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NAPLEX review 2024 RXPrep Book > Infectious Diseases III: Antifungals & Antivirals > Flashcards

Infectious Diseases III: Antifungals & Antivirals Flashcards

1
Q

Amphotericin B MOA

A

binds to ergosterol, altering cell membrane permeability and causing cell death

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2
Q

Amphotericin B formulations

A

Amphotericin B deoxycholate = conventional, many toxicities
Amphotericin B lipid formulation = fewer toxicities compared to conventional

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3
Q

Amphotericin B Boxed warning

A

mixing between conventional and lipid formulation, conventional should not be more than 1.5mg/kg/day can cause cardiopulmonary arrest and death

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4
Q

Ampthotericin B Side effects

A

infusion related, fevers, chills, headache, dec K/Mg, nephrotoxicity

** conventional req premed to reduce incidence **

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5
Q

Amphotericin B DI

A

additive risk with other nephrotoxic agents
can inc risk of digoxin toxicity, use caution with any other agent that dec K/Mg

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6
Q

Flucytosine MOA

A

goes inside cells, converts to fluorouracil and interferes with fungal RNA and protein synthesis

using in combo with Amp B due to resistance

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7
Q

Flucytosine and AmpB combo used in….

A

invasive cryptococcal (meningitis) or candida infections

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8
Q

Azole MOA

A

decrease ergosterol synthesis and cell membrane formation

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9
Q

Fluconazole info

A

only azole that req renal dose adjustment, rest cleared hepatically

works against C.albicans, parapsilosis and tropicalis
Limited activity against C. glabrata and C kruse = resistant

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10
Q

primary use for itraconazole?

A

dimorphic fungi (blastomycoses & histoplasma)
nail bed infections

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11
Q

Voriconazole is treatment of choice for….

A

aspergillus

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12
Q

which azole can treat fungal meningitis?

A

fluconazole and voriconazole, both penetrate the CNS

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13
Q

Itraconazole boxed warning

A

can worsen or cause HF, dont used to treat onychomycosis in pts with ventricular dysfunction or hx of HF

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14
Q

Ketoconazole warnings

A

hepatotoxicity which has led to liver transplantation or death
QT prolongation

use only as last resort

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15
Q

Voriconazole warnings and SE

A

SE: visual changes, inc LFTs, Scr, CNS tox
Warnings: hepatotoxicity, visual disturbances, phototox, QT prolong

avoid direct sunlight, caution driving at night

** take on empty stomach **

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16
Q

Isavuconazonium info

A

causes QT shortening not prolongation

micron filter req when admin IV

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17
Q

Azole drug interactions

A

Itraconazole/ketoconazole req acidic environment, so if on PPI drink soda before taking

PPI can dec absorption of posaconazole suspension, dont take w/ it

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18
Q

Echinocandins (-fungins) MOA

A

inhibit synthesis of beta (1,3) D-glucan, part of fungal cell wall

active against candida species, used in combo against Aspergillus

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19
Q

Echinocandins info

A

all given once daily
no dose adjustments in renal impairment

Micafungin req light protection during admin

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20
Q

Griseofulvin info

A

used for fungal infection of skin, hair,nails

dont use in pregnant people, severe liver disease
take w/ fatty meal to inc absorb and dec GI upset
inc metabolism of hormone BC, use backup

SE: photosensitivity, inc LFTs

21
Q

Terbinafine Info

A

Lamictal = topical

Warning: hepatotoxicity
SE: headache, inc LFTs

22
Q

empiric treatment for Candida albicans thrush

A

mild = topical anti fungal
mod-severe = fluconazole

alternative = Nystatin

23
Q

empiric treatment for Candida albicans esophageal infection

A

fluconazole

alternative: echinocandin

24
Q

empiric treatment for Candida kruse and globarata, all candida blood stream infections

A

echinocandin

alternative: amp B, high dose fluc

25
Q

empiric treatment for aspergillus

A

Vorivonazole

alternative: amp B, isavuconazonium

26
Q

Cryptococcus neoformans meningitis empiric treatment

A

ampB + flucytosine

alternative: high dose fluc + flucytosine

27
Q

Dermatophytes empiric treatment

A

terbinafine or itraconazole

Alternative: fluconazole

28
Q

Neuraminidase inhibitors

A

oseltamivir - tamiflu
zanamivir
peramivir

29
Q

to be most effective, neuraminidase inhibitors should be taken within….

A

48hrs of illness onset

30
Q

Baloxavir (Xofluza)

A

endonuclease inhibitor = MOA
single dose
still start within 48hrs of symptom onset

31
Q

Tamiflu treatment dosing

A

75mg BID X 5 days ( > 12 yrs old)

32
Q

Tamiflu ppx dosing

A

75mg QD X 10 days ( > 12 yrs old)

33
Q

Tamiflu warnings and SE

A

Warning: neuropsych events

SE: HA, N,V

preferred in pregnancy over others

34
Q

Zanamivir treatment dosing

A

Two 5mg inhalations BID X 5 days ( > 7yrs)

35
Q

Zanamivir ppx dosing

A

Two 5mg inhalations QD X 10 days (> 5 yrs) if household, X 28 days if community

36
Q

Zanamivir warnings

A

dont use in Asthma/COPD due to bronchospasm

37
Q

Peramivir dosing

A

600mg IV single dose for txm, < 50 CrCl renal adjust

38
Q

Acyclovir warning

A

use caution with renal impairment, elderly and the on other nephrotoxic drugs.

hydrate well and infuse over 1 hr at least

39
Q

Initial oral herpes txm

A

Acyclovir - 200mg X 5 times daily or 400mg TID
Valacyclovir - 1g BID

40
Q

Chronic suppression oral herpes txm

A

Acyclovir - 400mg BID
Valacyclovir - 500mg or 1g QD

41
Q

HSV encephalitis txm

A

IV acyclovir 10mg/kg Q8H for 14-21 days

42
Q

Shingles Vaccine recommendations

A

> 50 yrs old or > 19yrs old if immunosuppressed

43
Q

Shingles txm

A

Acyclovir - 800mg 5 times a day for 7/10 days
Valacyclovir - 1g TID for 7 days

44
Q

CMV txm of choice and what’s back up?

A

Ganciclovir and valganciclovir

Foscarnet and cidofovir back up

Maribavir if resistant to everything else

45
Q

CMV ppx

A

Letermovir = getting stem cell transplant
Ganciclovir/valganciclovir = sold organ transplant

46
Q

Ganciclovir/valganciclovir boxed warning

A

Myelosuppression

47
Q

Ganciclovir/Valganciclovir notes

A

females use contraception during txm and 30 days after
males use contraception 90 days after

48
Q

Foscarnet boxed warnings

A

renal impairment, pre-hydration is important

NAPLEX review 2024 RXPrep Book (78 decks)

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