Therapeutics - Fungus 3

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kyleannkelsey
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287934
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Therapeutics - Fungus 3
Updated:
2014-11-02 23:23:56
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Therapeutics Fungus
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Therapeutics - Fungus
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Therapeutics - Fungus
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  1. What are the S/S of esophageal Candidiasis?
    • Pain
    • Difficulty swallowing
    • Feeling of obstruction
    • Substernal chest pain
    • (Feels like GERD)
  2. How would you NORMALLY treat Esophageal Candidiasis?
    Oral fluconazole 200-400 mg QD x 14-21 days
  3. What are the ALTERNATIVE options to treat Esophageal Candidiasis?
    • Itraconazole 200 mg/day (solution)
    • IV fluconazole, voriconazole or echinocandin
  4. When and how should you treat a Candidia UTI?
    • If symptomatic
    • Fluconazole 200 mg QD for 2 weeks
    • Alternative: Ampho B bladder irrigation
  5. How is Aspergillosis usually obtained?
    Inhaled
  6. What are the risk factors for Aspergillosis?
    • Neutropenia
    • Drugs: Corticosteroids, Antineoplastics, Broad-spectrum antibiotics
    • Graft Vs. Host disease
    • CMV
    • Hepatitis
    • Alcoholics
    • DM
  7. What is the normal and alternative treatment for INVASIVE Aspergillosis?
    • DOC: Voriconazole IV then switch to Oral
    • Alternative: AmphoB (lipid), Caspofungin, Micafungin, Posaconazole, Itraconazole
  8. What is the treatment for Allergic bronchopulmonary Aspergillosis?
    Itraconazole or Voriconazole with a steroid
  9. What is the treatment for AspergillOMA?
    Surgery then Itra or Voriconazole
  10. How efficacious is Voriconazole at treating Invasive Aspergillosis?
    53%
  11. Is combination therapy recommended for Invasive Aspergillosis?
    No, unless refractory or progressive
  12. How has Aspergilus formed ressitance to Azoles?
    Mutations in 14-alpha-demethylase enzyme
  13. Aspergillus is rarely resistant to what drugs?
    Polyenes and Echinocandins
  14. What are the risk factors for Cryptococcus?
    • Immunosuppressed:
    • HIV
    • Organ-transplant
    • Malignancies
    • DM
  15. How would you treat a Cryptococcus infection in a Non-HIV patient?
    • Isolated pulmonary:
    • Mild-Moderate: Fluconazole 6-12 months
    • Severe: Same as CNS disease for 12 months
    • CNS disease:
    • Induction: Ampho B + Flucytosine x 4 weeks
    • Consolidation: Fluconazole 400-800 mg x 8 weeks
    • Maintenance: Fluconazole 200 mg x 6 – 12 months
  16. How would you treat a Cryptococcus infection in an HIV patient?
    • Isolated pulmonary:
    • Mild-Moderate: Fluconazole for life
    • Severe: Same as CNS disease for > 12 months
    • CNS disease:
    • Induction: Ampho B + Flucytosine x 4 weeks
    • Consolidation: Fluconazole 400 mg x 8 weeks
    • Maintenance: Fluconazole 200 mg x > months
  17. What are the risk factors for Histoplasmosis?
    • Immune status
    • Amount inhaled
    • Previous exposure
  18. How would you treat ACUTE pulmonary histoplasmosis?
    • Severe: AmphoB with steroid then Itraconazole for 12 weeks
    • Mild/Moderate: Symptoms < 4 weeks = no treatments, Symptoms > 4 weeks = itraconazole for 6-12 weeks
  19. How would you treat CHRONIC pulmonary histoplasmosis?
    • Severe: AmphoB then Itraconazole for 12-24 months
    • Mild/Moderate: Itraconazole for 12-24 months
  20. How would you treat Non-AIDs disseminated histoplasmosis?
    • Severe: AmphoB then Itraconazole for at least 12 months
    • Mild/Moderate: Itraconazole for 12 months
  21. How would you treat AIDs Disseminated histoplasmosis?
    • Severe: AmphoB then Itraconazole for life
    • Mild/Moderate: Itraconazole for life
  22. What is the treatment for Pulmonary Blastomycosis?
    • Life-threatening: AmphoB then Itraconazole for 6-12 months
    • Mild/Moderate: Itraconazole for 6-12 months
  23. What is the treatment for Disseminated or Extrapulmonary Blastomycosis?
    • CNS: AmphoB for 4-6 weeks then Itraconazole or Voriconazole for 12 months
    • Non CNS:
    • Severe: AmphoB for 4-6 weeks the Itraconazole for 12 months
    • Mild/Moderate: Itraconazole for 6-12 months
  24. What is the treatment for Immunocomprimised patients with Blastomycosis?
    AmphoB the Itraconazole for life
  25. What are the risk factors for Coccidiodomycosis?
    • Soil related occupation
    • Immunosuppressed
    • Travelers to endemic SW
  26. How is most Coccidioidomycosis treated?
    • No treatment, self-resolving
    • Initial therapy: Fluconazole or Itraconazole, Ampho B if critical
    • 3-6 months with follow up for 2 years
  27. C. glabrata is usually resistant to what drugs?
    • Fluconazole
    • Itraconazole
    • Voriconazole
    • Posaconazole
    • 5-FC
  28. What drugs have demonstrated efficacy against C. galbrata?
    • AmphoB
    • Anid
    • Cspo
    • Mica
  29. What antifungals have hepatic SEs?
    • All azoles
    • Ampho B
    • Echinocandins
    • 5-FC
  30. What antifungals have Kidney SEs?
    • Ampho B
    • Vori/Itra (IV)
  31. What antifungals have CNS SEs?
    Voriconazole
  32. What antifungals have Cardiac SEs?
    • Itra (cardiomyopathy)
    • Azoles
    • (QTc prolongation)
  33. What antifungals have Skin SEs?
    • Rash (all)
    • Photosensitivity (vori)
  34. What antifungals have Ocular SEs?
    Voriconazole
  35. What antifungals have Bone Marrow SEs?
    • 5-FC
    • AmphoB
  36. What antifungals have GI SEs?
    • Itraconazole
    • Posaconazole
    • 5-FC
  37. What antifungals have Infusion rxns SEs?
    AmphoB

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