseudomonas

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16
Q

Which cephalosporins covers Pseudomonas?

A

Ceftazidime (Fortaz, Tazicef)
Cefepime (Maxipime)
Ceftolozane/tazobactam (Zerbaxa)
Cefiderocol (Fetroja)

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17
Q

Cephalosporins

5th Generation

Meds & Coverage

A

IV Ceftaroline (Teflaro),
Gram (-) similar to ceftriaxone
Broad gram (+) MRSA coverage

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18
Q

Cephalosporins combo

Meds & Coverage

A

ceftazidime/avibactam (Avycaz)
ceftolozane/tazobactam (Zerbaxa)
Similar spectrum to ceftazidime
Added activity against MDR gram (-) rods

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19
Q

Siderophore Cephalosporin

Meds & Coverage

A

IV cefiderocol (Fetroja)
PEK
Enterobacter
Pseudomonas

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20
Q

What cephalosporin covers MRSA?

A

Ceftaroline (Teflaro)

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21
Q

Cephalosporins do not cover?

A

Enterococcus
Atypicals

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22
Q

Cephalosporins Class Effects

A

Betam-lactam allergy
Risk of seizures

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23
Q

BV is a 42-year-old male who comes to his primary care provider with a 2-day history of new-onset shortness of breath, fever, chills, fatigue, and persistent cough. He has no other health issues and no known drug allergies. A chest x-ray confirms pneumonia. The local antibiogram shows Streptococcus pneumoniae is 60% susceptible to macrolides. What is the most appropriate antibiotic therapy for this patient?

A. Amoxicillin for 10 days

B. Azithromycin for 5 days

C. Azithromycin for 10 days

D. Doxycycline for 5 days

E. Doxycycline for 10 days

A

Doxycycline for 5 days

The recommended treatment options for outpatient community-acquired pneumonia in healthy patients with no comorbidities include monotherapy with amoxicillin, doxycycline, or a macrolide (if local pneumococcal resistance is less than 25%).

The typical duration of treatment is 5 to 7 days.

Longer durations of treatment offer no benefit and increase the risk of adverse effects.

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24
Q

Community Acquired Pneumonia (CAP) Tx

Outpatient - no comorbidities

A

Amoxicillin 1 g TID
Doxycycline
Macrolide (azithromycin or clarithromycin)

For 5 to 7 days

Macrolid - only rec in healthy pts if local pneumococcal macrolide resistance is < 25%

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25
Q

Community Acquired Pneumonia (CAP) Tx

Outpatient - w/ comorbidities

Comorbidities:
* Chronic heart, lung, liver, or renal disease
* Diabetes
* Alcohol use disorder
* Malignancy
* Asplenia

A

Beta-lactam (amoxicillin/clavulnate, cefpodoxime [Vantin, 3rd], or cefuroxime [Ceftin, 2nd])
+
Doxycycline or Macrolide (azithromycin or clarithromycin)

Respiratory fluroroquinolone (moxifloxacin [Avelox], levofloxacin, or gemifloxacin [Factive])

For 5 to 7 days

Macrolid - only rec in healthy pts if local pneumococcal macrolide resistance is < 25%

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26
Q

Respiratory fluroquinolone Mnemonic

A

My Good Lung Died
* Moxifloxacin (Avelox)
* Gemifloxacin (Factiv)
* Levofloxacin
* Delafloxacin (Baxdela)

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27
Q

Antiviral agents active against cytomegalovirus (CMV) include which of the following:

A. Valganciclovir, valacyclovir, acyclovir

B. Atazanavir, valganciclovir, foscarnet

C. Foscarnet, acyclovir, cidofovir

D. Valganciclovir, foscarnet, cidofovir

E. Acyclovir, valacyclovir, ganciclovir

A

Valganciclovir (Valcyte), foscarnet (Foscavir), cidofovir

Ganciclovir, valganciclovir, foscarnet and cidofovir are indicated for CMV.

Others listed are indicated for HSV (acyclovir, valacyclovir) or HIV (atazanavir).

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28
Q

GP is receiving amphotericin B deoxycholate for the treatment of mucormycosis. Which of the following side effects are most likely to occur with treatment?

