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31 Cards in this Set
- Front
- Back
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what kind of fungi is candida and asperigullus
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candida - yeast
aperigillus - mold |
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deep invasive candidiasis/candidemia and asperigullosis are what type of systemic mycoses
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oppurtunistic
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what are the endemic systemic mycoses
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blastomyces
histoplasma coccidioides |
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what are the risk factors for candidemia
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prosthetic device
neutropenia immunosuppressive therapy TPN |
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what fungi are resistant to fluconazole
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C krusei
C glabrata |
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what bacteria are resistant to amphotericin B
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C krusei
C glabrata |
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what bacteria are resistant to Echinocandins
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C parapsilosis
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what antifungals has susceptibility for all fungi
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voriconazole
posaconazole |
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what is the empiric management of candidemia for non neutropenic pt
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fluconazole: 800 mg (12mg/kg) loading dose 400 mg (6mg/kg) maintenance dose
echinocandin: caspofungin - 70 mg load 50 mg maintenance daily micafungin - 100 mg daily anidulafungin - 200 mg load 100 mg maintenance daily |
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if a pt has had previous azole therapy and has candidemia what drug do you use for initial therapy
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echinocandin
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if pt has had no recent azole therapy and has candidemia what drug do you use
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fluconazole
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when would you switch from fluconazole to echinocandin and v.v.
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flu > echino
-C glabrata, C krusei, previous Abx therapy, moderate to severe echino > flu -C parapsilosis, or if bug is susceptible to fluconazole |
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when would you use voriconazole
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to treat C krusei or C glabrata that is susceptible to Voriconazole
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how long is tx for candidemia and when does it begin
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tx is usually 2 weeks and begins at the 1st negative blood culture
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what is the empiric treatment for invasive candidiasis in non neutropenic patient
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fluconazole: 800 mg (12mg/kg) loading dose 400 mg (6mg/kg) maintenance dose
echinocandin: caspofungin - 70 mg load 50 mg maintenance daily micafungin - 100 mg daily anidulafungin - 200 mg load 100 mg maintenance daily |
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what can pharmacists do for better management of patients with candidemia
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initiate empiric therapy 24 hrs after onset of symptoms
make sure they get adequate dose (not less than 6mg/kg) |
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what pts are usually affected by invasive aspergillosis
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immunocompromised
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what pathogen is a common cause of Aspergillosis
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A fumigatus
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what drugs are the primary tx for invasive aspergillosis
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voriconazole and amphotericin B
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what drugs are used as salvage therapy for invasive aspergillosis
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itraconazole, lipid amphotericein B, caspofungin
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what drug(s) are used as prophylaxis for invasive aspergillosis
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posaconazole
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what is the tx regimen for invasive asperigillosis
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voriconazole 6mg/kg q 12hrs day 1 4 mg/kg q 12 hrs or 200 mg PO q12 hrs
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what kind of substrate are azoles
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CYP450
they are also inhibitors of CYP450 (fluconazole is a weak inhibitor) |
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how are the azoles eliminated
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fluconazole/voriconazole - renal
itraconazole - hepatic posaconazole - unchanged |
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which azoles have poor CSF penetration
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itraconazole
posaconazole |
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which azoles are not available as IV and require no dose adjustments
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itraconazole
posaconazole |
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how are the echinocandins metabolized
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caspofungin and micafungin hepatically
anidulafungin not metabolized |
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how are the echinocandins eliminated
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caspofungin and anudulafungin via feces
micafungin via urine |
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which echinocandin requires dose adjustment
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caspofungin
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how does amphoterecin B work
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binding to ergesterol forming a poor which results in ions and macromolecules looking leading to cell death
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what is the main toxicity of amphotericin B
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nephrotoxicity
also causes anemia via decrease in EPO and hepatotoxicity via increase in LFt |
