Infectious Disease 3: Antifungals & Antivirals Flashcards
MOA amphotericin B
Binds ergosterol altering cells membrane permeability causing cell death
Boxed warning for amphotericin B
conventional amphoB dosing is much lower than the lipid formulations. Overdose causes cardiopulmonary arrest
Amphotericin B
SE and notes
Infusion related reactions: fevers, chills, HA, malaise, rigors
Decreased K, Mg
Nephrotoxicity
amphotericin B diluent and filter
D5W only, filter for lipid formulations
premediation for amphotericin B
required for conventional
optional for lipid
use APAP/NSAID and diphenhydramine +/- meperidine
use of flucytosine
combination with AmphoB for invasive Crytooccal and Candida infection
SE myelosuppression
Never monotherapy
MOA azole
decrease ergosterol synthesis
Azole class effects
increase LFT
QTc prolongation
fluconazole (Diflucan)
dosing
vaginal candidiasis: 150 mg PO x1
PO/IV
IV:PO = 1:1
requires renal adjustment
intraconazole
BW
Can worsen or casue heart failure
ketoconazole
warning
hepatotoxicity that leads to transplant
voriconazole
SE
visual changes
phototoxicity
Which azoles can cross the BBB to treat fungal meningitis?
fluconazole
voriconazole
Which azole is taken on an empty stomach?
Vfend
Which azole is taken with food?
posaconazole (Noxafil)
Which azole causes QT shortening?
isavuconazonium sulfate (Cresemba)
Which azoles use SBECD as a vehicle and can accumlate?
voriconazole
posaconazole
MOA echinocandins
inhibits synthesis of beta 1,3-D-glucan
echinocandins agents (brand)
caspofungin (Cancidas)
micafungin (Mycamine)
anidulafungin (Eraxis)
echinocandin SE and dosing frequency
histamine-mediated symptoms
Given once daily, no renal dose adjustment
Griseofulvin
indication, CI, SE, administration
indicated for fungal infections of the skin, hair, and nails
CI pregnancy
SE photosensitivity, increase LFT
Take with a fatty meal or with food or milk
terbinafine (Lamisil AT)
formulation, warning, SE
topical form
warning: hepatotoxicity
SE: HA, increased LFT
treatment for candida albicans (thrush)
mild:
nystatin; suspension or tablet
clotrimazole; troche/lozenges
moderate or HIV+: fluconazole
treatment for candida albicans (esophageal infection)
fluconazole
treatment for candida krusei and glabrata
echinocandin
treatment for aspergillus
voriconazole
treatment for crytococcus neoformans meningitis
amphotericin B + flucytosine
treatment for dermatophytes
terbinafine
intraconazole
treatment for influenza
neuraminidase inhibitors
oseltamivir (Tamiflu)
zanamivir (Relenza diskhaler)
peramivir (Rapivab)
endonuclease inhibitors
baloxavir marboxil (Xofluza)
oseltamivir (Tamiflu)
T/Px dosing, warning
Tx >12 yo : 75 mg BID x 5 days
Px >12 yo: 75 mg daily x 10 days
warning: neuropsychiatric events
zanamivir (Relenza diskhaler)
formulation, warning
inhaler
warning: bronchospasm
baloxavir marboxil (Xofluza) dosing frequency
1 time dose
weight used for acyclovir dose
IBW
Treatment for herpes viruses (including genital herpes)
acyclovir (Zovirax)
valacyclovir (Valtrex)
Warning for Zovirax and Valtrex
caution in patients with renal impairment, the elderly and those receiving nephrotoxic agents
Topical treatments (dosing frequency) for cold sores
docosanol (Abreva)
acyclovir (Zovirax)
apply 5 x daily
Treatment for invasive HSV infections
acyclovir IV
Treatment for herpes Zoster (Shingles)
acyclovir (Zovirax) for 7 days
valacyclovir (Valtrex) for 7 days
Treatment for cytomegalovirus
ganciclovirr (Cytovene)
valganciclovir (Valcyte)
foscarnet (Foscavir)
ganciclovirr (Cytovene) and valganciclovir (Valcyte)
BW, notes
myelosuppression
refrigerate suspension
foscarnet (Foscavir)
indication and BW
CMV retinitis; resistant HSV
BW: renal impairment
