Infectious Diseases: Fungal Treatments

Question 1

Yeasts

Answer 1

Candida

Cryptococcus neoformans

Question 2

Molds

Answer 2

Aspergillus

Question 3

Amp B Deoxycholate vs Liposomal Amp B

Answer 3

Amp B Deoxy: 1.5 mg/kg/day

Liposomal Amp B (AmBisome): 6 mg/kg/day

Question 4

Amp B Deoxy Considerations / ADRs

Answer 4

Premedicate with:
Analgesic
Antihistamine
+/- Steroid

ADR:
HYPO-kalemia
HYPO-magnesemia

Question 5

Cryptococcal meningitis Treatment

Answer 5

1) Amp B
PLUS
2) Flucytosine (prodrug of fluorouracil, so ADR = myelosuppression)

Question 6

Azole Class Considerations

Answer 6

1) All increase LFTs
2) All have QT prolongation (EXCEPT: isavuconazonium - QT shortening!)
3) CYP3A4 INHIBITORS
4) Increase warfarin, apixaban, rivaroxaban
5) HYPO-kalemia

Question 7

Fluconazole

Answer 7

Use = C. albicans (Topical / IV infections)

Avoid:

1) Pregnant vaginal Candida
2) C. glabrata
3) C. krusei

Considerations:
*Only Azole that requires renal adjustment

Question 8

Voriconazole

Answer 8

[Vfend]

Use = DoC for Aspergillosis

ADR: visual changes / photosensitivity

Take on EMPTY STOMACH

Question 9

Itraconazole & Ketoconazole consideration

Answer 9

Requires acidic pH for absorption
- separate antacids

Itraconazole = causes heart failure
Ketoconazole = causes liver failure (never used systemically)

Question 10

Itraconazole

Answer 10

Use = onychomycosis (nail bed infection)

CI: heart failure

Question 11

Echinocandins

Answer 11

Caspofungin (Cancidas)
Micafungin (Mycamine)

Use:

1) Bloodstream C. albicans
2) C. glabrata or C. krusei

NO renal adjustments

Question 12

Aspergillosis

Answer 12

1st) Voriconazole

2nd) Amp B