Invasive Fungal Infections Flashcards
Yeasts
Candida spp.
Molds
Aspergillus spp.
Dimorphic fungi
- Blastomyces spp.
- Histoplasma spp.
- Coccidiodes spp.
Polyene
Amphotericin B
Amphotericin B SOA
- C. Lusitania often R
- C. auris variable
- often R A. terreus
Amphotericin B SE dose- or [ ]- dependent
dose-dependent
Amphotericin B DDI
Nephrotoxic agents -
Hypokalemia - Digoxin
Amphotericin B formulations
- CONVENTIONAL: AMphotericin B Deoxycholate (AmBd)
- Amphotericin B Colloidal Dispersion (ABCD, Amphotec)
- Amphotericin B Lipid Complex (ABLC, Abelcet)
- Liposomal AMphotericin B (L-AmB, Ambisome)
Amphotericin B SOA
C. Lusitania often R, C. auris variable, often R A. terries)
Amphotericin lipid formulations
- lower nephrotoxicity
- higher cost
- preferred over AmBd
infusion related rxn from greatest to least
ABCD > AmBD > ABLC > L-Amb
Azoles SOA
- C. krusei
- C. glabrata
- C. auris
- Aspergillus spp.
Which azole is the exception to covering Aspergillus
Fluconazole
Fluconazole
renally excreted
- ADE- seen w/ dose >400 mg/day >2 mo)
- monitor - increased LFTs, QTc, DDIs, renal fx
- avoid in pregnancy - especially 1st trimester
- lactation compatible
Itraconazole (Sporanox, Tulsura)
- take on an empty stomach
- CI - HF, neg ionotropic drugs
- ADEs - hypokalemia
- monitoring - LFTs, QTc, electrolytes, TDM
- AVOID IN PREGNANCY AND LACTATION
Voriconazole (Vfend)
- take on empty stomach; 1HR B4 OR 2HR AFTER MEAL-avoid high fat meal
- ADEs - VISUAL DISTURBANCES <– stop tx; photosensitive rash
- AVOID IN PREG. & LACTATION
- TDM
- excreted through the liver
Posaconazole (Noxafil)
- give w/ high fat meal or nutritional supplement or acidic beverage
- widely distributed in tissues; poor eyes & urine, variable CSF
- AVOID IN PREG & LACTATION
Isavuconazonium (Cresemba)
- A: F=98% independent of food & acidity
- extensively distributed including brain; poor CSF & urine
E - feces and urine
ADEs - shorten QT interval - no TDM necessary
- AVOID IN PREG. & LACTATION
Echinocandins SOA
variable R to C. parapsilosis
Echinocandin SE
hypersensitivity or hepatotoxicity
Echinocandin drug itxn
minimal
- Cyclosporine increase Caspofungin & anidulafungin
- Micafungin increases cyclosporine
- CYP450 inducers: decreases caspofungin
Rezafungin (Rezzayo)
- admin: weekly
- limited tissue penetration
- E: 75% feces and 25% urine
- counseling/education: slow or pause infusion; restart at a lower rate; use protection against sun exposure
Which antifungal is/are assoc. w/ ocular disturbances?
Voriconazole
Which anti-fungal classes are assoc. with infusion-related rxns?
Azoles, Polyenes, Echinocandins
