Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
29 Cards in this Set
- Front
- Back
|
What does amphotericin B cover?
|
Pretty much everything: candida, aspergillus, cryptococcus, coccidioides, histoplasmosis, mucromycoss, blastomycoses, flusarium
|
|
|
What are the advantages of liposomal amphotericin B?
|
- Allows for administration of larger doses for longer periods of time
- lower potential to induce nephrotoxicity |
|
|
Are there differences in efficacy between the liposomal and non-liposomal amphotericin B formulations?
|
No
|
|
|
Which amphotericin B formulation as more infusion-related reactions?
|
ABCD (Amphotericin B Colloidal Dispersion): more hypotension and bronchospasms
|
|
|
Is amphotericin B metabolized by the Cyt P450 system?
|
No
|
|
|
Which amphotericin B formulation requires renal adjustment?
|
Amphotericin B Deoxycholate (non-liposomal)
|
|
|
What are the adverse reactions to polyenes (amphotericin B)?
|
-Infusion-related reactions in 70% of patients include hypotension, rigors, chills, fever, nausea, vomiting, dyspnea, hypoxia, wheezing. ABCD >> AmB> ABLC > L-AmB
- Nephrotoxicity. AmB > ABLC > L-AmB - Flushing, muscle and joint pain - Potassium and magnesium losses - Local phlebitis |
|
|
How does AmB cause nephrotoxicity?
|
Direct damage to the distal tubular membranes leading to wasting of Na, K, Mg. This causes constriction of afferent arterioles and decreased GFR.
|
|
|
What drug interactions does AmB have?
|
Additive Nephrotoxicity:
- aminoglycosides, cyclosporine, loop diuretics, contrast dye Potassium depletion - corticosteroids, digitalis, neuromuscular blockers |
|
|
What is the spectrum of activity of Isavuconazole (ISA)?
|
Everything
|
|
|
What is the spectrum of activity of posaconazole (PSC)?
|
Everything
|
|
|
What is the spectrum of activity of voriconazole (VRC)?
|
Everything EXCEPT mucormycoses
|
|
|
What is the spectrum of activity of itraconazole (ITC)?
|
Mostly candida. Not mucormycoses or fusarium.
|
|
|
What is the spectrum of activity of fluconazole (FLC)?
|
Candida, cryptococcus, and coccidioides
|
|
|
What do you know about isavuconazole?
|
Currently in Phase 3 trials. Similar to posaconazole. Available IV and PO.
|
|
|
Which triazoles have pH dependent bioavailability?
|
Isavuconazole and voriconazole
|
|
|
Which triazole requires a high fat meal for oral bioavailability?
|
Posaconazole
|
|
|
Which triazole has high oral bioavailability and CNS penetration?
|
Fluconazole
|
|
|
Which triazole requires renal dosing?
|
Fluconazole (if CrCL is <50, then half the dose). Avoid ITC and VRC if CrCL is less than 30.
|
|
|
What are the adverse reactions of triazoles?
|
GI symptoms
Hepatotoxicity (ITC > FLC) Skin reactions Fluconazole: adrenal suppression Itraconazole: negative inotropic effect Voriconazole: dose-related visual disturbances and photosensitivity Posaconazole: potential QT prolongation |
|
|
What drug interactions do triazoles have?
|
Triazoles are CYP Inhibitors. Fluconazole is a strong CYP2C9, CYP2C19 inhibitor. Itraconazole is a strong CYP3A4 inhibitor. Voriconazole is a weak-moderate inhibitor of the three.
|
|
|
If a person has a CrCL <30, can you use Voriconazole?
|
Yes, but you must use PO
|
|
|
What is the spectrum of activity of echinocandins?
|
Candida and Aspergillus
|
|
|
Can echinocandins penetrate the CNS and is it a CYP substrate?
|
No and No
|
|
|
Which echinocandin has to be hepatically adjusted?
|
Caspofungin
|
|
|
What are the adverse reactions of echinocandins?
|
-limited SE profile
- Infusion related reactions |
|
|
What are the drug interactions with Echinocandins?
|
Caspofungin: tacrolimus, cyclosporine, enzyme inducers like rifampin, phenytoin, carbamazepine, dexamethasone
Micafungin: mild inhibitor of cyclosporine metabolism Anidulafungin: increased drug levels with concomitant cyclosporine |
|
|
What are advantages and disadvantages of echinocandins compared to triazoles?
|
- They can be given once daily, they have less drug interactions than triazoles
- They have a more narrow spectrum of activity, they cannot get into the CNS, they can only be given IV. |
|
|
Which antifungals require monitoring to determine efficacy?
|
Itraconazole: routinely get level after 4-7 days
Voriconazole: monitor if patient has GI dysfunction, lack of response, co-medication, hepatic disease Posaconzaole: GI dysfunction, co-medication with PPI Monitor level 4-7 days after start of therapy |
