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Pulmonary Block > Pharmacology Funal and Viral Pneumonia > Flashcards

Pharmacology Funal and Viral Pneumonia Flashcards

1
Q

Treatment for Candida albicans

A

amphotericin B (IV) and fluconazole

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2
Q

Treatment for Cryptococcus neoformans

A

CNS: amphotericin B (IV) and flucytosine (PO)

Non-CNS: Fluconazole (PO)

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3
Q

Treatment for Aspergillus

A

Voriconazole IV (step down PO)

2nd: amphotericin B (step down Posconazole PO)

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4
Q

Treatment forBlastomyces dermatitidis

A

1st line: Fluconazole IV or Amph B IV (step down: voriconazole, itraconazole, fluconazole)
2nd line: amph B IV (step down voriconazole or fluconazole PO)

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5
Q

Treatment for Histoplasma capsulatum

A

Severe/Immunocompromised: amphotericin B IV followed by Itraconazole PO

Mild/Moderate: Voriconazole or Posaconazole or Fluconazole PO

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6
Q

Treatment for Coccidioides immitis

A

Severe/Immunocompromised: amphotericin B IV followed by Itraconazole or fluconazole PO

Mild/Moderate: Voriconazole or Posaconazole PO

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7
Q

Amphotericin B issues

A

nephrotoxicity (try to avoid by putting in lipid medium), hypokalemia

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8
Q

Flucystine issues

A

hematotoxic - anemia, blood dyscrasias, agranulocytosis

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9
Q

Azole metabolism

A

CYP2C9, CYP2C19, CYP3A4

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10
Q

Antifungal that crosses blood brain barrier

A

Fluconazole

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11
Q

Absorption of Itraconazole

A

oral absorption is low and variable from patient to patient so newer azoles are recommended more

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12
Q

Primary first line antifungals

A

Azole or Amphotericin B

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13
Q

Indication for Flucytosine

A

Cryptococcal infections

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14
Q

Reason for Aspergillus resistance to Azoles

A

mutations in the promoter region of CYP51A which encodes lanosterol 14alpha sterol demthylase activity (the drug target of azoles)

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15
Q

Antifungals that do not undergo hepatic metabolism

A

Amphotericin B and Flucytosine

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16
Q

Variables suggesting viral cause of pneumonia

A

younger than 5yo, ongoing epidemic, slow onset, rhinitis, wheezing, normal WBC, low CRP, low pro calcitonin, sole interstitial bilateral infiltrates on CXR, slow/non-responsive to ABX

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17
Q

Treatment for Influenza A and B virus

A

Oseltamivir (PO) or Zanamivir (inhalation)

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18
Q

Prevention for influenza A and B

A

Vaccines (inactivated, live); oseltamivir, zanamivir

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19
Q

Treatment of Influenza A virus

A

Amantadine (PO) or Rimantadine (PO)

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20
Q

Treatment of RSV

A

Ribavirin (inhalation, IV)

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21
Q

Prevention of RSV

A

Palivizumab (intramuscular)

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22
Q

Treatment of Adenovirus

A

Cidofovir (IV)

23
Q

Prevention of Adenovirus

A

Vaccine for types 4&7

24
Q

Prevention of Rhinovirus

A

Alfa interferon (intranasal); Ribavirin

25
Q

Treatment/Prevention of Enteroviruses

A

None

26
Q

Treatment of human metapneumovirus

A

Ribavirin (IV)

27
Q

Treatment of Hantavirus

A

Ribavirin (IV)

28
Q

Treatment of Varicella-Zoster virus

A

Acyclovir (IV) or Valacyclovir (PO)

29
Q

Prevention of Varicella-Zoster virus

A

vaccine

30
Q

Acyclovir MOA

A

inhibition of viral DNA synthesis (DNA polymerase inhibition)

31
Q

Amantadine MOA

A

inhibition of viral entry or uncoating

32
Q

Cidofovir MOA

A

inhibition of viral DNA synthesis

33
Q

Oseltamavir MOA

A

inhibition of release of influenza virus from infected cell

34
Q

Ribavirin MOA

A

inhibition of viral nucleic acid synthesis

35
Q

Rimantadine MOA

A

inhibition of viral entry or uncoating

36
Q

Valacyclovir MOA

A

pro-drug from acyclovir

37
Q

Zanamivir MOA

A

inhibition of release of influenza virus from infected cell

38
Q

Acyclovir metabolism

A

Viral cells transform acyclovir to its active triphosphate form; systemic elimination unchanged by glomerular filtration and tubular secretion

39
Q

Amantadine metabolism

A

systemic elimination unchanged by glomerular filtration and tubular secretion

40
Q

Cidofovir metabolism

A

metabolized via pyriminidine nucleoside monophosphate kinase to mono and then diphosphate analogs and finally to the monophosphate choline; systemic elimination by glomerular filtration and tubular secretion

41
Q

Oseltamavir metabolism

A

hepatically metabolized to the carboxylate active form of the drug; systemic elimination by glomerular filtration and tubular secretion

42
Q

Ribavirin metabolism

A

undergoes non-CYP metabolism in nucleated cells with systemic elimination of drug and products in the urine

43
Q

Rimantadine metabolism

A

extensive hepatic metabolism with renal elimination of drug and metabolites

44
Q

Valacyclovir metabolism

A

Converted ot acyclovir and L-valine by 1st pass metabolism; systemic elimination of acyclovir by glomerular filtration and tubular secretion

45
Q

Zanamivir metabolism

A

renal elimination unchanged

46
Q

Acyclovir toxicities

A

HA, nausea, elevated hepatic enzymes, nasopharyngitis, neutropenia; maintain hydration to prevent renal precipitation; se cautiously in renal impairment or with reno-toxic drugs

47
Q

Amantadine toxicities

A

Neurologic, nausea, orthostatic hypotension, contra in narrow angle glaucoma and with breast feeding

48
Q

Cidofovir toxicities

A

neurologic, hematologic and tubular damage; Black box warning for renal impairment/toxicities

49
Q

Oseltamavir toxicities

A

minimal; potential for fatal neuropsychiatric adverse effects in flue patients; serious skin reaction reported rarely

50
Q

Ribavirin toxicities

A

fatigue, headache, myalgia, nausea, fever; Black Box - hemolytic anemia and M/F teratogenicity

51
Q

Rimantadine toxicities

A

Minimal adverse effects

52
Q

Valacylovir toxicities

A

HA, nausea, elevated hepatic enzymes, nasopharyngitis, neutropenia; hydrate to avoid renal precipitation; use cautiously in patients with renal impairment or renal toxic drugs

53
Q

Zanamivir toxicities

A

HA, throat/tonsil pain, cough, viral infection, NOT to be used with underlying pulmonary disease due to Fatal Bronchospasm

Pulmonary Block (8 decks)

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