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17 Cards in this Set
- Front
- Back
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What is important to remember during adminstration of lipid amphotercin B?
liposomal? |
Lipid, do not use an in-line filter; flush line with D5W
Liposomal, in-line membrane filter maybe used, not less than 1 micron; flush line w D5W |
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At what dose of Amphotercin B does permanent renal damage often occur?
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dose > 5 gm
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What are the directions for reconstitution for Amph B?
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do initial reconstitution ONLY with steril water for injection. DO NOT use saline, dextrose, electrolytes, etc.
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Flucytosine (5FC)
MOA Indication |
MOA - interferes with DNA synthesis. Sometimes used with AmpB. This combo allows lower dose and renal tox; but you must watch for bone marrow suppression
Indication - Adjunctive treatment of systemic fungal infections (eg septicemia, endocarditis, UTI, meningitis, or pulmonary) caused by susceptible strains of Candida or Cryptococcus |
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What are 4 major fungal infections?
Treatment? What drugs are given post Tx to prevent relapse? |
Histoplasmosis
Blastomycosis Coccidioidomycosis Cryptococcis **100% morbidity w/o Tx; 20-45% morbibity w/ Tx Amp B Azole drugs (fluconazole + itraconazole) given post Tx to prevent relapse |
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Vfend (voriconazole)
MOA Indication Dosage form Pharmacokinetics/contraindications Metabolism Important note |
MOA - destroys fungal cell wall due to loss of ergosterol
Indication: Superior first line drug in invasive aspergillosis compared to Amp B also superior for candidemia and esophageal candidiasis Dosage form - Vfend is IV only; oral is indicated for the first-line treatment of both mold and yeast infections Pharmacokinetics - non-linear due to saturation of metabolism. Greater than propportional increase in exposure is observed with increasing dose Metabolism 2c9 extensively poor metabolizers have 4 fold increase of AUC Contraindicated w/ sirolimus, terfenadine, astemizole, cisapride, pimozide, quinidine, efavirenze, rifabutin Important Note: only antifungal indicated for hard to treat infections due to Fusarium spp and Scedosporium apiospermum in pts who are refractory to, intolerant of other antifungals |
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What does voriconazole to do liver enzymes?
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Inhibits them, esp 3a4
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Grisofluvin Ultramicro
Indication PCN sensitivity effect on liver enzymes dietary concerns |
Indication
ringworm/tenia of skin, hair and nails PCN sensitivity: drug is derived from same organism as PCN; use with caution in pts who are allergic to PCN Dietary concerns; give after meals to decrease GI concerns; also, high fat meals increase absorption |
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Caspofungin
MOA Indication dose Side effects |
MOA - glucan synthesis inhibition
Indication: Candidiasis, aspergillosis **severe candida aspergillus pulmonary Dose: 70mg IV on day 1; then 50mg IV daily Side effects intra abdominal abscesses, peritonitis, pleural infections |
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list 3 azoles
what two require stomach acid effect on liver enzymes Can sporanox (itraconazole) caps be interchanged with the po solution? |
fluconazole, itraconazole, ketoconazole
ketoconazole, itraconazole liver enzyme inhibitors, 3A4 NO INTERCHANGABILITY |
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Lamisil (terbinafine)
indication metabolizm effect on liver enzymes |
indication
fungal nail infections metabolized by 2D6 induce liver enzymes |
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Mycostatin (nystatin)
Indication |
candida infections of mucus membranes, specifically candida albicans
oral thrush - creamy what leasions, usually on your tongue or inner cheeks candida esophagitis - thrus of the esophagus vaginal thrush thrush of skin systemic |
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nystatin/triamcinolone - Mykacet
indication |
indication - cutaneous candidiasis; nystatin-steroid combo provides greater benefit than nystatin alone for the first few days of treatment
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what is the KOH test?
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the potassium hydroxide test is an inexpensive and quick test to differentiate between dermatophytes and candida albicans symptoms from other disorders like psoriasis and eczema
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What four species have shown resistance to fluconazole?
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C. krusei, C. tropicalis, Torulopsis glabrata, and C. lusitania, demonstrate resistance to fluconazole
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Fungizone (Amphotercin B)
List three other brand names MOA t1/2 Indication Dose Side effects |
Amphotech, Ambisome, Abelcet
MOA - disrupts the permeability and fluidity of the fungal cell membrane by binding ergosterol in the membrane t1/2 - initial half life is 24 hrs; second elimination phase is 16 days Indication DOC for life threatening fungal infections; severe candida; aspergillus pulmonary and others Dose 0.25 mg - 1.5 mg/kg/d; usually once a day IV over 2 hours **May want to give test dose to see how patient reacts; 1 mg in 20 ml D5W IV over 20-30 mins; record pt BP, HR, temp q 30 mins over two hours Side effects - shaking, chills, fever, myalgias, HA >50% Nephrotoxicicty - during therapy do lab work requently; Renal Fnx, LFTs, electrolyts, blood counds *Renal Tox is the limiting factor in Amp B therapy |
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What can you do to help prevent patient intolerance?
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It helps to give APAP, NSAIDs, antihistamines, antiemetics, prior to infusion.
Merperidine 25-50mg IV may decrease duration of shaking chills |
