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48 Cards in this Set
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Candidemia/Disseminated candidiasis treatment of choice for susceptible strains
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Fluconazole x14days
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Candidemia/Disseminated candidiasis drug of choice for infections due to fluconazole resistant isolates and/or severe infections
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Amp B x14days
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Candidemia/Disseminated candidiasis 2nd line therapy for patients not responding to conventional therapy or with renal insufficiency
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a.Liposomal amp B x14days
b.Amp B lipid complex x14days |
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Candidemia/Disseminated candidiasis agents reserved for resistant organisms or intolerance to other antifungals
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Caspofungin, Micafungin, Anidulafungin, Voriconazole
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Agents used for empiric therapy of Candidemia/Disseminated candidiasis
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AmpB, Caspofungin, Micafungin, Anidulafungin
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This agent is an excellent choice for completion of therapy for fluconazole resitant isolates (oral)
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Voriconazole
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Hepatosplenic candidiasis treatment for stable patients
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Fluconazole
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Hepatosplenic candidiasis treatment for severely ill patients
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Amp B
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Urinary candidiasis important points
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1. Foley cathetar must be changed
2. DON'T treat colonization 3. Evaluate the urinalysis |
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Treatment for urinary candidiasis
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Fluconazole
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This agent should not be used for urinary candidiasis unless a resistant organism is present secondary to toxicity
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Amp B
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These agents may be considered for urinary candidiasis for resistant isolates
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Voriconazole, Caspofungin
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Invasive aspergillosis gold standard for therapy
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Amp B 1-1.5mg/kg IV Q24H
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Invasive aspergillosis treatment that many clinicians consider the therapy of choice
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Voriconazole 6mg/kg IV BID x 2 doses then 4mg/kg IV BID
OR 200mg PO BID |
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These agent is reserved for patients intolerant to voriconazole or amphortericin products for invasive aspergillosis
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Caspofungin 70mg IV x 1 then 50mg IV Q24H
Severe liver disease: 70mg IV x 1 then 35mg IV Q24H |
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Histoplasmosis treatment for severe disease/initial CNS disease
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AmpB 0.7mg/kg IV Q24H
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Histoplasmosis agents for treatment of mild to moderate disease
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-Itraconazole
-Fluconazole (preferred for CNS disease) |
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Acute Pulmonary Histoplasmosis treatment for mild/moderate symptoms
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i.sx's <4weeks=No therapy
ii.sx's >4weeks=Itraconazole x6-12weeks |
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Chronic Pulmonary Histoplasmosis treatment for mild/moderate symptoms
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Itraconazole x12-24months
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Disseminated Histoplasmosis in non-AIDS for mild/moderate symptoms
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Itraconazole x6-18months
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Disseminated Histoplasmosis in AIDS for mild/moderate symptoms
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Itraconazole lifelong
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Meningitis Histoplasmosis for mild/moderate symptoms
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AmpB x3months then fluconazole x12 months
*same for severe disease |
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Blastomycosis "Chicago's Disease" agents for severe disease/initial CNS disease
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Amp B 1mg/kg IV Q24H
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Blastomycosis agents for mild/moderate disease
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-Itraconazole 200-400mg IV/PO Q24H
-Fluconazole 400-800mg IV/PO Q24H (preferred for CNS disease) -Lipid Amp B 3mg/kg IV Q24H |
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Blastomycosis treatment for immunocompromised patients
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AmpB-after completed suppressive therapy w/ itraconazole should be started
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Blastomycosis treatment for pregnancy and pediatrics
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AmpB
Alternative for peds=Itraconazole |
