Pharmacotherapy of antifungal agents II Flashcards
What are the most common causes of candidiasis, ways to prevent
Cathether or GI, remove central venous catheter if able
What are presentations of cadidiasis
CNS, eye, intraabdominal, thrush, vulvovaginal
What are the three options if a patient has candida in the urine and is symptomatic
remove catheter, give flucanozole, get blood drawn and check other areas of the body
What are risk factors for candidiasis
use of broad spectrum antibiotics, central venous catheters, TPN (espicially lipid based), dialysis, neutropeniea, implants, intrabdominal surgery, colonization at multiple sites
What is the empiric treatment for candidiasis
Echinocandins especially with azole exposure, risk of flucanazole resistance and neutropenia
What would be used if the candida is shown to be highly succpetible, dose, what if highly resistance
Flucanazole 800 mg (12/mgkg) load followed by 400 mg (6mg/kg) daily/ Echinocandins
How long should candidiasis treatment be if it is not uncomplicated
2 weeks starting from first negative blood culture or source control
What are common ways presentations of aspergillosis
invasive pulmonary aspergillois, allergic bronchopulmonary aspergillus, fungal balls
What are the species of aspergillosis from common to least common
A. fumigatus, A. flavus, A. niger
What are risk factors for getting aspergillosis
prolonged neutropenia ANC less than 100, hematologic malignancies, Bone marrow transplant, solid organ transplant (especially the lung), acute myeloid leukemia, long term steroid use
What is the definitive way to diagnosis aspergillosis why is it not done, what are the other ways
Tissue biopsy but it is too invasive/ galacctomannan in high risk patients, CT scan showing nodules, wedge shaped lesions. or halo signs
What is the drug of choice for aspergillosis, what is the 2nd line, what other antifungals have activity
Voricanazole, isavuconazole/ amphotericin, echinocandins
T/F: If using voricanazole trough levels should be monitored to see if they are between 1-5 for best efficacy
True
What fungi is opportunistic and increase virus replication with a large capsule, what are some presentations, who does it effect most
Cryptococcal, meningitis and pneumonia, HIV/AIDS patients and/or those with diminished immune systems
What is the treatment regimen for Cryptococcal disease
Amphotericin B PLUS Flucytosine for two weeks FOLLOWED by Fluconazole 400 mg for 8 weeks then flucanozole 200 as maintenance for at least one year
What is the key concern when treating crytococcal disease, how can it be avoided
Immune Reconstitution Inflammatory Syndrome (IRIS), defer Antiretroviral therapy for 5 weeks after starting crypto therapy
What are the three most common dimporphic (endemic) fungi in the US
Coccidiodes immitis, Histoplasmosis.capsulatum, and Blastomyces dermatitidis
What is the antifungal used for emperic endemics
Amphotericin B/ H capsulatum: Itraconazole, Coccidoiodes immitis: Itraconazole or flucanazole, Blastomyces dermatitidis: Itraconazole, flucanazole (CNS), or voriconazole
What is the fungal infection that attacks patients the most immunocompromised, what are the funga strands
Zygomycosis, mucor/mucormycosis, rhizopus
What are the patients who are the most at risk for getting zygomycosis
Extremely immunocompromised and patient with long standing uncontrolled diabetes
Why is the presentation of zygomycosis
Invasive sinus/rhinocerebral disease with rapid tissue necrosis, facial pain, unilateral headache, drainage, tissue swelling
What is the primary treatment of zygomycosis, what antifungals can be given
aggresive surgery and restoration of the immune system/ amphotericin, posaconazole, isavuconazole
