Antifungal in DSM III

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mcucullu
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199247
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Antifungal in DSM III
Updated:
2013-02-09 22:42:21
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antifungal Xavier University College Pharmacy Disease State Management III Dr Camtu Ho
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All materials covered in the Antifungal portion of Disease State Management III
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  1. What is the clinical presentation of histoplasmosis?
    • 1)  flu-like pulmonary symptoms
    • 2)  acute pulmonary
    • 3)  chronic pulmonary
    • 4)  disseminated
  2. What is the drug of choice for patients with histoplasmosis and what is an alternative?
    Drug of choice:  amphotericin B; Amphotec (amphotericin B cholesteryl sulfate complex); Abelcet (amphotericin B lipid complex); AmBisome (amphotericin B liposomal)

    Alternative:  Sporanox (itraconazole)
  3. What is the clinical presentation for patients with blastomycosis?
    • 1)  Pulmonary
    • 2)  Chronic pulmonary
    • 3)  Disseminated
  4. What is the drug of choice for patients with blastomycosis and what is an alternative?
    • Drug of choice:  Sporanox (itraconazole)
    • Alternative:  amphotericin B; Amphotec (amphotericin B cholesteryl sulfate complex); Abelcet (amphotericin B lipid complex); AmBisome (amphotericin B liposomal)
  5. What is the clinical presentation for patients with coccidioidomycosis?
    • 1)  URI
    • 2)  Valley fever
    • 3)  Pulmonary
    • 4)  Disseminated
  6. What drugs may be used in the treatment of patient with coccidioidomycosis?
    • amphotericin B; Amphotec (amphotericin B cholesteryl sulfate complex);
    • Abelcet (amphotericin B lipid complex); AmBisome (amphotericin B liposomal); Sporanox (itraconazole); Diflucan (fluconazole)
  7. What species are considered to be non-albicans, which are very resistant?
    • 1)  Candida glabrata
    • 2)  Candida krusei
    • 3)  Candida parapsilosis
    • 4)  Candida tropicalis
  8. What is the clinical presentation of Candida infection?
    • 1)  Fever
    • 2)  Tachycardia
    • 3)  Tachypnea
    • 4)  Chills
    • 5)  Hypotension
  9. What are some Candida species that have developed resistance to amphotericin B; Amphotec (amphotericin B cholesteryl sulfate complex); Abelcet (amphotericin B lipid complex); AmBisome (amphotericin B
    liposomal)?
    • 1)  Candida lusitaniae
    • 2)  Candida guilliermondii
  10. What are some Candida species that have developed resistance to Diflucan (fluconazole) and Sporanox (itraconazole)?
    • 1)  Candida krusei
    • 2)  Possibly Candida glabrata
  11. What are some Candida species that have developed resistance to VFEND (voriconazole) and Noxafil (posaconazole)?
    • 1)  Maybe Candida krusei
    • 2)  Often Candida glabrata
  12. What are some first line therapies for Candidemia?
    • 1)  VFEND (voriconazole)
    • 2)  Diflucan (fluconazole)
    • 3)  Cancidas (caspofungin)
    • 4)  Mycamine (micafungin)
    • 5)  Eraxis (anidulafungin)
    • 6)  amphotericin B
  13. What are some salvage therapies for Candidemia?
    • 1)  Abelcet (amphotericin B lipid complex)
    • 2)  AmBisome (amphotericin B liposomal)
  14. What is the clinical presentation of a patient with invasive aspergillosis?
    • 1)  pleuritic chest pain
    • 2)  fever
    • 3)  hemoptysis
    • 4)  friction rub
    • 5)  wedge shaped infiltrate
    • 6)  halo sign on CT scan
    • 7)  fungus ball
  15. What are the first line therapies for patients with invasive aspergillosis?
    • 1)  VFEND (voriconazole)
    • 2)  amphotericin B; Amphotec (amphotericin B cholesteryl sulfate complex); Abelcet (amphotericin B lipid complex); AmBisome (amphotericin B liposomal)
  16. What are some salvage therapies for patients with invasive aspergillosis?
    • 1)  Cancidas (caspofungin)
    • 2)  Sporanox (itraconazole)
    • 3)  Abelcet (amphotericin B lipid complex)
    • 4)  AmBisome (amphotericin B liposomal)
  17. What are the polyenes?
    • 1) Nystat-Rx (nystatin)
    • 2)  amphotericin B; Amphotec (amphotericin B cholesteryl sulfate complex); Abelcet (amphotericin B lipid complex); AmBisome (amphotericin B liposomal)
  18. What are the imidazoles?
    1)  Apo-Ketoconazole/Novo-Ketoconazole (ketoconazole)
  19. What are the triazoles?
    • 1)  Diflucan (fluconazole)
    • 2)  Sporanox (itraconazole)
    • 3)  VFEND (voriconazole)
    • 4)  Noxafil (posaconazole)
    • 5)  ravuconazole
  20. What are the allylamines?
    • 1)  LamiSIL (terbinafine)
