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Naplex 2025 > Infectious Disease III > Flashcards

Infectious Disease III Flashcards

1
Q

What are some of the Yeast fungal bacteria?

A
  • Candida Species (Albicans, Tropicalis, Parapsilosis, Glabrata, Krusi)

Krusi & Blabrata have resistance to some azoles

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2
Q

What are some of the mold fungal bacteria?

A
  • Apergillus
  • Zygomycetes (Mucor & Rhuzopus)
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3
Q

What are some of the dimorphic fungi?

A
  • Histoplamsa
  • Blastomyces
  • Coccidioides immitis
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4
Q

What is the MOA for Amphotericin B?

A
  • Binds to ergosterol, altering cell membrane permeability = cell death
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5
Q

What is the Activity for Amp B?

A
  • Most Candida and Cryptococcus Neoformins (Yeast)
  • Aspergillus (mold)
  • Dimorphics
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6
Q

What are the Two types of Amp B Formulations?

A
  • Amp B Deoxycholate (Conventional)
  • Liposmal Amp B (Ambisome) (Lipid Formulation)
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7
Q

What is the Boxed Warning for Amp B?

A
  • Confusing Conventional with Lipid Form = Cardiopulmonary Arrest
  • MAX Conventional doses should NOT exceed 1.5 mg/kg/day
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8
Q

What are some of the Side Effects for Amp B?

A
  • Fever, Chills, Headache, Malaise, Rigors
  • Nephrotoxicity, Decreased K & Mg
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9
Q

What are some additional notes about Amp B?

A
  • Conventional needs premedication (Tylenol & Benadryl)
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10
Q

What is the MOA for Flucytosine

A
  • Penetrates fungal eclls and makes Fluorouracil, which interferes with Fungal RNA and Protein Synthesis
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11
Q

What is the Activity for Flucytosine?

A
  • NOT used alone (resistance), so given with Amp B
  • Invasive Cryptococcal (i.e.; Meningitis) or Candida
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12
Q

What are some Side effects for Flucytosine?

A
  • Myelosuppression
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13
Q

What is the MOA for the Azole Antifungals?

A
  • Decrease ergosterol synthesis and cell membrane formation

STONG CYP3A4 Inhibitors

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14
Q

What is the Activity for the Azole Antifungals?

A
  • Flucon: Good for Albicans, Paprapsilosis, Tropicalis; Limited coverage for Glabrata; Krusi is resistant
  • Itra: Dimorphics
  • Vori: aspergillus
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15
Q

What is some Important dosing for Fluconazole

A
  • 150 mg po x1 for Vaginal Candidiasis
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16
Q

What are the Boxed warnings for Itra and Keto?

A
  • Itra: worsen Heart Failure; may cause QTc Prolongation
  • Keto: Hepatotoxicity, QTc Prolongation
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17
Q

What are some of the Side Effects for Flucon, Itra, Keto?

A
  • Increased LFTs, QTc Prolongation
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18
Q

What are some Additional Notes for Flucon, Itra, Keto?

A
  • All azole are cleared hepatically but Flucon is renally cleared
  • Flucon and Vori penetrate the CNS = best for fugal meningitis
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19
Q

What are some key class effects for Azole Antifungals?

A
  • Increase LFT
  • QTc Prolongation
  • Drug interaction
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20
Q

What are some key drug specific concerns for azole antifungals?

A
  • Flucon: Renal dose adjustment
  • Keto: Hepatotoxicity –> Liver Transplant
  • Itra: Cause heart failure
  • Vori: visual changes/phototoxicity
  • Posa: tablet =/= suspension; take with food
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21
Q

What are the Warnings for Voriconazole?

A
  • Hepatotoxicity
  • Visual Disturbances
  • Phototoxicity
  • QTc Prolongation
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22
Q

What are the Side Effects for Voriconazole?

A
  • Visual Changes
  • Increased LFTs, Incresed SCr (CrCl < 50 = Switch IV to PO), CNS Toxicity
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23
Q

What are some additional notes for Voriconazole?

A
  • Take on empty stomach
  • Caution with driving at night
  • Avoid direct sunlight
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24
Q

What are some warnings for Posaconazole?

