TP3 Systemic Fungal Infections

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Author:
islandgirljane
ID:
209453
Filename:
TP3 Systemic Fungal Infections
Updated:
2013-03-25 22:29:24
Tags:
antifungals
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Description:
Fungal infections
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  1. Name the polyene antifungals?
    • Amphotericin B deoxycholate-Fungizone cAmB
    • Amphotericin B lipid complex-Abelcet (ABLC)
    • Liposomal amphotericin B-Ambisone (L-AMB)
    • Amphotericin B colloidal dispersion-Amphocil or Amphotec (ABCD)
  2. What is the MOA of Azoles?
    • 14-α-demethylase inhibitors, deplete ergosterol of fungus (and human cholesterol cell membrane
    • many CYP450 interactions
  3. What is the MOA of Amphotericin B?
    directly binds ergosterol ⇒ pore formation and leakage of intracellular contents
  4. List Amphotericin B PK parameters
    • Fungicidal
    • Concentration-dependent killing (Cmax/MIC)
    • Broad-spectrum agent for yeasts and molds
  5. List the species that AmpB does not cover.
    • Aspergillu terreus
    • Trichosporon 
    • Scedosporium and occasionally
    • Candida lusitaniae
  6. List the AmpB AEs
    • Severe infusion related reactions
    • ⇓ K+  & ⇓ Mg 
    • Nephrotoxicity
    • Anemia
  7. What medication is given to prevent severe infusion related reactions (the fever, chills, rigors, & anaphylaxis) associated with AmpB?
    • APAP
    • DIPHENHYDRAMINE
  8. The Johnson RC prospective trial showed an advantage for the treatment of what pathogen and with which AmpB formulation ?
    • H. capsulatum
    • Liposomal (L-AMB)
  9. List in order AmpB formulations in order from least to most nephrotoxic:
    • colloidal dispersion; amphotec, amphocil ABCD
    • lipid complex; ablecet ABLC
    • liposomal; ambisome L-AMB
    • deoxycholate; fungizone cAmB
  10. Which AmpB formulation has the least Infusion site reactions?
    liposomal AmpB; Ambisome L-AmB
  11. What is the dose for cAmB?
    • 0.5-1 mg/kg
    • for invasive disease 1-1.5 mg/kg
  12. What Amp form. has the highest Cmax?
    Liposomal AmpB, Ambisome, L-Amb
  13. Longest  t 1/2 for AmpB formulation
    lipid complex, Abelcet, ABLC
  14. What is cAmb % in urine?
    3-20% not for UTI unless be given directly
  15. What is cAmb % in CSF?
    0-4 %
  16. Give the brand name for the Triazoles:
    Fluconazole
    Itraconazole
    voriconazole
    posaconazole
    • Fluconazole- Diflucan
    • Itraconazole- Sporanox
    • voriconazole- Vfend
    • posaconazole- Noxafil
  17. Fluconazole covers?
    • majority of:
    • Candida
    • Crytococcus
    • Coccidioides
    • Does NOT cover molds
  18. Dosing for L-AMB and ABLC
    3-6 mg/kg
  19. Itraconazole coverage?
    • Candida
    • Crytococcus
    • Coccidioides
    • Aspergillus
    • Blastomyces & Histoplasma
    • Does NOT cover molds
  20. Voriconazole coverage?
    • Aspergillus
    • Scedosporium & Fusarium
    • resistant Candida sp
    • (caution in S-DD isolates) susceptible dose-dependent
  21. Posaconazole coverage?
    • Aspergillus
    • Scedosporium & Fusarium
    • resistant Candida sp
    • Zygomycetes sp
    • only azole that covers mucomycoses
  22. Which azoles have both IV/PO formulations?
    • Fluconazole 
    • voriconazole
  23. Posaconazole has to be taken with        ?
    fatty food♨
  24. Voriconazole has to be taken                  ?
    withOUT food
  25. What is the sig for Itraconazole solution and capsules? and oral BA?
    • solution: take withOUT food; 70-80% BA
    • capsules: take with food♨ or acidic drink ☕; 50% BA
  26. What is the concentration of fluconazole in:
    CSF
    Urine
    Vitreous?
    • CSF > 60%
    • Urine 90%
    • Vitreous 28-75%
  27. Fluconazole has the        half-life?
    longest; 31 hours
  28. Which azole has a BBW?
    Itraconazole; CHF/cardiomyopathy, edema, pulmonary, edema HA
  29. What are the AEs of Voriconazole?
    • transient ocular sx (enhanced brightness, blurry vision, color changes, photophobia-25% of pts w/in 60min)
    • hallucinations, elevated alkaline phosphatase
    • phototoxic: cheilitis, erythema, and occasional blistering
  30. Which 2 azoles are well tolerated
    • fluconazole
    • posaconazole
    • usually only a HA
  31. What are the general AEs associated with all azoles?
    • GI (N/V/D, epigastric pain)
    • rash
    • elevated hepatic enzymes
    • QT prolongation
  32. Triazoles are the mostly inhibit which hepatic enzyme? which azoles in particular?
    • all but mainly CYP3A4
    • itraconazole and posaconazole
  33. What is the dose of fluconazole?
    200-800 mg daily
  34. What is the dose, level, & target for itraconazole?
    • 200mg TID X 3d, then 200 mg BID
    • random 2 wks
    • 0.5-1.5 mcg/mL
  35. What is the dose, level, & target for voriconazole?
    • 6mg/kg (max 600mg) IV/PO BID X 2 doses, then 4mg/kg IV or 200mg PO BID
    • trough 5-7 days
    • 2-5.5 mcg/mL
  36. What is the dose, level, & target for posaconazole?
    • 200 mg QID, 400 mg BID
    • random 5-7 days
    • 0.5- 1.5 mcg/mL
  37. Name the echinocandins
    • Caspofungin (Cansidas)
    • Micafungin (Mycamine)
    • Anidulafungin (Eraxis)
  38. Echinocandins are        for Candida sp. and        for Aspergillus sp.
    fungicadal for candida and fungistatic for aspergillus
  39. Echinocandin AEs
    N/V/D and infusion related reactions similar to red man syndrome
  40. 5-FC bone marrow suppression is seen at what level ?
    levels > 100 mcg/mL

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