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Coccidioidmycosis primary respiratory infection uncomplicated
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i.Asx=no treatment
ii.treat all sx patients and high-risk patients (HIV, organ transplant, pregnancy, severe infections) Severe infections= a. >10%wt. loss b. bilateral pneumonia or 1/2 of lung involved c. night swts >3weeks d. symptoms for >2months |
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Coccidioidmycosis primary respiratory infection uncomplicated agents
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1. AmpB x3-6months (until response, then complete course with azoles)
2. Azole antifungals x3-6months 3. Immunocompromised may require lifelong therapy |
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Coccidiodmycosis primary respiratory infection diffuse pneumonia agents
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1. AmptB x1year (until response then complete course w/ azole)
2. Azole antifungals x1year 3. Immunocompromised may require lifelong therapy |
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Coccidiodmycosis pulmonary nodule treatment
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Asx=solitary lesions don't require tx unless pt. immunocompromised
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Coccidiodomycosis Pulmonary cavity asymptomatic treatment
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i. most benign requiring no tx
ii. RESECTION considered if cavity progresses, has been present about 2 years, or if it's immediately adjacent to pleura |
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Coccidiodomycosis Pulmonary cavity symptomatic treatment
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i. Azole therapy shows improvemtn, but sxs may return after discontinuation
ii. resection alternative |
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Coccidiodomycosis Pulmonary cavity ruptured treatment
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i. lobectomy is tx of choice in young healthy patients along with antifungal therapy until the procedure
ii. patients for whom surgery not option antifungal therapy indicated |
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Coccidiodomycosis Disseminated infection non-meningeal treatment
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i. azole antifungals
ii. AmpB for more severe infections |
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Coccidiodomycosis Disseminated infection meningitis treatment
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i. Fluconazole 400-800mg PO/IV Q24H treatment of choice
ii. Itraconazole and intrathecal AmpB alternatives |
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Cryptococcal disease in non-HIV infected (pulmonary) mild/moderate disease
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i. Fluconazole 200-400mg Q24Hx 6-12months
ii. Itraconazole iii. AmpB |
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Cryptococcal disease in non-HIV infected (CNS) INDUCTION
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1. AmpB 0.7-1mg/kg Q24H
PLUS flucytosine 25mg/kg IV Q6H x2 weeks |
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Cryptococcal disease in non-HIV infected (CNS) CONSOLIDATION
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1. Fluconazole 400mg at least for 10weeks
2. AmpB PLUS flucytosine 3. AmpB 4. Lipid AmpB |
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Cryptococcal disease in HIV infected (pulmonary) mild/moderate disease
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1.Fluconazole lifelong
2.Itraconazole lifelong 3.Fluconazole PLUS flucytosine x10weeks |
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Cryptococcal disease in HIV infected (CNS) INDUCTION
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1.AmpB PLUS flucytosine x2weeks
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Crytpococal disease in HIV infected (CNS) CONSOLIDATION
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1.Fluconazole for atleast 10weeks
2. AmpB PLUS flucytosine 3. AmpB 4.Fluconazole x10-12weeks 5.Itraconazole x10-12weeks 6.Fluconazole PLUS flucytosine x6weeks 7. Lipid AmpB x6-10weeks |
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Cryptococcal disease in HIV infected (CNS) MAINTENANCE
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1.Fluconazole lifelong
2.Itraconazole lifelong 3. AmpB 1-3 times per week lifelong |
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Amphotericin products toxicities
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1. infusion related side effects
-fever, hypotension, HA, flushing 2.Nephrotoxicity |
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Azoles drug interactions
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All potent inhibitors of CYP3A4
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Azoles toxicities
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All:
1. GI-N/V 2. Hepatotoxicity 3. Rash VORICONAZOLE ONLY: -transient changes in vision |
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Echinochandins-Caspofungin drug interactions
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i.increased caspofungin
-cyclosporine ii.decreased caspofungin -carbamazepine, efavirenz, nevirapine, phenytoin, rifampin iii.Decreased effect of other drug -tacrolimus |
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Echinochandins-Micafungin drug interactions
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i. Increased effect of other drugs
-sirolimus, nifedipine |
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Echinochandins Toxicities
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i.HA
ii.Fever iii.Infusion reactions iv.elevated AST,ALT, ALK phosphatase |