A. Hyponatremia, hypocalcemia, hypokalemia

B. Hyponatremia, hypokalemia, chest tightness

C. Hypocalcemia, hyperkalemia, leukopenia

D. Hypomagnesemia, hypokalemia, rigors

E. Hyperkalemia, hypermagnesemia, hypotension

A

Hypomagnesemia, hypokalemia, rigors

Common side effects associated with amphotericin B deoxycholate include
* hypokalemia
* hypomagnesemia,
* hypotension
* fever,
* chills,
* rigors,
* headache,
* nephrotoxicity.

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29
Q

ART unchanged for 5 years with good virologic response; elevated serum creatinine; switch ART to Biktarvy and refer to nephrology

Which medication is most likely contributing to the abnormal laboratory test identified today?

A. Emtricitabine

B. Hydrochlorothiazide

C. Pitavastatin

D. Raltegravir

E. Tenofovir disoproxil fumarate

A

Tenofovir disoproxil fumarate

Tenofovir disoproxil fumarate (TDF), a nucleoside reverse transcriptase inhibitor, can cause nephrotoxicity (evident by an elevated serum creatinine) with long-term use.

Tenofovir alefenamide (TAF) has a lower risk of nephrotoxicity; switching from TDF to TAF is associated with improvement in TDF-associated renal dysfunction.

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30
Q

Nucleoside reverse transcriptase inhibitors (NRTIs) Meds

A

Zidovudine (Retrovir)

Lamivudine (Epivir)

Abacavir (Ziagen)

Tenofovir disoproxil fumarate, TDF (Viread)

Tenofovir alafenamide, TAF
* Only in combination products for HIV;
* Vemlidy is a single-entity product for HBV

Emtricitabine (Emtriva)

No longer recommended:
* Didanosine
* Stavudine

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31
Q

Nucleoside reverse transcriptase inhibitors (NRTIs) MOA

A

Competitively inhibit the reverse transcriptase enzyme, preventing the conversion of HIV RNA to HIV DNA in stage 3 (reverse transcription) of the HIV life cycle

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32
Q

NRTIs Mnemonic

A

ZDS LATTE
Zidovudine (Retrovir)
Didanosine
Stavudine

Lamivudine (Epivir)
Abacavir (Ziagen)
Tenofovir disoproxil fumarate, TDF (Viread)
Tenofovir alafenamide, TAF (Vemlidy)
Emtricitabine (Emtriva)

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33
Q

NRTIs Effects

A

Lactic acidosis
Hepatomegaly with steatosis (fatty liver)
Nausea, diarrhea

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34
Q

Abacavir (Ziagen)

What do you need to test for?

A

Risk of HSR if positive for HLA-B 5701 (abacavir contraindicated)
Patients should carry warning card listing HSR symptoms

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35
Q

Which NRTIs is use for HBV/HIV coinfection?

A

Tenofovir, emtricitabine (Emtriva) & lamivudine (Epivir)

Abrupt discontinuation can cause acute HBV exacerbation

TDF (Viread)
TAF (Vemlidy)

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36
Q

Which NRTI causes hyperpigmentation of palms (hands) & soles of feet

A

emtricitabine (Emtriva)

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37
Q

Tenofovir

Common Toxicities

A

Two salt forms: TAF & TDF
Common toxicities (TDF > TAF)
* Nephrotoxicity (including Fanconi syndrome, a rare renal disorder)
* ↓ BMD (ie, osteopenia, osteoporosis)

Lipid abnormalities (primarily with TAF)

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38
Q

Which NRTI causes hematologic toxicity?

A

Zidovudine (Retrovir)

neutropenia & anemia (↑ MCV is sign of adherence)

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39
Q

Biktarvy

A

bictegravir
emtricitabine
TAF

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40
Q

Admit to labor and delivery and start HIV perinatal prophylaxis STAT.

Based on the assessment and plan, the pharmacist should expect to receive orders for which medication?

A. Intramuscular cabotegravir

B. Intravenous ibalizumab

C. Intravenous zidovudine

D. Oral darunavir boosted with ritonavir

E. Oral emtricitabine/tenofovir alafenamide

A

Intravenous zidovudine

Intravenous zidovudine is recommended to prevent perinatal (mother-to-child) HIV transmission in mothers with a new or unknown HIV diagnosis and/or an HIV viral load greater than 1,000 copies/mL.

