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Antifungal + Antivirals > Side effects > Flashcards

Side effects Flashcards

1
Q

Amphotericin B Deoxycholate

A

BW: do NOT exceed 1.5 mg/kg/day because of cardiopulmonary arrest

SE: infusion related rxn (fever, HA, malaise, rigors), decreased K, decreased Mg, NEPHROTOXICITY

*compatible with D5W only

*requires premedication to prevent infusion rxn:
- APAP, NSAID
-Benadryl, Hydrocortisone
-NS bolus to help with nephrotoxicity
- maybe meperidine to decrease rigors

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2
Q

Amphotericin B + Digoxin is a high risk of what?

A

Hypokalemia

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3
Q

Liposomal Amphotericin B (AmBisone

A

BW: cardiopulmonary arrst and death
SE: infusion rxn, nephrotoxicity (less likely), hypokalemia, hypomagnesia

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4
Q

Liposomal Amp B + Tacrolimus would be a higher risk of what?

A

Nephrotoxicity

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5
Q

Flucytosine (prodrug of fluoruracil)

A

mainly used for crypto!

MYELOSUPPRESSION
nephrotoxicity
hepatoxicity
hypokalemia
hypoglycemia

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6
Q

Common side effects for Azole antifungals

A

increased LFTs
QTc prolongation
DRUG INTERACTIONS

all IV to PO is 1:1

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7
Q

Fluconazole (Diflucan)

A

increased LFTs
QTc prolongation
DRUG INTERACTIONS

not recommended in pregnancy

penetrates into the CNS really well!!!! meningitis treatment :)

RENAL DOSING: CrCl < 50 decrease dose by 50%

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8
Q

Ketoconazole (Nizoral A-D)

A

increased LFTs - HEPATOTOXICITY = death
QTc prolongation
DRUG INTERACTIONS

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9
Q

Voriconazole (Vfend)

A

CI: coadministration with CYP inducers (barbituates, carbamazepine, efavirenz, quinidine, rifampin, ritonavir, sirolimus, St John’s Wart)

Warning: HEPATOTOXICITY, Phototoxicity, QTc

SE: visual changes, nephrotoxicity, CNS toxicity (hallucinations)

** good CNS penetration

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10
Q

Posaconazole (Noxafil)

A

CI: coadministration with some CYP inducers

Warning: QTc prolongation - correct Ca, K, Mg

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11
Q

Posaconazole + Vincristine creates increase risk of what?

A

Neurotoxicity (seizures, peripheral neuropathy, SIADH, parlytic ileus)

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12
Q

What azoles cause increase in INR?

A

Fluconazole + Voriconazole

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13
Q

Isavuconazoium (Isavuconazole)

A

CI: Use with CYP inducers or inhibitors
**Teratogenic
QTc prolongation
increased LFTs

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14
Q

Caspofungin (Cancidas)

A

mainly used for more coverage of Candida species, only IV

Warning: Histamine related symptoms (pruritis, rash, swelling, hypotension)

SE: increased LFTs, HA, hypotension, hyperglycemia

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15
Q

Micafungin (Mycamine)

A

mainly used for more coverage of Candida species, only IV

Warning: histamine related rxn (pruritus, rash, hypotension, swelling)

SE: increased LFTs, HA, hypotension, hyperglycemia

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16
Q

Nystatin

A

SE: N/V/D, stomach pain
- very low systemic risk due to low GI absorption

17
Q

Terbinafine (Lamisil AT)

A

Warning: Hepatotoxicity , SJS, hematologic
SE: HA, increased LFT

18
Q

Griseofulvin

A

CI: PREGNANCY
SE: photosensitivity, increased LFTs

19
Q

Which antifungals have photosensitivity?

A

Griseofulvin
Voriconazole

20
Q

Which anti-fungals have renal dose adjustments?