    • 2)  Lotrimin ultra/Mentax (butenafine)
  21. What are the fluorinated pyrimidine?
    1)  Ancobon (flucytosine)
  22. What are the echinocandins?
    • 1)  Cancidas (caspofungin)
    • 2)  Eraxis (anidulafungin)
    • 3)  Mycamine (micafungin)
  23. What is the mechanism of action for amphotericin B; Amphotec (amphotericin B cholesteryl sulfate complex); Abelcet (amphotericin B lipid complex); AmBisome (amphotericin B liposomal)?
    • 1)  Binds to sterols in cell membrane lining
    • 2)  Allow K+ and Mg++ to leak out, altering fungal cell metabolism
  24. What is the mechanism of action for Nystat-Rx (nystatin)?
    • 1)  Binds to sterols in cell membrane lining
    • 2)  Allow K+ and Mg++ to leak out, altering fungal cell metabolism
  25. What is the mechanism of action for Apo-Ketoconazole/Novo-Ketoconazole (ketoconazole)?
    Inhibit an enzyme, resulting in cell membrane leaking
  26. What is the mechanism of action for Diflucan (fluconazole)?
    Inhibit an enzyme, resulting in cell membrane leaking
  27. What is the mechanism of action for Sporanox (itraconazole)?
    Inhibit an enzyme, resulting in cell membrane leaking
  28. What is the mechanism of action for VFEND (voriconazole)?
    Inhibit an enzyme, resulting in cell membrane leaking
  29. What is the mechanism of action for Noxafil (posaconazole)?
    Inhibit an enzyme, resulting in cell membrane leaking
  30. What is the mechanism of action for Cancidas (caspofungin)?
    Inhibits synthesis of beta-(1,3)-D glucan
  31. What is the mechanism of action for Eraxis (anidulafungin)?
    Inhibits synthesis of beta-(1,3)-D glucan
  32. What is the mechanism of action for Mycamine (micafungin)?
    Inhibits synthesis of beta-(1,3)-D glucan
  33. What are some side effects associated with amphotericin B; Amphotec (amphotericin B cholesteryl sulfate complex); Abelcet (amphotericin B lipid complex); AmBisome (amphotericin B liposomal)?
    • 1)  Nephrotoxicity
    • 2)  Hypokalemia
    • 3)  Glomerular damage
    • 4)  Renal tubule degeneration
    • 5)  Fevers
    • 6)  HA
    • 7)  N/V/D
    • 8)  Reversible anemia
    • 9)  Thrombophelbitis
    • 10)  Hypersensitivity reactions
    • 11)  Chills
    • 12)  Anorexia
    • 13)  Malaise
    • 14)  Hypotension
    • 15)  Tachycardia
    • 16)  Muscle and joint pain
    • 17)  Lowered magnesium levels
    • 18)  Seizures
    • 19)  Paresthesias
  34. What are some drug interactions with amphotericin B; Amphotec (amphotericin B cholesteryl sulfate complex); Abelcet (amphotericin B lipid complex); AmBisome (amphotericin B liposomal)?
    • 1)  Rifampin
    • 2)  5-FC
    • 3)  Tetracyclines
    • 4)  Imidazoles
  35. In what order do the different formulations of amphotericin B cause the greatest nephrotoxicity?
    AMB-deoxy>>ABCD>ABLC>L-AMP
  36. In what order do the different formulations of amphotericin B cause the greatest infusion related toxicity?
    AMB-deoxy>ABCD>ABLCV>L-AMB
  37. In what order do the different formulations of amphotericin B cost the most?
    L-AMB>ABLV>ABCD>AMB-deoxy
  38. What are the side effects associated with Apo-Ketoconazole/Novo-Ketoconazole?
    • 1)  G.I.
    • 2)  N/V
    • 3)  Anti-androgenic effects
  39. What are the side effects associated with Sporanox (itraconazole)?
    • 1) Elevation of liver enzymes
    • 2)  N/V/D
  40. What are some drug interactions with Sporanox (itraconazole)?
    1) CYP3A4
  41. What are some side effects associated with Diflucan (fluconazole)?
    • 1)  Elevation of liver enzymes
    • 2)  N/V/D
    • 3)  Abdominal pain
  42. What are the drug interactions with Diflucan (fluconazole)?
    1)  tipranavir (with doses > 200 mg/day of Diflucan)
  43. What are some side effects associated with VFEND (voriconazole)?
    • 1)  Transient visual disturbances
    • 2)  Crcl < 50 mL/min must use oral formulation
    • 3)  Elevation of liver enzymes
    • 4)  N/V/D
    • 5)  Rash
  44. What are some drug interactions associated with VFEND (voriconazole)?
    • 1)  CYP3A4
    • 2)  CYP2C9
  45. What are some side effects associated with Noxafil (posaconazole)?
    • 1)  QTC prolongation
    • 2)  Elevation of liver enzymes
    • 3)  N/V/D
  46. What are some drug interactions associated with Noxafil (posaconazole)?
    • 1)  CYP3A4
    • 2)  CYP2C9
  47. What are some side effects associated with Cancidas (caspofungin)?
    1)  Hepatic elevations
  48. What are some side effects associated with Mycamine (micafungin)?
    1)  Hepatic elevations
  49. What are some side effects associated with Eraxis (anidulafungin)?
    1)  Hepatic elevations

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