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41
Q

Management of pregnant patients with HIV infection

During pregnancy

A

Continue ART if already taking
Start ART as soon as possible (if not already taking); preferred regimens include:
* Darunavir/ritonavir (Prezista) or dolutegravir (Tivicay), PLUS
* Two NRTIs (eg, emtricitabine/tenofovir or abacavir/lamivudine [Epzicom])

emtricitabine/tenofovir Brand:
TAF - Descovy,
TDF - Truvada

42
Q

Management of pregnant patients with HIV infection

During delivery

A

Prevent perinatal (mother-to-child) transmission if new/unknown HIV infection and/or HIV viral load >1,000 copies/mL

Administer IV zidovudine (Retrovir) to the mother prior to delivery

43
Q

Management of pregnant patients with HIV infection

After delivery

A

Neonatal ART prophylaxis (regimen and duration depending on risk)

Replacement feeding (eg, formula, donor milk) eliminates the risk of postnatal HIV transmission and may be preferred over breastfeeding

44
Q

An 85-year-old man is hospitalized with a fungal infection. He has CKD stage 3 and chronic pain (on methadone). Micafungin 100 mg intravenous is given. During the infusion, the man develops a drop in blood pressure, pruritis and flushing. What is the most likely cause of this reaction?

A. The micafungin dose should have been renally adjusted.

B. Micafungin is causing a histamine-release reaction.

C. Micafungin increased the methadone levels, resulting in an adverse reaction.

D. Acetaminophen and meperidine should have been given prior to micafungin.

E. It is unlikely that this reaction is due to methadone or micafungin.

A

Micafungin is causing a histamine-release reaction.

Micafungin, an echinocandin, can cause histamine-mediated symptoms such as rash, pruritus, facial swelling, flushing and hypotension. To decrease the potential of a histamine reaction, infuse over 1 hour.

45
Q

Empiric Treatment For Select Fungal Pathogens/Infections

Candida albicans

Oropharyngeal infection (thrush)

A

Mild disease: topical antifungals (clotrimazole [Mycelex troche], miconazole)
Moderate-severe disease or HIV+: fluconazole
Alternative: Nystatin

Nystatin - Swish and swallow

46
Q

Empiric Treatment For Select Fungal Pathogens/Infections

Candida albicans

Esophageal infection

A

Fluconazole
Alternative: Echinocandin

47
Q

Empiric Treatment For Select Fungal Pathogens/Infections

Candida krusei and glabrata

All Candida species bloodstream infections

A

Echinocandin
Alternative: Amphotericin B, high-dose fluconazole (susceptible isolates only)

48
Q

Empiric Treatment For Select Fungal Pathogens/Infections

Aspergillus

Invasive

A

Voriconazole
Alternative:Amphotericin B, isavuconazonium

49
Q

Empiric Treatment For Select Fungal Pathogens/Infections

Cryptococcus neoformans

Meningitis

A

Amphotericin B + flucytosine (5-FC)
Alternative: High-dose fluconazole + flucytosine (5-FC)

50
Q

Empiric Treatment For Select Fungal Pathogens/Infections

Dermatophytes

Nail bed infection

A

Terbinafine or itraconazole (confirm fungal infection prior to treatment)
Alternative: Fluconazole

51
Q

The pharmacist is on rounds with the internal medicine team. They are discussing a patient who has oral candidiasis due to a recent chemotherapy treatment. The infection is very painful for the patient and is considered moderate to severe. Which of the following is the best regimen to recommend for this patient?

A. Clotrimazole troches 10 mg PO 5 times per day

B. Fluconazole 200 mg IV daily

C. Posaconazole 400 mg PO BID

D. Amphotericin B 15 mg/kg IV BID

E. Itraconazole 200 mg PO daily

A

Fluconazole 200 mg IV daily

Patients with severe and painful oral candidiasis will not tolerate taking medications orally without analgesics.

Localized treatment with clotrimazole is used for mild infections only, in patients without immunosuppression.

The most appropriate therapy would be an antifungal given intravenously until oral medications are tolerated.

Fluconazole has appropriate activity and the amphotericin dosing is too high.

52
Q

Which of the following statements is correct regarding nafcillin?