A

Fluconazole

21
Q

Acyclovir (Zovirax)

A

SE: malaise, neutropenia, SEIZURES, crystal nephropathy (increased SCr and BUN), burning with topical formulations

Warning: renal impairment, elderly, and use with other nephrotoxic drugs; infuse over at least 1 hour

**dose with IBW

22
Q

Valacyclovir (Valtrex)

A

SE: malaise, HA, neutropenia, increased LFTs, increased seizures, nephrotoxicity

23
Q

Famiciclovir

A

Prodrug of Penciclovir
SE: malaise, HA, neutropenia, increased LFTs, increased seizures, nephrotoxicity

24
Q

Ganciclovir

A

BW: MYLEOSUPPRESSION, carcinogenic, teratogenic
SE: fever, thrombocytopenia, neutropenia, leukopenia, anemia, increased SCr, rare seizures, retinal detachment (CMV retinitis patients)

**use extracontraception 30 days after treatment

25
Q

Valganciclovir (Valcyte)

A

BW: MYLEOSUPPRESSION, carcinogenic, teratogenic
SE: fever, thrombocytopenia, neutropenia, leukopenia, anemia, increased SCr, rare seizures, retinal detachment (CMV retinitis patients)

** use extra contraception for 30 days after treatment

26
Q

Foscarnet

A

Renal impairment, seizures from electrolyte imbalances
decreased: K, Ca, Mg, Phos
increased: Scr, BUN, QTc

27
Q

Osesltamivir (Tamiflu)

A

Warning: neuropsychiatric events (confusion, delirium, hallucination), SJS

SE: HA, nausea, vomiting

*** preferred neuraminidase inhibitor in pregnancy

28
Q

Sofosbuvir

A

Warning: serious BRADYCARDIA, do NOT use with amiodarone

29
Q

All DAA for HCV

A

BW: risk of reactivating HBV === test for HBV BEFORE DAA

Warning: hypoglycemia when used with insulin or hypoglycemia drug

SE: well tolerated, HA, fatigue, diarrhea, hypoglycemia

CI: strong CYP3A4 inducers

**most increase statin dose

30
Q

Epclusa

A

Velpatasvir
Sofosbuvir - do NOT use with amiodarone

PPI not recommented!!! decreases concentrations of Velpatasvir

BW: HBV reactivation
Warning: Hypoglycemia
SE: fatigue, diarrhea

VS - Victoria’s Secret

31
Q

Mayvret

A

Glecaprevir
Pibrentasvir
PG

CI: moderate to severe hepatic impairment or hx of hepatic decompensation

Do NOT use with HIV protease inhibitors “navir”

***approved for 8 week course AND salvage therapy in select patients

32
Q

Ribavirin

A

BW: Teratogenic; not to be used at monotherapy , hemolytic anemia

CI: PREGNANCY, CrCl < 50 mL/min
SE: hemolytic anemia (can lead to MI), fatigue, hypothyroidism

AVOID in pregancy and 6 months after

DI: can increase the hepatotoxicity of NRTIs, Zidovudine can increase risk of severe anemia

33
Q

Interferon Alfa

A

BW: can exacerbate neuropsych, autoimmue, ischemis or infection disorders

CI: neonates, autoimmune hepatitis, decompensated liver disease

Warnings: neuropsych, cardiovascular, endocrine, cisual, pancreatic, myelosuppression, skin reactions

SE: CNS effects, increased LFTs, myelosuppression
Flu-like syndrome —- pretreat with APAP + antihistamine

34
Q

All HBV NRTIs

A

BW: Lactic Acidosis and severe hepatomegaly with steatosis
exacerbations of HBV

SE: increased LFTs, nephrotoxicity

DI: rilavirin can increase hepatotoxicity in NRTIs

35
Q

Viread

A

TDF
Warning: renal toxicity, osteomalacia, decreased bone mineral density

SE: renal impairment, decreased bone mineral density, increased LFTs and CPK

36
Q

Vemlidy

A

TAF
SE: nausea, less renal impairment and bone toxicity, increased LFTs

37
Q

Baraclude

A

Entecavir
SE: increased LFT, peripheral edema, nephrotoxicity, pyrexia, ascites

38
Q

Epivir HBV

A

Lamivudine
contains lower dose for HBV than HIV
SE: headache, N/V/D, increased LFTs

Bactrim increased lamivudine

Antifungal + Antivirals (4 decks)

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