Antifungals - Gillis

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Author:
jcu1
ID:
211355
Filename:
Antifungals - Gillis
Updated:
2013-04-04 04:18:03
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Antifungals
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Description:
ID2 exam 3
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  1. causes infusion related side effects
    AmB
  2. how to prevent infusion related effects of AmB
    • slow infusion
    • give with APAP, antihistamine, or hydrocortisone for shaking, chills and fevert
    • give meperidine for rigors
  3. antifungal that can cause severe acute renal failure? what is the sign? How do you monitor?
    • AmB
    • inc in SCr
    • monitor hypoK and hyperMg
  4. how are the AmB lipid products diff from AmB?
    • lower incidence of renal toxicity
    • dosed with higher doses
    • more expensive and only IV
  5. DDIs for Triazoles as a class?
    inhibitors of CYP 450 (voriconazole most problematic)
  6. Bioavailability of:
    fluconazole
    intraconazole
    voriconazole
    posaconazole
    • flucon and voricon - high
    • itraconazole solution > capsule
    • posacon - very low
  7. Therapeutic drug monitoring of:
    flu
    itra
    vori
    posa
    • flu - no
    • itra, vori, posa - yes
  8. Effects of food on:
    flu
    itra
    vori
    posa
    • flu - doesn't matter
    • itra capsule - with food
    • itra solution - empty stomach
    • vori - empty stomach
    • posa - with high fat meal
  9. Itraconazole trough after 4-7 days of therapy
    >0.5 mcg/ml
  10. voriconazole trough after 4-7 days of therapy
    1.1 - 5.5 mcg/mL
  11. posaconazole trough after 4-7 days of therapy
    >0.5 mcg/ml
  12. Triazole Vd order
    flu
    posa
    itra
    vori
    • large Vd
    • flu - hydrophilic
    • posa > itra > vori
  13. Triazole protein binding
    itra/posa (99%) > itra (58%) > fluc (12%)
  14. triazole CSF penetration
    fluc (>60%) > vori (60%) > posa/itra

    fluc and vori two highest
  15. triazole vitreal penetration
    • fluc - highest
    • vori > posa > itra
  16. urine penetration
    fluc - 90%

    others are less than 10%
  17. triazole metabolism
    flu
    itra
    vori
    posa
    • flu - minimal
    • itra - extensive hepatic
    • vori - extensive hepatic
    • posa - glucuronidation
  18. triazole elimination
    flu
    itra
    vori
    posa
    • flu - unchanged in urine
    • itra - metabolized; fecal>urine
    • vori - metabolized; urine>fecal
    • posa - unchanged feces
  19. triazole drug interactions - inc efficacy (7)
    • warfarin
    • phenytoin
    • cyclosporine
    • tacrolimus
    • macrolides
    • Statins
    • protease inhibitors
  20. triazole drug interaciton - decrease efficacy
    clopidogrel
  21. triazole drug interactions - decreased fluconazole levels
    • rifamycin derivatives
    • cimetidine
  22. Which azoles have cyclodextrin?
    • itraconazole (solution)
    • voriconazole (IV)
  23. triazole hepatotoxicity
    vori/fluc > itra > posa
  24. triazole skin rash
    itra > vori > fluc
  25. triazole that cause alopecia
    fluconazole
  26. triazole that causes visual disturbances, psych symptoms, cutaneous phototoxicity
    voriconazole
  27. triazole that causes htn, hypoK, edema and negative inotropic effects
    itraconazole
  28. triazole that causes QTc prolongations
    all
  29. azoles that are renally adjusted
    • fluconazole
    • itraconazole oral solution (CrCl <30)
    • voriconazole IV (CrCl <50) - b/c of cyclodextrin
  30. azoles that are adjusted for hepatic impairment
    voriconazole (based on Child-Pugh Class)
  31. what goes into the Child Pugh score
    • bilirubin
    • albumin
    • INR
    • encephalopathy
    • ascites
  32. fluconazole dosage forms
    • tablet
    • suspension
    • IV
  33. itraconazole dosage form
    • capsule
    • solution (cyclodextrin)
  34. voriconazole dosage form
    • tablet
    • suspension
    • IV (cyclodextrin)
  35. posaconazole dosage form
    suspension
  36. echinocandins adverse effects
    very well tolerated
  37. echinocandins dose adjustments
    decrease caspofungin dose for mild to moderate hepatic insufficiency
  38. echinocandin route of admin
    IV only
  39. echinocandin penetration of eye, CNS, and urine
    poor
  40. which antifungals have activity against Asperillus?
    all but fluconazole
  41. which antifungals have activity against Candida?
    • albicans - all
    • glabatra - all (~flu/itra)
    • tropicalis - all
    • parapsilosis - all (~echinocandins)
    • krusei - all but fluconazole (~itra)
  42. which antifungals have activity against Cryptococcus neoformas?
    all but echinocandins
  43. which antifungals have activity against cocidioides species?
    all (~echinocandin)

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