A
  • QTc Prolongation
  • PPIs decresae absoprtion
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25
What are some **contraindications** for **Isavuconazole (Cresemba)**?
- QTc Shortening
26
What is the **MOA** for the **Enchinocandins**
- Inhibits the synthesis of beta (1, 3)-D-Glucan, which is essentail for fungal cell walls
27
What is the **Activity** for the **enchinocandins**?
- Most **Candida** species
28
What are the **Enchinocandins** that are used?
- *Capso**fungin*** (Cancidas) - *Mica**fungin*** (Mycamine) - Anidulafungin - Rezafungin
29
What are some **warnings** for the **enchinocandins**?
- Histamine Mediated Symptoms (rash, icthy, facial swelling, flushing...)
30
What are some **additional notes** for the **Enchinocandins**?
- ALL are given Once Daily (Except Reza) - **DOES NOT** require dose adjustments - Mica: light protection during administration
31
What are some **other antifungal** agents that are used?
- **Nystatin** (suspenion, tablet) - Griseofulvin - **Terbinafine** (topical cream OTC: Lamisil AT) - Clotrimazole - Miconazole - Oteseconazole
32
What are some **addtional notes** about **Nystatin**?
- Suspension: swish in the mouth and retain (for several minutes) before swallowing
33
What are some **contraindications** for **Griseofulvin**?
- Pregnancy
34
What are some **side effects** for **Griseofulvin**?
- Photosensitivity, Increase LFTs
35
What are some **additional notes** for **Griseofulvin**?
- Take with a fatty meal to increase absorption - Take wiht milk to decrease upset stomach
36
What are some **warnings** for **Terbinafine**?
- Hepatotoxicity
37
What are some **side effects** of **Terbinafine**?
- Headache, Increase LFTs
38
What is the **empiric treatment** for **Candida Albicans/Thrush**?
- Mild: Clotrimazole, Miconazole [Preferred] - Mod: Fluconazole [Preferred] - Nystatin [Alt]
39
What is the **empiric treatment** for **Candida Albican/Esophageal**?
- Fluconazole [Preferred] - Echinocandin [Alt]
40
What is the **empiric treatment** for **Candida Krusi & Glabrata (bloodstream infections)**?
- Enchinocandins [Preferred] - Amp B, High Dose Fluconazole [Alt]
41
What is the **empiric treatment** for **Aspergillis (invasive)**?
- Voriconazole [Preferred] - Amp B, Isavuconazole [Alt]
42
What is the **empiric treatment** for **Cryptococcus Neoformins (Meningitis)**?
- Amp B + Flucytosine (5-FC) [Preferred] - High Dose Fluconazole + Flucytosine (5-FC) [Alt]
43
What is the **empiric treatment** for **Dermatophytes (nail bed infections**?
- Terbinafine or Itraconazole [Preferred] - Fluconazole [Alt]
44
45
What is the **MOA** for the **Neuroaminidase Inhibitors**?
- Inhibits an enzyme that enables the release of viral particles from infected cells
46
What is important to know about the **Neruamidiase Inhibitors**? | -
- Decrease the flu symptoms by **one day** and need to be started within **48h** of onset
47
What are the **Neuraminidase Inhibitors** that are used?
- **Oseltamivir (Tamiflu)** - Zanamivir - Peramivir
48
What is the recommended **dosing** for **Tamiflu**
- > 12 yo: 75 mg BID for x 5d - < 12 yo: 75 mg BID fo x 10d
49
What are the **warnings** for **Tamiflu**?
- Neuropsychiartic Events (confusion, delirium, hallucinations)
50
What are the **side effects** for **Oseltamivir**?
- Headache, Nausea, Vomiting
51
What are the **warnings** for **zanamivir**?
- Bronchospams [avoid in asthma and COPD]
52
What are the **Antivirals** that are used for **Herpes Simplex and Varicella Zoster Viruses**?
- Acyclovir [Zovirax] - Valacyclovir [Valtrex] - Famciclovir
53
What are the **Warnings** for the **Herpes/Varicella Antivirals**?
- Caution in those with renal impairment - Caution in those elderly patients - Caution in those getting other nephrotoxic drugs
54
What are some **additional notes** about the **Herpes/Varicella Virus**?
- Acyclovir dosing is based on **IBW**
55
Are **herpes simplex labialis (cold sores)** highly contagious?
- Yes; they are very common and highly contagious
56
What are some of the **Topical Treatments** for **Herpes Labialis** and the **dosing** for them?
- **Dosocanol (Abreva) - OTC** Cream: **x5 daily at 1st signs of outbreak** - **Acyclovir (Zovirax) - Rx** Cream: **x5 daily for 4 days** - Acyclovir (Sitavig) - Rx Buccal Tab - Penicilovir (Denavir) - Rx Cream
57
What are some of the **systemic treatments** for **herpes labialis**?
- Acyclovir - Valacyclovir - Famciclovir
58
For someone that is experiencing **Gential Herpes**, when is the best time to start treatment?
- within one day of lesion onset (Typically Acyclovir or Valacyclovir)
59
What is the most common **Invasive HSV infection**?
- Viral Encephalitis; treated with IV Acyclovir
60
What is important to know about **Varicella Zoster Virus and Herpes Zoster**? ## Footnote When does someoen get it in their life
- Chicken Pox (Varicella) occurs in Kids and is dormant; Herpes Zoster reactives it causing Shingles ## Footnote Shingles: icthy, painful, on one side of the body
61
For someone with **shingles** what are some of the treatments?
- Antivirals within **72 hours** of onset - Pain: Topical Patches (Lidoderm), Neuropathic Pain (Gabapentin, Pregabalin, Duloxetine, TCAs), NSAIDs, Opioids
62
What is the **recommended age** that someone should get the **shingles vaccine**?
- > 50 yo normally - > 19 yo if immunsuppressed
63
What are some of the **treatments** for **Herpes Zoster (Shingles** and their **dosing**?
- Acyclovir (Zovirax): 800 mg PO 5x daily for **7 days** - Valacyclovir (Valtrex): 1 g PO TID for **7 days** - Famciclovir: 500 mg PO TIV for **7 days**
64
What are the **treatments** of choice for someone with **Cytomegalovirus (CMV)**?
- Ganciclovir & Valganciclovir - Foscarnet and Cidofovir for those with refractory cases
65
For **secondary prophylaxis** of **CMV** what are some **Treatment** options?
- Letermovir in kidney transplant or bone - Ganciclovir or Valganciclovir in high CMV risk organ transplants
66
What are some **boxed warnings** for **Gancicolvir/Valganciclovir**?
- Myelosuppression
67
What are some **side effects** for **ganciclovir/valganciclovir**?
- Fever, N/V/D, Increase SCr - Retinal Detachment (in those with CMV retinitis)

Naplex 2025 (57 decks)

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