Therapeutics - Fungus 2

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kyleannkelsey
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287933
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Therapeutics - Fungus 2
Updated:
2014-11-02 23:23:01
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Therapeutics Fungus
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Therapeutics - Fungus
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Therapeutics - Fungus
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  1. What is Terbinafine usually used for?
    • Dermatophytes
    • Toe and fingernail infections
  2. What is the half life of Terbinafine?
    400 hours
  3. Does Terbinafine have good Bioavailability?
    Decent w/ or w/o food
  4. What are the risk factors for vulvovaginal candidiasis?
    • Sexual factors
    • Oral contraceptives
    • Antibiotics
  5. What is the most common vulvovaginal fungal infecting agent?
    Candidia albicans
  6. What are the S/S of Vulvovaginal candidiasis?
    • Erythemia
    • Cheese like discharge
    • Edema
    • Vulvar itch
    • Irritation
    • Burning upon urination
    • Normal Vaginal pH
    • Pseudohyphae
  7. What are the treatments for uncomplicated vulvovaginal candidiasis?
    • Topical azoles: Clotimazole, Miconazole cream/suppository or ovule or Ticonazole
    • Oral azoles: Fluconazole (150 x1) or Itraconazole (200 BID x1)
    • Nystatin 100,000 U tab
  8. What is the DOC for OTC treatment of Vulvovaginal Canididasis?
    None, all are equivalent
  9. How should you treat complicated vuvlovaginal candidiasis?
    • 7-14 days
    • Consider: Fluconazole 150 mg PO Q72H x3 doses
  10. What is recurrent vulvovaginal candidiasis?
    > 4 in 12 months
  11. How do you treat recurrent vulvovaginal candidiasis?
    • Indiction: Fluconazole 150 mg PO Q72H x 3 doses
    • Maintenance: 150 mg QW x 6 months
  12. What is the most common etiology of oropharyngeal candidiasis?
    Candida albicans
  13. What are the risk factors for Thrush/Oropharyngeal candidiasis?
    • Steroids/Antibiotics (Inhalers/Advair, etc.)
    • Smoking
    • Chemotherapy/Radiation
    • Immunosuppression (HIV, Cancer, DM)
    • Nutritional deficiencies
  14. What are the S/S of Thrush/Oropharyngeal candidiasis?
    • Variable
    • Erythema
    • White patches on surface
    • Pain
    • Metallic taste
    • Dysphagia
  15. What is a good way to treat thrush in small children/infants?
    Gentian violet
  16. What drugs are used to treat Oropharyngeal Candidiasis?
    • Uncomplicated: Nystain or Clotrimazle
    • Moderate to Severe disease: Fluconazole
    • Refractory or High Risk: Vori, Itra, POsa or AmB systemic therapy
  17. What is the dose for Nystatin in the treatment of thrush?
    • 100,000 U/mL
    • 5 mL swish/spit/swallow sometimes
    • QID for 7-14 days
  18. What is the dose for Clomitrazole in the treatment of thrush?
    • 10 mg troche
    • Slowly dissolve in mouth for 15-20 minutes 4-5 x day
  19. What is the dose for Fluconazole in the treatment of thrush?
    100 mg QD 7-14 days
  20. How long should you treat Onchomycosis?
    • Fingernail: 6 weeks
    • Toenail: 12 weeks
  21. How is Onychomycosis treated?
    • Orally
    • Terbinafine 250 mg/day x6-12 weeks
    • Itraconazole 200 mg PO BID x 1 week/month (repeat 2x for finger, 3x for toe)
  22. What are the risk factors for Systemic Candidiasis?
    • Indwelling catheter/IV line
    • Surgery
    • Broad-spectrum antibiotics
    • TPN therapy
    • IV drug users
    • Immunocompromised (Neutropenic, Immunosuppressed, HIV/AIDS)
  23. How does systemic candidiasis present?
    • Acute onset of fever
    • Tachycardia
    • Tachypnea
    • Hypotension
    • Worsening deterioration w/ or w/o fever
    • (Like sepsis)
  24. How would you Usually treat systemic Candidia in an ImmunoCOMPETENT adult?
    • Fluconazole 800 mg loading dose
    • 400 mg IV thereafter
    • OR
    • Echinocandin
    • 14 days
  25. How would you Usually treat systemic Candidia in an ImmunoCOMPRIMISED adult?
    • Echinocandin
    • Or
    • Amphotericin
  26. What are the ALTERNATIVE treatments for Systemic Candida in an ImmunoCOMPETENT adult?
    • Amphotericin
    • Voriconazole
  27. What are the ALTERNATIVE treatments for systemic Candida in an ImmunoCOMPRIMISED adult?
    • Fluconazole
    • Voriconazole
    • (Only if no previous azole exposure and not critically ill)
  28. How would you treat SEVERE Systemic Candida in an ImmunoCOMPETENT adult?
    Echinochandin x 14 days
  29. How would you treat Systemic Candida in an ImmunoCOMPETENT adult who has recently been exposed to an azole?
    Echinochandin x 14 days
  30. In general Candida albicans should be treated with _______________________ if at all possible.
    Fluconazole or echinocandin
  31. What type of antifungal should be used to treat commonly resistant C. glabrata?
    Echinocandin preferred
  32. What type of antifungal should be used to treat commonly resistant C. krusei?
    Echinocandin preferred
  33. What type of antifungal should be used to treat commonly resistant C. lusitaniae?
    Fluconazole (tends to be resistant to amphoB)
  34. Voriconazole should be reserved for what situation?
    Step-down cases of C. glabrata or C. krusei (fluconazole resistant sp.)

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