A. Nafcillinis active against MRSA.

B. Nafcillin is a vesicant.

C. Nafcillin should be dose adjusted in renal impairment.

D. Nafcillin is compatible with NS only.

E. Nafcillin cannot be used in a sulfa allergic patient.

A

Nafcillin is a vesicant.

Nafcillin is a vesicant (blistering). If extravasation occurs, use cold packs and hyaluronidase injections to treat.

Ampicillin, ampicillin/sulbactam and ertapenem are compatible with NS only.

Extravastion: leakage of blood, lymph, or other fluid, such as an anticancer drug, from a blood vessel or tube into the tissue around it

53
Q

Which beta-lactams are complatible w/ NS only?

A

Ampicillin, ampicillin/sulbactam and ertapenem

54
Q

Natural Penicillins

A

PO : Penicillin V Potassium
IV: Penicillin G Aqueous
IM: Penicillin G Benzathine (Bicillin L-A)
Covers Gram-positive cocci, Gram-positive anaerobes

55
Q

Aminopenicillins

A

PO Amoxicillin (Moxatag),
IV: Ampicillin
Adds Gram-negative coverage (HNPEK)

56
Q

Aminopenicillin + Beta- Lactamase Inhibitor

A

PO: Amoxicillin/clavulanate (Augmentin)
IV : Ampicillin/sulbactam (Unasyn)
Adds MSSA, more resistant strains of HNPEK, Gram- negative anaerobes (B. fragilis)

57
Q

Extended Spectrum + Beta- Lactamase Inhibitor

A

IV: Piperacillin/tazobactam (Zosyn)
Adds CAPES, Pseudomonas

CAPES:
Citrobacteer
Acinetobacter
Providencia
Enterobacter
Serratia

58
Q

Antistaphylococcal

A

Nafcillin, oxacillin
Covers MSSA and Streptococci only

59
Q

Penicillin Class coverage

A

All cover Eenterococcus (exceptt antistaphylococcal PCNs)
Do not cover atypicals or MRSA

60
Q

Penicillin Class Effect

A

Beta-lactam allergy
Risk of seizures

61
Q

Outpatient (Oral)

Penicillin VK

A

A first-line treatment for pharyngitis (“strep throat”)
Mild nonpurulent skin infections (no abscess)

62
Q

Outpatient (Oral)

Amoxicillin (Moxatag)

A

First-line treatment for acute otitis media (pediatric dose: 80-90 mg/kg/day)

Drug of choice for infective endocarditis prophylaxis before dental procedures (2 grams PO x 1, 30-60 minutes before procedure)

Used in H. pylori treatment*

63
Q

Outpatient (Oral)

Amoxicillin/Clavulanate (Augmentin)

A

First-line treatment for acute otitis media (pediatric dose: 90 mg/kg/day) and bacterial sinusitis (if antibiotics indicated)

Use the lowest dose of clavulanate to↓ diarrhea

64
Q

Outpatient (Oral)

Dicloxacillin

A

Covers MSSA only (no MRSA)
No renal dose adjustment needed

65
Q

Inpatient (Parenteral)

Penicillin G Benzathine (Bicillin L-A)

A

Drug of choice for syphilis (2.4 million units IM x 1)
Not for IV use; can cause death

66
Q

Inpatient (Parenteral)

Nafcillin and Oxacillin

A

Covers MSSA only (no MRSA)
No renal dose adjustment needed

67
Q

Inpatient (Parenteral)

Piperacillin/Tazobactam (Zosyn)

A

Only penicillin active against Pseudomonas
Extended infusions (4 hours) can be used to maximize T > MIC

68
Q

A 32-year-old female who is receiving chemotherapy for acute leukemia is diagnosed with mucormycosis via tissue culture and will begin therapy with IV isavuconazonium. The nurse contacts the pharmacist asking what he needs to know, as he has never administered the drug before. Which of the following is an important point regarding this medication?

A. This medication requires light protection during administration.

B. This medication is not compatible with PVC containers and will be supplied in a glass bottle.

C. This medication requires a filter for administration.

D. This medication requires PTT monitoring.

E. This medication can prolong the QT interval.

A

This medication requires a filter for administration.

Isavuconazonium (Cresemba) is a prodrug of isavuconazole.

