RxPrep Infectious Diseases III - Antifungals & Antivirals

Candida

C. albicans, C. tropicalis, C. papsilosis, C. glabrata, and C. krusei are members of the ________ species.

yeasts

Candida species and Cryptococcus neoformans are examples of ________.

molds

Aspergillus species and Zygomycetes are examples of ________.

dimorphic fungi

Histoplasma capsulatum, Blastomyces dermatitidis, and Coccidioides immitis are examples of ________.

high

Invasive fungal infections are associated with (high/low) morbidity and mortality.

fungi

________ are classified as either yeasts, molds, or dimorphic species.

mucormycosis

invasive disease caused by the Mucor and Rhizopus Zygomycetes species

true

True or False: Certain types of fungi, including yeasts such as Candida, can colonize body surfaces and are considered to be normal flora in the intestine as long as they don't contaminate a sterile space or the immune system isn't weakened by drugs/diseases.

amphotericin B

broad-spectrum drug that binds to ergosterol, altering cell membrane permeability and causing cell death; active against yeasts (such as Cryptococcus neoformans), molds (such as Aspergillus), and dimorphic fungi

deoxycholate

Amphotericin B ________ is the conventional formulation.

lipid

The amphotericin B ________ formulations are associated with fewer toxicities.

injection

What dosage form does amphotericin B come in?

AmBisome

What is the brand name for liposomal amphotericin B?

cardiopulmonary arrest

What is the boxed warning associated with amphotericin B?

1.5

Conventional amphotericin B doses should not exceed ________ mg/kg/day.

chills, fever, headache, malaise, rigors

What are 5 infusion-related side effects of amphotericin B?

decreased magnesium,

decreased potassium,

nephrotoxicity

What are 3 side effects of amphotericin B?

D5W

What is the only fluid amphotericin B is compatible with?

filtration

What must lipid formulations of amphotericin B go through during preparation?

acetaminophen or NSAID,

diphenhydramine,

and/or hydrocortisone

What are 3 premedications that are required when using conventional amphotericin B formulations?

flucytosine - fluorouracil

drug that penetrates fungal cells and is converted to fluorouracil, which competes with uracil and interferes with fungal RNA and protein synthesis

false (should not be used alone)

True or False: Flucytosine is often used in monotherapy treatment of fungal infections.

amphotericin B

Flucytosine is recommended in combination with ________ for the treatment of invasive cryptococcal (meningitis) or Candida infections.

myelosuppression

What is a side effect associated with flucytosine?

azole antifungal

drug class that decreases ergosterol synthesis and cell membrane formation

drug interactions

Azole antifungal use is sometimes limited due to their significant ________.

3A4; inhibitors

Azole antifungals are CYP________ (inducers/inhibitors).

C. glabrata; C. krusei

Fluconazole has limited efficacy against ________ due to resistance, and ________ is considered fluconazole-resistant.

onychomycosis

fungal infection of the nail bed

thrush

yeast infection in the mouth that presents with white-colored, sore patches on the tongue and oral mucosa

nail bed, yeast

Fluconazole can be used for many infections, including ________ and ________ infections.

itraconazole

________ is primarily used for the dimorphic fungi (Blastomycoses and Histoplasma) and nail bed infections.

Aspergillus

Voriconazole is the treatment of choice for ________.

azole antifungals

Fluconazole, itraconazole, ketoconazole, voriconazole, posaconazole, and isavuconazonium are examples of ________.

Diflucan

What is the brand name for fluconazole?

IV, PO

What 2 routes of administration are used for fluconazole?

150 mg PO x 1 dose

What is the oral fluconazole dosing for vaginal candidiasis?

Nizoral A-D

What is the brand name for OTC topical ketoconazole?

heart failure,

QT prolongation

ventricular arrhythmias

increased plasma concentration of drugs (inhibitor),

What are 4 boxed warnings associated with itraconazole?

hepatotoxicity, QT prolongation

What are 2 boxed warnings associated with ketoconazole?

increased LFTs, QT prolongation

What are 2 side effects associated with fluconazole, itraconazole, and ketoconazole?

fluconazole

All azole antifungals are cleared hepatically except ________, which requires renal dose adjustment.

a) fluconazole

b) isavuconazonium

c) itraconazole

d) ketoconazole

e) posaconazole

f) voriconazole

fluconazole

voriconazole

Which of the following azole antifungals penetrate the CNS adequately enough to treat fungal meningitis? (select all that apply)

a) fluconazole

b) isavuconazonium

c) itraconazole

d) ketoconazole

e) posaconazole

f) voriconazole

ketoconazole

keto killed the liver

Hepatotoxicity associated with ________ has led to liver transplantation.

a) fluconazole

b) isavuconazonium

c) itraconazole

d) ketoconazole

e) posaconazole

f) voriconazole

itraconazole

Which azole antifungal can cause heart failure?

a) fluconazole

b) isavuconazonium

c) itraconazole

d) ketoconazole

e) posaconazole

f) voriconazole

voriconazole

vori = visual

Which azole antifungal can cause visual changes and phototoxicity?

a) fluconazole

b) isavuconazonium

c) itraconazole

d) ketoconazole

e) posaconazole

f) voriconazole

true

True or False: Tablet and suspension doses of posaconazole are not interchangeable due to different bioavailabilities.

posaconazole

posa = plate of food

Which azole antifungal must be taken with food?

a) fluconazole

b) isavuconazonium

c) itraconazole

d) ketoconazole

e) posaconazole

f) voriconazole

1:1

IV to PO ratios for all azole antifungals is ________.

posaconazole

voriconazole

= parenteral vehicle

Which of the following azole antifungals use the intravenous vehicle SBECD (sulfobutyl ether beta-cyclodextrin)? (select all that apply)

a) fluconazole

b) isavuconazonium

c) itraconazole

d) ketoconazole

e) posaconazole

f) voriconazole

Vfend

What is the brand name for voriconazole?

