Therapeutics - Fungus 1

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  1. What histology finding indicates Yeast?
    • Unicellular, budding
    • Asexual reproduction
  2. What histology finding indicates Molds?
    Hyphae, spores
  3. What histology finding indicates Dimorphs?
    • Mold in environment
    • Yeast in host
  4. Budding yeast on histology indicates what species?
  5. What histology finding indicates Cryptococcus?
    Budding yeast
  6. Filamentous hyphae on histology indicates what species?
    Mold: Aspergillus, Mucor, Fusarium
  7. What histology finding indicates Aspergillus, Mucor or Fusarium?
    • Filamentous hyphae
    • (Mold)
  8. Dimorphic on histology indicates what species?
    • Blastomyces
    • Coccidiodes
    • Histoplasmosis
  9. What histology finding indicates Blastomyces, Coccidiodes or Histoplasmosis?
  10. What organismusually cause superficial/cutaneous fungal infections?
    Tinea or Dermatophytes
  11. What are the risk factors for a fungal infection?
    • OC
    • Pregnancy
    • DM
    • Malnutrition
    • Immunosupression
  12. What are the Polyenes?
    • Amphotericin B (AmB-d)
    • Lipid-based Amphotericin:
    • AmphoB lipid complex (ABLC)
    • AmphoB collodial dispersion (ABCD)
    • Liposomal Ampho-B (L-AmB)
  13. What are the Azoles?
    • Fluconazole (Diflucan)
    • Itraconazole (Sporonox)
    • Voriconazole (Vfend)
    • Posaconazole (Noxafil)
  14. What are the Echinocandins?
    • Caspofungin
    • Micafungin
    • Anidulafungin
  15. What are the Allylamines?
  16. What is the MOA of Polyenes?
    Membrane holes
  17. What is the MOA of Echinocandins?
    • Cell wall synthesis inhibitors
    • Blocks the synthesis of a major fungal cell wall component, 1-3-beta-D-glucan
  18. What is the MOA of Azoles?
    • Inhibit ergosterol synthesis
    • Inhibit cytochrome P450 14a-demethylase ; conversion of lanosterol to ergosterol
  19. Are echinocandins fungistatic or cidal?
  20. What are the dosage forms available for Fluconazole?
    IV and oral
  21. How is Fluconazole excreted?
    Renally (dosage adjustments if CrCl = ~<50)
  22. What is the major benefit to Fluconazole?
    Great Bioavailability: IV ~ = PO
  23. What Azoles have great Bioavailability?
    • Fluconazole, Voriconazole and Posaconazole
    • (All except Itraconazole)
    • (Posaconazole only with 50% fat diet)
  24. What Azoles have poor Bioavailability?
  25. How would you counsel a patient on Itraconazole?
    • Do not take SOLUTION with food if possible (bad taste)
    • If have to take with food – choose a non-diet cola or orange juice
    • Take CAPSULE with food (delays GI emptying and increases absorption) – OJ is good
  26. When should you avoid Itraconazole IV?
    • Avoid in renal dysfunction due to cyclodextrin in formulation
    • (may caution in hepatic dysfunction as well…doesn’t say clearly)
  27. Do you need to make renal or hepatic adjustments for Voriconazole?
    • None for renal
    • Yes for hepatic
  28. Which Azoles need dose adjustment with renal or hepatic impairment?
    • Renal: Fluconazole, IV itraconazole, Voriconazole IV
    • Hepatic: Voriconazole IV and Oral (maybe itraconazole…?)
  29. What is the most common SE of Voriconazole?
    Almost 20% have visual disturbances (blurry/color changes)
  30. Does Posaconazole have high Bioavailability?
    • Yes, High bioavailability when given with fatty foods, acidic environment
    • 50% of oral intake must be fat
  31. How often is Posaconazole dosed?
    Given 3-4 x a day
  32. What DDIs do azoles have?
    • PPI or H2RA decrease Bioavailability
    • CYP3A4 and 2C19 (Flu and Vori for later)
    • Increases digoxin via P-gp
  33. By what route are Echinocandins given?
    All are IV
  34. What is the dose for Caspofungin?
    70mg IV load, then 50mg daily
  35. What is the dose for Micafungin?
    100 mg IV daily
  36. When would you dose adjust Echinocandins?
    • Biliary reductions
    • (No renal adjustments)
  37. What are the SE of Echinocandins?
    Histamine release: rash, facial swelling/itchiness
  38. How do the spectrums of activity differ between formulations of Amphotericin B?
    All have similar spectrum
  39. What is a normal dose for invasive candidiasis of Amphotericin B?
    • AmB-D 0.5-1mg/kg daily IV
    • LFAmB 3-5mg/kg daily IV
  40. How can you reduce renal toxicity of Amphotericin B?
    • Give a liposomal formula:
    • AmphoB lipid complex (ABLC)
    • AmphoB collodial dispersion (ABCD)
    • Liposomal Ampho-B (L-AmB) tion:
  41. How can you reduce infusion related reactions of Amphotericin B?
    Pre-medicate with APAP, diphenhydramine, steroids or meperidine
  42. What are the major SE of Amphotericin B?
    • Nephrotoxicity
    • Infusion reactions
Card Set
Therapeutics - Fungus 1
Therapeutics - Fungus
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