It does not contain a solubilizing agent as with voriconazole and posaconazole, so a filter is required for administration to prevent any particulates (undissolved drug) from entering a patient’s bloodstream.

This agent can shorten the QT interval, which is unique within the azole class (all of the other agents are associated with prolonged QT).

69
Q

Quinolones Boxed warnings

Concentration-dependent killing

A

Tendon rupture achilles

Peripheral neuropathy long-lasting

CNS effects (including seizures)

Use last-line (only if no alternatives)

70
Q

Quinolones Warnings

Concentration-dependent killing

A

QT prolongation

Hypo and hyperglycemia

Psychiatric disturbances

Photosensitivity

Avoid use in children (risk vs. benefit)

71
Q

Quinolones Interactions

A

Chelation with divalent cations

72
Q

Quinolones Common Uses

A

Can vary by agent: pneumonias, UTIs, intra-abdominal infections, travelers’ diarrhea

73
Q

Antipseudomonal Quinolones

A

Ciprofloxacin, levofloxacin

74
Q

Only quinolone that is not renally adjusted

A

Moxifloxacin

Do not use for UTIs

75
Q

Quinolones where IV to PO Ratio 1:1

A

Levofloxacin and moxifloxacin

76
Q

Quinolones Profile Review Tips

A

Caution with CVD, ↓ K/Mg and with other QT-prolonging drugs (e.g., azole antifungals, antipsychotics, methadone, macrolides)

Avoid in patients with a seizure history or if using seizure drugs

Avoid in children

77
Q

Quinolones Counseling

A

Avoid sun exposure, separate from polyvalent cations, monitor blood glucose (in diabetes)

Watch for tendon rupture, neuropathy, CNS or psychiatric side effects

78
Q

An otherwise healthy patient presents withafoot infection that developed 1 week after stepping on a child’s toy. The wound culture is growingGram-positive and Gram-negative bacteria; Pseudomonas is not suspected. The physician would like to use a cephalosporinfor treatment of the patient’s infection. Which of the following statements regarding cephalosporins is correct?

A. Cefazolin is an oral cephalosporin that is considered to be the most effective therapy for mild-moderate Gram-negative foot infections.

B. Cefixime is the only oral cephalosporin with Gram-negative and enteric anaerobic coverage.

C. Cephalexin is an oral, second-generation cephalosporin with sufficient Gram-negative and Gram-positive coverage for moderate severity foot infections.

D. Cefuroxime is an oral, second-generation cephalosporin with adequate Gram-negative and Gram-positive coverage for mild-moderate foot infections.

E. Cefpodoxime is an intravenous, third-generation cephalosporin with adequate Gram-positive and Gram-negative coverage for severe foot infections.

A

Cefuroxime is an oral, second-generation cephalosporin with adequate Gram-negative and Gram-positive coverage for mild-moderate foot infections.

Cefazolin is an intravenous cephalosporin.

Cefixime is not effective for enteric anaerobes.

Cephalexin is a first generation cephalosporin and cefpodoxime is an oral, third-generation cephalosporin.

Cefuroxime is a second generation cephalosporin and is effective in treating Streptococci, MSSA and Gram-negative bacteria associated with mild-moderate foot infections.

79
Q

A phlebotomist had an accidental needlestick injury while drawing a blood sample from an HIV-positive patient. Which drug combination is the preferred regimen for post-exposure prophylaxis?

A. Emtricitabine + tenofovir alafenamide

B. Efavirenz + tenofovir disoproxil fumarate + emtricitabine

C. Raltegravir + tenofovir disoproxil fumarate + emtricitabine

D. Dolutegravir + abacavir + lamivudine

E. Rilpivirine + emtricitabine + tenofovir alafenamide

A

Raltegravir + tenofovir disoproxil fumarate + emtricitabine

Post-exposure prophylaxis (PEP) guidelines recommend 28 days of Truvada (tenofovir disoproxil fumarate + emtricitabine) + Isentress (raltegravir).

