Infectious Disease Pt 3 (Antifungals, Antivirals) Flashcards
Antifungals
- Treat disease causing y____ and m___
- Common classes
- P______ (amphotericin B)
- T______ (fluconazole)
- E______ (Micafungin)
- Common pathogens (2)
- yeast, mold
- Polyenes
- Triazoles
- Echinocandins
- Candida, Aspergillus species
Indications for Antifungal Therapy
- Invasive ________
- Mucocutaneous disease, Candiduria, Candidemia (4th most common blood stream infection), Intra-abdominal infections, Meningitis, Endocarditis
- Invasive ____ infections (lung, sinus, skin, CNS)
- Aspergillosis, Other mold species
- Candidiasis
- Mold
Triazoles Spectrum of Activity
+Fluconazole (Diflucan)
- Bioavailability
- __\_ azole that concentrates well in ____
- Think: _______ infections (3)
- Given as a ___ time dose for _____ infection
- Excellent oral bioavailability
- ONLY, urine
- Candida albicans (thrush, UTI, blood)
- one, yeast
+Voriconazole (VFEND)
- Drug of choice for?
- Excellent distribution, except for ____\_
- Routes (____ bioavailability)
- Requires _____
- Goal __-__ mcg/ml
- SE (2)
- Do not make mistake of using voriconazole for (1)
- pulmonary aspergillos
- urine
- PO, IV (great)
- Monitoring
- 2 - 5.5
- Visual disturbances, Hallucinations (SE at high doses)
- Drug resistant fungal UTIs
+Antivirals
(3)
Routes
Acyclovir (Zovirax) IV, PO
Valacyclovir (Valtrex) PO
Oseltamivir (Tamiflu)
+Acyclovir, Valacyclovir
MOA
Inhibits DNA replication
+Acyclovir, Valacyclovir
SE
- ___________ with IV formulation if not well ____ (carefully monitor ____ function and administer bolus or continuous ____)
Well tolerated (main SE: HA, Nausea)
- Nephrotoxicity, hydrated, renal, fluids
- These drugs can crystallize in the urine -> nephrotoxic*
+Valacyclovir
What is it?
Half life:
Dosing:
Prodrug -> converted to acyclovir
longer
less frequently
Acyclovir requires frequent dosing -> low compliance
+Oseltamavir (Tamiflu)-Influenza
- MOA
- For better outcomes: _____ tx (within __-__hrs)
- Dosing Prophylaxis:
- Dosing Treatment:
- SE?
- Neuraminidase inhibition (halts replication)
- early (24-48)
- 1x/day
- 2x/day
- N/V (well tolerated)
Therapy based on culture data
Definitive Therapy
Therapy based on no culture data to guide abx selection
Takes into account (3)
Empiric Therapy
common pathogens, pt hx, local resistance
+Treatment of CAP, OUTPATIENT
- First line (uncomplicated) (2)
- First line (allergy or complicated) (2)
Duration: __ days
Complicated = pt has multiple _____ including either (3) OR (1)
- Azithromycin, Doxycycline
- Levofloxacin, Moxifloxacin
5 days
comorbities (COPD, DM, CHF), recent abx use
+Treatment of CAP, INPATIENT
- _____ PLUS _______
- PCN allergic: _______ OR ______
Duration:
Structural lung disease (ie COPD) = _______ concern
Recent influenza (super infection) = ______ concern
Ceftriaxone PLUS Azithromycin
Levofloxacin OR Moxifloxacin
5-7 days
Pseudomonas
MRSA
“isavucazole sounds like i save you azole”
+Treatment of UTI
- Depends on area of ____
- _______ is a huge concern
- ________ NO LONGER recommende as first-line therapy (preserve and minimize toxicity)
- Reserve for _____ and ____ presentations
- practice
- Resistance
- Fluoroquinolones
- allergy, severe
+Treatment of UTI
Preferred Agents (MUST obtain urine _____)
- For uncomplicated disease (1)
- (1) - (3)
Typical duration is ___-___ days
Culture
- Nitrofurantoin (Macrobid)
- Bactrim
- Fluoroquinolones
- Beta-lactams (amoxicillin-clavulanate, cefpodoxime), fosfomycin if susceptibilities are known
3-5 days
+Nitrofurantoin (Macrobid)
Route
Indication
- Requires pts to have CrCl > ___
- Requires minimum of __ days treatment
- Safe in ______, ___-tolerated
- Covers many gram _____ organisms causing cystitis
- Concern for _____ after multiple courses
PO
Only for uncomplicated cystitis (poor GU tissue conc)
- >40 (will not be filtered to sites of action in kidney properly)
- 5 (other abx can be 3)
- pregnancy, well
- negative
- resistance
+Other Agents for UTI
-
Sulfamethoxazole-trimethoprim (Bactrim)
- Not in ______
-
Fluoroquinolones (Levofloxacin, Ciprofloxacin)
- Use in _____ pts or ___/___ cases
- Avoid in ____
- DO NOT use _____ for UTI (low urinary concentrations)
-
Beta-Lactams (______)
- (2)
- Bactrim
- Pregnancy
- Fluoroquinolones
- allergic, severe/refractory
- pregnancy
- X moxifloxacin
- Beta-Lactams (Definitive)
- Amoxicillin-clavulanate (Augmentin)
- Oral cephalosporins (eg cefpodoxime)
+Outpatient Treatment for Skin Infections
(5)
Cephalexin (Keflex)
Tetracyclines (Doxycycline, Minocycline)
Sulfamethoxazole-trimethoprim (Bactrim)
Clindamycin (Cleocin)
Linezolid (Zyvox)
+Outpatient Tx for Skin Infections
- This drug is used as a last line agent dt high rates of GI intolerances, incidence of C.diff
- You cannot use this drug in pts with penicllin allergies (higher-cross reactivity)
- This drug has a risk of toxicities if used > 2 weeks and is reserved for MRSA or VRE
- This drug is great for MSSA and Strep (NO MRSA COVERAGE)
- This drug has to be dosed 4 times a day (may cause issue with compliance)
- Clindamycin
- Cephalexin
- Linezolid
- Cephalexin
- Cephalexin
+When should we treat a URI with antibiotics?
(5)
- Strep Throat - Steptococcus pyogenes (amoxicillin -/+ clavulanate (augmentin) in those with hx of amoxicillin exposure)
- Otitis Exterman (usually bacterial in nature
- Otitis media with pus draining
- Sinusitis w fever
- Worsening URI
