Tieman Flashcards
candida risk factors
prolonged ICU stay
pic/port line
TPN
gastro surgery
aspergillus risk factors
immunocompromised hosts
neutropenia
cryptococcus side effects
CNS effects
cryptococcus common pathogen
neoformans
amphotericin B first line fungi
cryptococcus
blastomyces
histoplasma
mucor
amphotericin B adverse effects
nephrotoxicity
increase in SCr and BUN
electrolyte abnormalities
hypokalemia
hypomagnesemia
dosing of liposomal amphotericin B
liposomal 3-5 mg/kg/day
flucystosine 1st line
cryptococcus
adverse effect of flucytosine
bone marrow suppression
monitoring of flucytosine
CBC
platelets
SCr
BUN
flucytosine indication
cryptococcal meningitis in combo with amphotericin B
which antifungals require dose adjustment in renal
flucytosine
fluconazole
fluconazole adverse effects
QTc prolongation
fluconazole dose for candida albicans in candidemia
800 mg load then 400 mg daily
fluconazole 1st line
candida albicans
candida parapsilosis
candida tropicalis
candida lusitaniae
plat
coccidioides
itraconazole 1st line
blastomyces
histoplasmosis
itraconazole contraindication
CHF
itraconazole adverse effects
hepatotoxicity
QTC prolongation
itraconazole drug interactions
CYP3A4 inhibitor
itraconazole dosing for histo
200 mg TID x 3 days then 200 mg PO BID
which drugs to avoid if CrCl < 50
posaconazole IV
voriconazole
posconazole adverse effects
QT prolongation
inccreased liver enzymes
posconazole 1st line
nothing
broad spectrun
voriconazole interactions
CYP3A4
voriconazole use
invasive aspergillosis
voriconazole adverse effect
visual disturbances
isavuconazole adverse effect
no QT interval prolongation
(shortens)
which azole has the least interactions
isavuconazole
contraindication in isavuconazole
those with shortened QT interval
echinocandins 1st line coverage
candida glabrata
candida krusei
candida lusitaniaw
candida auris
GALK
- can add to voriconazole in severe aspergillus
caspofungin adverse effects
histamine related symptoms
rash
face swelling
pruritic
flushing
phlebitits
fever
micafungin dosage form
IV
micafungin dosage adjustment for renal and CYPs
no dose adjust renal
no CYP interactions
micafungin adverse effects
very minimal
hyperbilirubinemia
ibrexafungerp consideration
contraindicated in pregnancy
use effective contraception during and 4 days after treatment
echinocandins coverage
candida only
glabrata
auris
lusitaniae
krusei
most common OI in HIV
oropharyngeal candidiasis
what is the primary line of defense against superficial candida infections
cell mediated immunity
T cells
risk factors for oropharyngeal and esophageal candidiasis
inhaled steroid use
chemo
HIV
antibiotic use
immunosuppression after transplant
treatment mild oropharyngeal candidiasis
nystatin 100,000 units /ml 5 ml QID x 7-14 days
treatment moderate to severe oropharyngeal
fluconazole 100-200 mg daily x 7-14 days
treatment of esophageal candidiasis
fluconazole 200-400 mg x 14-21 days
can we do oral therapy for esophageal candidiasis
no always systemic
vulvovaginal candidiasis biggest risk factor
antibiotic use
vulvovaginal candidiasis treatment
fluconazole 150 mg PO one dose
topical OTC azoles
candidiasis symptoms similar to what
bacteremia
fever, chills, tachycardia, hypotension
risk factors for candidiasis
use broad spectrum antibiotics
CVC, PIC use
TPN
neutropenia (ANC<500)
immunosuppressive agents
surgery (intraabdominal)
candidemia first lines
micafungin 100 mg
fluconazole 800 mg load, then 400 mg
candidemia with albicans preferred
fluconazole
candidemia with glabrata preferred
micafungin
candidemia with paapsilosis preferred
fluconazole
(amphotericin B)
candidemia with tropicales preferred
fluconazole
candidemia with krusei preferred
micafungin
voriconazole
amphotericin B
candidemia with lusitaniae preferred
fluconazole
micafungin
candidemia with auris preferred
micafungin
how long is candidemia treated
14 days after first negative culture
disseminated histoplasmosis symptoms
weight loss
night sweats
hepatosplenomegaly
fever
chills
CNS histoplasmsosis symptos
fever
seizure
mental status changes
mild to moderate acute pulmonary histo treatment (sx >4 weeks)
itraconazole 200 mg TID x 3 days then 200 BID x 6-12 weeks
moderate to severe acute pulmonary histo treatment
lipid amphotericin B 3-5 mg/kg/day x 1-2 weeks then
itraconazole 200 mg TID x 3 days then 200 mg BID x 12 weeks
disseminated histo treatment
lipid amphotericin B 3-5 mg/kg/day x 1-2 weeks then
itraconazole 200 mg TID x 3 days, then 200 mg BID x 12 months!
duartion of pulmonary histo vs disseminatedd histo
pulmonary 6-12 weeks
disseminated 12 months
blastomycosis treatment
mild
itraconazole x 6 months
mod-severe
lipid amphot + itraconazole x 6-12 months
coccidioidomycosis presentation
primary pulmonary disease
coccidioidonycosis treatment
fluconazole 400-800 x 3-6 months (primary resp)
x 12 months (pneumonia)
how is cryptococcus diagnosed
lumbar puncture
meningitis presentation
cryptococcus meningitis non HIV infected treatment
Induction
amphotericin B + flucytosine
(2 weeks HIV, 4 weeks non-HIV)
consolidation
fluconazole 800 mg x 8 weeks
Maintenance
fluconazole 400 mg x 12 months
invasive pulmonary aspergillosis treatment
voriconazole x 6-12 weeks
aspergillosis prophylaxis
posaconazole
