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Advanced Pharmacology > Infectious Disease Pt 3 (Antifungals, Antivirals) > Flashcards

Infectious Disease Pt 3 (Antifungals, Antivirals) Flashcards

1
Q

Antifungals

  • Treat disease causing y____ and m___​
  • Common classes
    • ​P______ (amphotericin B)
    • T______ (fluconazole)
    • E______ (Micafungin)
  • Common pathogens (2)
A
  • yeast, mold
    • Polyenes
    • Triazoles
    • Echinocandins
  • Candida, Aspergillus species
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2
Q

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
A
  • Candidiasis
  • Mold
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3
Q

Triazoles Spectrum of Activity

A
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4
Q

+Fluconazole (Diflucan)

  • Bioavailability
  • __\_ azole that concentrates well in ____
  • Think: _______ infections (3)
  • Given as a ___ time dose for _____ infection
A
  • Excellent oral bioavailability
  • ONLY, urine
  • Candida albicans (thrush, UTI, blood)
  • one, yeast
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5
Q

+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)
A
  • pulmonary aspergillos
  • urine
  • PO, IV (great)
  • Monitoring
    • 2 - 5.5
  • Visual disturbances, Hallucinations (SE at high doses)
  • Drug resistant fungal UTIs
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6
Q
A
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7
Q

+Antivirals

(3)

Routes

A

Acyclovir (Zovirax) IV, PO

Valacyclovir (Valtrex) PO

Oseltamivir (Tamiflu)

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8
Q

+Acyclovir, Valacyclovir

MOA

A

Inhibits DNA replication

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9
Q

+Acyclovir, Valacyclovir

SE

  • ___________ with IV formulation if not well ____ (carefully monitor ____ function and administer bolus or continuous ____)
A

Well tolerated (main SE: HA, Nausea)

  • Nephrotoxicity, hydrated, renal, fluids
  • These drugs can crystallize in the urine -> nephrotoxic*
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10
Q

+Valacyclovir

What is it?

Half life:

Dosing:

A

Prodrug -> converted to acyclovir

longer

less frequently

Acyclovir requires frequent dosing -> low compliance

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11
Q
A
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12
Q

+Oseltamavir (Tamiflu)-Influenza

  • MOA
  • For better outcomes: _____ tx (within __-__hrs)
    • Dosing Prophylaxis:
    • Dosing Treatment:
  • SE?
A
  • Neuraminidase inhibition (halts replication)
  • early (24-48)
    • 1x/day
    • 2x/day
  • N/V (well tolerated)
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13
Q

Therapy based on culture data

A

Definitive Therapy

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14
Q

Therapy based on no culture data to guide abx selection

Takes into account (3)

A

Empiric Therapy

common pathogens, pt hx, local resistance

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15
Q

+Treatment of CAP, OUTPATIENT

  1. First line (uncomplicated) (2)
  2. First line (allergy or complicated) (2)

Duration: __ days

Complicated = pt has multiple _____ including either (3) OR (1)

A
  1. Azithromycin, Doxycycline
  2. Levofloxacin, Moxifloxacin

5 days

comorbities (COPD, DM, CHF), recent abx use

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16
Q

+Treatment of CAP, INPATIENT

  • _____ PLUS _______
  • ​PCN allergic: _______ OR ______

Duration:

Structural lung disease (ie COPD) = _______ concern

Recent influenza (super infection) = ______ concern

A

Ceftriaxone PLUS Azithromycin

Levofloxacin OR Moxifloxacin

5-7 days

Pseudomonas

MRSA

17
Q
A
18
Q
A
19
Q
A

“isavucazole sounds like i save you azole”

20
Q

+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
A
  • practice
  • Resistance
  • Fluoroquinolones
    • allergy, severe
21
Q

+Treatment of UTI

Preferred Agents (MUST obtain urine _____)

  1. For uncomplicated disease (1)
      1. (1) - (3)

Typical duration is ___-___ days

A

Culture

  1. Nitrofurantoin (Macrobid)
  2. Bactrim
  3. Fluoroquinolones
  4. Beta-lactams (amoxicillin-clavulanate, cefpodoxime), fosfomycin if susceptibilities are known

3-5 days

22
Q

+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
A

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
23
Q

+Other Agents for UTI

  1. Sulfamethoxazole-trimethoprim (Bactrim)
    • Not in ______
  2. Fluoroquinolones (Levofloxacin, Ciprofloxacin)
    • ​​Use in _____ pts or ___/___ cases
    • Avoid in ____
      • DO NOT use _____ for UTI (low urinary concentrations)
  3. Beta-Lactams (______)
    • ​​(2)
A
  1. Bactrim
    • Pregnancy
  2. Fluoroquinolones
    • allergic, severe/refractory
    • pregnancy
      • X moxifloxacin
  3. Beta-Lactams (Definitive)
    • ​​Amoxicillin-clavulanate (Augmentin)
    • Oral cephalosporins (eg cefpodoxime)
24
Q

+Outpatient Treatment for Skin Infections

(5)

A

Cephalexin (Keflex)

Tetracyclines (Doxycycline, Minocycline)

Sulfamethoxazole-trimethoprim (Bactrim)

Clindamycin (Cleocin)

Linezolid (Zyvox)

25
Q

+Outpatient Tx for Skin Infections

  1. This drug is used as a last line agent dt high rates of GI intolerances, incidence of C.diff
  2. You cannot use this drug in pts with penicllin allergies (higher-cross reactivity)
  3. This drug has a risk of toxicities if used > 2 weeks and is reserved for MRSA or VRE
  4. This drug is great for MSSA and Strep (NO MRSA COVERAGE)
  5. This drug has to be dosed 4 times a day (may cause issue with compliance)
A
  1. Clindamycin
  2. Cephalexin
  3. Linezolid
  4. Cephalexin
  5. Cephalexin
26
Q

+When should we treat a URI with antibiotics?

(5)

A
  • 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

Advanced Pharmacology (14 decks)

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