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Pharmacology > LO 12 > Flashcards

LO 12 Flashcards

Anti Fungals and Anti Virals

1
Q

Describe fungal infections

A

They are more likely to occur in patients who are immunocompromised, and they can become chronic

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2
Q

What are the two common groups of fungal infections and the interventions used?

A
  1. Mucocutaneous candidal infections - managed with nystatin, clotrimazole, ketoconazole, or fluconazole
  2. Tinea - affects the skin and produces athlete’s foot, “jock itch,” and ringworm; managed both with prescription and over-the-counter medications
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3
Q

How long is the treatment course for anti-fungals?

A

Usually 2 weeks

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4
Q

What common drug do anti-fungals tend to disrupt?

A

Oral contraceptives

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5
Q

C. Albicans infections typically result in __________ patients as a result of ____________

A
  1. immunocompromised
  2. superinfection/suprainfection
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6
Q

What are the predisposing factors for fungal infections?

A
  1. Chronic antibiotic use
  2. Immune compromised (chemo/radiation, HIV, Chronic corticosteroids)
  3. Appliances (e.g. dentures)
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7
Q

Antifungal medications can be divided into _________ and __________

A
  1. Natural
  2. Synthetic
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8
Q

Natural antifungals are in the drug group __________

A

Polyene

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9
Q

Synthetic anti-fungal medications are in the drug group ________ or __________

A
  1. Imidazole
  2. Triazole
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10
Q

What are the trade names for nystatin? (natural antifungal=Polyene)

A
  1. Candistatin
  2. Mycostatin
  3. Nilstat
  • Don’t confuse w/ cholesterol “statin” meds
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11
Q

What is the first choice ant-fungal medication?

A

nystatin

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12
Q

How does nystatin impact fungi?

A

Fungicidal and fungistatic

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13
Q

What are the adverse reactions of nystatin?

A

GI adverse reactions - nausea, vomiting, and diarrhea

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14
Q

What dose form does nystatin come in?

A
  1. aqueous suspension containing 50% sucrose
  2. Swish, swirl, and spit or swallow 5 ml four times daily - The suspension should remain in the mouth for 2 minutes for the best effect
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15
Q

What is the common suffix for synthetic anti-fungals?

A

azole

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16
Q

What do synthetic antifungals tend to interact with?

A

inhibitors liver enzymes cytochrome P450

17
Q

The trade name for ketoconazole is ___________

A

Nizoral

18
Q

ketoconazole/ Nizoral requires __________ for optimal absorption

A

High acidity - take with OJ or cola

19
Q

What drugs do ketoconazole/ Nizoral interact with?

A

Antacids will lower absorption - requires highly acidic environment for optimal absorption

20
Q

What are the adverse affects of ketoconazole/ Nizoral

A
  1. GI effects - nausea and vomiting
  2. Hepatotoxicity
21
Q

Describe the RX for ketoconazole/ Nizoral

A
  1. For treatment of Candida is 200 to 400 mg orally daily
  2. Used for at least 2 weeks; 6 to 12 months may be required for chronic mucocutaneous candidiasis
22
Q

What is the trade name for clotrimazole?

A

Canesten

23
Q

What are the adverse reactions of clotrimazole/Canesten?

A
  1. GI - abdominal pain, diarrhea, and nausea
  2. Xerostomia
24
Q

Who should NOT take clotrimazole/Canesten?

A
  1. Diabetics
  2. Children
25
Q

What is the trade name of fluoconazole?

A

Diflucan

26
Q

What is the benefit of fluoconazol/Diflucan?

A

Improved safety and predictable absorption

27
Q

What is Dr. I’s #2 choice for an antifungal?

A

Diflucan

28
Q

List the drugs in the Polyene group

A

nystatin =Candistatin =Mycostatin =Nilstat

29
Q

List the drugs in the Imidazole group

A

ketoconazole/Nizoral & clotrimazole/ Canesten

30
Q

List the drugs in the Triazole group

A

fluoconazol/Diflucan

31
Q

What are antivirals used for?

A
  1. Shown to reduce both the duration of the lesion and the pain of the lesions on the lips and face associated with both primary and recurrent herpes simplex
  2. MOST EFFECTIVE DURING PRODROMAL STAGE
31
Q

List 3 common antiviral medications

A
  1. acyclovir
  2. Abreva
  3. penciclovir
32
Q

What is the effective spectrum of acyclovir (Zovirax)?

A
  1. HSV #1
  2. HSV #2
  3. HHV #3
  4. HHV #5
  5. EBV (Epstein Barr virus)
33
Q

What are the routes of administration for acyclovir (Zovirax)?

A
  1. Topical: burning, itching
  2. Oral: nausea, vomiting, diarrhea
  3. Injection: irritation at injection site, Seizures
34
Q

What is suggested for patients with Frequent HSV#1 lesions?

A
  1. Zovirax (acyclovir ointment) to have on hand and apply during prodromal stage.
  2. Avoid systemic AV Rx for the severe adverse RXNs
35
Q

Describe treatment for HIV

A
  1. HIV+ is associated with increase opportunistic infections: Tb, HSV, C. albicans, Pneumonia, Flu virus
  2. ALWAYS check for C. albicans
  3. AB or AF prophylaxis? NOT REQUIRED
  4. Higly Affective AntiRetroviral Treatment =“HAART” or AntiRetroviral Treatment=“ART” ( Highly active anti retroviral treatment or anti retroviral treatment)🡺“Cocktail” e.g. Azidothymidine (AZT)
36
Q

What are the general and oral adverse reactions of AZT?

A

General
1. bone marrow depression
2. CNS effects include headache, agitation and insomnia

Oral
1. taste perversion
2. edema of the tongue
3. bleeding gums
4. mouth ulcers
5. Pigmentation of oral mucosa

37
Q

What 4 things should you know about HIV+ patients before treatment?

A
  1. CD4 count - should be > 200 cells/mm.
  2. Platelet count- should be >60,000/mcl (normal is 150,000-450,000)
  3. Absolute neutrophil count- if <500 cells/mcl., requires prophy AB
  4. Viral load - should be <3,000/mcl.
  • 1 & 4 are the most important
38
Q

What should you know if HIV patient has comorbidities such as diabetes or if client is on Coumadin?

A
  1. Diabetes - A1C- >8% is poorly controlled.
  2. Coumadin - Able to treat as long as it is in the therapeutic range of 2-3 (if >3, do not treat)

Pharmacology (15 decks)

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