<50

Oral voriconazole is preferred over IV in patients with a CrCl of ________ mL/min due to accumulation of SBECD.

SCr

What is a monitoring parameter for IV voriconazole?

hepatotoxicity,

optic neuritis,

qt prolongation

phototoxicity,

What are 4 warnings associated with voriconazole?

visual changes

hallucinations,

increased LFTs,

increased SCr,

What are 4 side effects of voriconazole?

false (empty stomach)

True or False: Vfend should be taken with food.

driving at night

When should patients use caution when taking voriconazole?

direct sunlight

What should patients avoid when taking voriconazole?

Noxafil

What is the brand name for posaconazole?

QT prolongation

What is a warning associated with posaconazole?

isavuconazole

Isavuconazonium is the prodrug of ________.

isavuconazonium

isuva what you did there - all are prolongation except this one

Which azole antifungal causes QT shortening, not prolongation?

a) fluconazole

b) isavuconazonium

c) itraconazole

d) ketoconazole

e) posaconazole

f) voriconazole

isavuconazonium

isuva = sieve

Which azole antifungal requires a filter during administration due to possible particulates?

a) fluconazole

b) isavuconazonium

c) itraconazole

d) ketoconazole

e) posaconazole

f) voriconazole

2C9; warfarin

Along with CYP3A4, fluconazole and voriconazole also inhibit CYP________, which can increase the effects of ________.

PPIs

________ can decrease the absorption of posaconazole suspension and should be stopped during therapy to avoid treatment failure.

itraconazole

ketoconazole

(the old ones)

The absorption of ________ requires an acidic gut. (select all that apply)

a) fluconazole

b) isavuconazonium

c) itraconazole

d) ketoconazole

e) posaconazole

f) voriconazole

echinocandin

drug class that inhibits the synthesis of beta (1,3)-D-glucan, an essential component of the fungal cell wall

Candida

Echinocandins = Candida

Echinocandins are effective against most ________ species.

injection

What dosage form are echinocandins available as?

echinocandins

-end in fungin

Caspofungin, micafungin, and anidulafungin are examples of ________.

Cancidas

What is the brand name for caspofungin?

Mycamine

What is the brand name for micafungin?

candidemia,

esophageal candidiasis

What 2 conditions are treated with micafungin or anidulafungin?

histamine-mediated symptoms

What is a warning associated with echinocandins?

QD

How often are echinocandins dosed?

true

True or False: Echinocandins don't require dose adjustment in renal impairment.

micafungin

Which echinocandin requires light protection during administration?

a) anidulafungin

b) caspofungin

c) micafungin

suspension, tablet

What are 2 oral dosage forms nystatin is available in?

intestinal infections,

oral candidiasis (thrush)

What are 2 conditions treated by nystatin?

swish in mouth and retain as long as possible before swallowing

What is a counseling point for nystatin suspensions?

hair, nails, skin

Griseofulvin is indicated for fungal infections of the ________, ________, and ________.

pregnancy

What is a contraindication for griseofulvin?

increased LFTs,

photosensitivity

What are 2 side effects of griseofulvin?

take w/ fatty meal or milk

What is a counseling point for griseofulvin?

Lamisil AT

What is the brand name for OTC topical terbinafine?

hepatotoxicity

What is a warning associated with terbinafine?

headaches,

increased LFTs

What are 2 side effects of terbinafine?

lozenge, troche

What are 2 oral dosage forms that clotrimazole comes in?

oropharyngeal candidiasis

What is a condition treated by clotrimazole?

oropharyngeal candidiasis

What is a condition treated by miconazole?

hormonal contraceptives

Griseofulvin increases the metabolism of ________.

topical clotrimazole, topical miconazole

What are 2 first line antifungal options when treating mild Candida albicans oropharyngeal infections?

fluconazole

What is a first line antifungal option when treating moderate-severe or HIV+ Candida albicans oropharyngeal infections?

fluconazole

What is a first line antifungal option when treating Candida albicans esophageal infections?

echinocandin

What is a second line antifungal option when treating Candida albicans esophageal infections?

echinocandin

What is a first line antifungal option when treating Candida krusei and glabrata?

amphotericin B

What is a second line antifungal option when treating Candida krusei and glabrata?

echinocandin

What is a first line antifungal option when treating all Candida species bloodstream infections?

amphotericin B

What is a second line antifungal option when treating all Candida species bloodstream infections?

voriconazole

What is a first line antifungal option when treating invasive Aspergillus?