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ID > Invasive Fungal Infections > Flashcards

Invasive Fungal Infections Flashcards

1
Q

Yeasts

A

Candida spp.

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2
Q

Molds

A

Aspergillus spp.

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3
Q

Dimorphic fungi

A
  • Blastomyces spp.
  • Histoplasma spp.
  • Coccidiodes spp.
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4
Q

Polyene

A

Amphotericin B

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5
Q

Amphotericin B SOA

A
  • C. Lusitania often R
  • C. auris variable
  • often R A. terreus
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6
Q

Amphotericin B SE dose- or [ ]- dependent

A

dose-dependent

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7
Q

Amphotericin B DDI

A

Nephrotoxic agents -
Hypokalemia - Digoxin

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8
Q

Amphotericin B formulations

A
  • CONVENTIONAL: AMphotericin B Deoxycholate (AmBd)
  • Amphotericin B Colloidal Dispersion (ABCD, Amphotec)
  • Amphotericin B Lipid Complex (ABLC, Abelcet)
  • Liposomal AMphotericin B (L-AmB, Ambisome)
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9
Q

Amphotericin B SOA

A

C. Lusitania often R, C. auris variable, often R A. terries)

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10
Q

Amphotericin lipid formulations

A
  • lower nephrotoxicity
  • higher cost
  • preferred over AmBd
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11
Q

infusion related rxn from greatest to least

A

ABCD > AmBD > ABLC > L-Amb

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12
Q

Azoles SOA

A
  • C. krusei
  • C. glabrata
  • C. auris
  • Aspergillus spp.
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13
Q

Which azole is the exception to covering Aspergillus

A

Fluconazole

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14
Q

Fluconazole

A

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

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15
Q

Itraconazole (Sporanox, Tulsura)

A
  • take on an empty stomach
  • CI - HF, neg ionotropic drugs
  • ADEs - hypokalemia
  • monitoring - LFTs, QTc, electrolytes, TDM
  • AVOID IN PREGNANCY AND LACTATION
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16
Q

Voriconazole (Vfend)

A
  • 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
17
Q

Posaconazole (Noxafil)

A
  • give w/ high fat meal or nutritional supplement or acidic beverage
  • widely distributed in tissues; poor eyes & urine, variable CSF
  • AVOID IN PREG & LACTATION
18
Q

Isavuconazonium (Cresemba)

A
  • 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
19
Q

Echinocandins SOA

A

variable R to C. parapsilosis

20
Q

Echinocandin SE

A

hypersensitivity or hepatotoxicity

21
Q

Echinocandin drug itxn

A

minimal
- Cyclosporine increase Caspofungin & anidulafungin
- Micafungin increases cyclosporine
- CYP450 inducers: decreases caspofungin

22
Q

Rezafungin (Rezzayo)

A
  • 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
23
Q

Which antifungal is/are assoc. w/ ocular disturbances?

A

Voriconazole

24
Q

Which anti-fungal classes are assoc. with infusion-related rxns?

A

Azoles, Polyenes, Echinocandins

25
Q

Which azole is NOT a CYP450 substrate

A

Posaconazole

26
Q

anti-fungal therapy selection

A
  • 1st gen Echinocandins (1st line therapy)
  • azoles - alt. empiric tx for non-crit. ill pts & those w/o recent azole exposure
  • AMB - alt agent if intolerant, anti-fungal resistance develops, or pregnant; lipid formulation preferred to minimize SE, toxicities —RESERVED FOR C. AURIS
27
Q

Aspergillosis

A

A. fumigatus > A. flavus > A. niger > A. terreus
- immunosuppressants (cytotoxic, corticosteroids, TNF-a inhibitors)
- lungs (common site)

28
Q

Endemic Dimorphic Fungi

A

Coccidioidomycosis
Blastomycosis
Histoplamosis

29
Q

Histoplasmosis found where?

A

central/eastern states including FL

30
Q

Blastomycosis found where?

A

“central”/eastern States excluding FL

31
Q

Coccidioidomycosis found where?

A

south/western states and parts of Washington, Oregon & Idaho

32
Q

Does Flucytosine cover Endemic Fungi?

A

no

33
Q

What are some nephrotoxic drugs that interact with Amphotericin B?

A
  • Antibiotics
  • Chemotherapeutic agents
  • NSAIDs
  • Tetracyclines
  • ACE inhibitors

ID (8 decks)

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