80
Q

Descovy

A

Emtricitabine + tenofovir alafenamide

81
Q

Atripla

A

Efavirenz + tenofovir disoproxil fumarate + emtricitabine

82
Q

Isentress

A

Raltegravir

83
Q

Truvada

A

tenofovir disoproxil fumarate + emtricitabine

84
Q

Triumeq

A

Dolutegravir + abacavir + lamivudine

85
Q

Odefsey

A

Rilpivirine + emtricitabine + tenofovir alafenamide

86
Q

Allof the following statementsregarding amphotericin B are correct EXCEPT:

A. Doses of conventional amphotericin B ≥ 1.5 mg/kg/day can cause cardiopulmonary arrest.

B. It is a fungicidal agent with broad antifungal spectrum of activity.

C. Lipid formulations have a greater risk for nephrotoxicity than conventional formulations.

D. The conventional formulation requires premedication to reduce infusion-related reactions.

E. All formulations can causehypomagnesemia and hypokalemia.

A

Lipid formulations have a greater risk for nephrotoxicity than conventional formulations.

Lipid formulations of amphotericin B are associated with fewer toxicities (including decreased infusion reactions and decreased nephrotoxicity) compared to amphotericin B deoxycholate (also referred to as conventional amphotericin).

Lipid-based amphotericin B doses are higher than conventional, ranging from 3-6 mg/kg/day.

To help prevent dosing errors, amphotericin B deoxycholate (conventional) carries a boxed warning to confirm any dose exceeding 1.5 mg/kg/day.

87
Q

Which of the following is the mechanism of action of Diflucan?

A. It binds to ergosterol in the cell membrane altering cell membrane permeability.

B. It interferes with fungal RNA and protein synthesis.

C. It inhibits the synthesis of beta (1,3)-D-glucan.

D. It decreases ergosterol synthesis and cell membrane formation.

E. It interferes with microtubule formation by binding tubulin.

A

It decreases ergosterol synthesis and cell membrane formation.

Diflucan is an azole. Azoles act by inhibiting the production of ergosterol, which decreases cell membrane formation.

88
Q

Azoles Class Effects

A

↑ LFTS

QT prolongation (except isavuconazonium)

Many drug interactions

89
Q

What is the only azole that requires renal dose adjustment?

A

Fluconazole

CrCl ≤ 50: ↓ dose by 50%

90
Q

What azole has hepatotoxicity has led to liver transplantation?

A

Ketoconazole

Topical forms Brand: Nizoral A-D, Extina, Ketozole

91
Q

What azole can cause heart failure?

A

Itraconazole (Sporanox)

92
Q

What azole can cause visual changes and phototoxicity?

A

Voriconazole

93
Q

Posaconazole

A

Noxafil

Tablet dose ≠ suspension dose (due to different bioavailability)

Take with food

94
Q

Azol IV Administration

A

IV to PO ratio is 1:1 for all azoles

Drugs with sulfobutyl ether beta-cyclodextrin (SBECD) vehicle: voriconazole, posaconazole

95
Q

Primary PPx in Pts w/ HIV

CD4 < 200

Or Oropharyngeal candidiasis
Or other AIDS-defining illness

A

Pneumoncystis pneumonia (PCP)

96
Q

Primary PPx in Pts w/ HIV

Pneumoncystis pneumonia (PCP) Regimen

A

Preferred: SMX/TMP DS tab PO daily or SS tab PO daily

Alternative:
SMX/TMP DS tab 3x/week or
Dapsone or
Dapsone + pyrimethamine + leucovorin
Pentamidine (aerosolized)
Atovaquone

CD4 < 200

Leucovorin is added to reduce myelosupression associated w/ pyrimethamine

97
Q

Primary PPx in Pts w/ HIV

CD4 < 100

A

Toxoplasma ondii encephalitis (Toxo)

w/ (+) Toxoplasma IgG

98
Q

Primary PPx in Pts w/ HIV

Toxoplasma ondii encephalitis (Toxo)

A

Preferred: SMX/TMP DS tab PO daily

Alternative: SMX/TMP SS tab daily or 1 DS TIW
Dapsone + pyrimethamine + leucovorin

99
Q

Primary PPx in Pts w/ HIV

CD4 < 50

A

Mycobacterium avium complex (MAC)

Must rule out active disseeminated MAC disease

100
Q

Primary PPx in Pts w/ HIV

Mycobacterium avium complex (MAC)

A

Azithromycin 1,200 mg PO 1x/week or 600 mg PO 2x/week
Clarithromycin 500 mg PO BID

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