Pharmacotherapy - Antifungals

Front 1

Describe the spectrum of activity of Fluconazole.

Back 1

All species of Candida are susceptible to Fluconazole except Glabrata which is Susceptible but Dose Dependent to resistant to Fluconazole.
Kruisei is also resistant to Fluconazole

Front 2

Voriconazole, Posaconazole?

Back 2

Vori and Posoconazole cover all species of Candida except Glabrata which shows a dose dependent susceptibility to resistance to these agents

**First line for C. Albicans is Fluconazole!
**First line for Aspergillosis is Voriconazole!

Front 3

Describe the metabolism of the three azole agents

Back 3

Fluconazole and Voriconazole are metabolized by the CYP450 system.
Posaconazole is metabolized by the UDP system via glucuronidation

Front 4

How is each azole eliminated?

Back 4

Fluconazole - Renally
Voriconazole - Hepatically
Posaconazole - Fecally

Fluconazole needs to be renally dose adjusted

Voriconazole needs to Hepatically dose adjusted

Front 5

What is each class of anti-fungal active against?

Back 5

Polyenes (Amphotericin) - Active against Most candida, aspergillus and zygomycetes

Echinocandins - Active against most candida species and aspergillosis

Flucytosine - Active against candida and cryptococcus

Front 6

What drug is good to give as empiric therapy for a likely Candida infection?

Back 6

Caspofungin - It covers all Candida species and can be given regardless of CrCl

Front 7

What are the 3 types of Candida Infection?

Back 7

Candidemia
Mucocutaneous
Candiduria

Front 8

What is the preferred treatment for each?

Back 8

Fluconazole, Echinocandin

Fluconazole, Clotrimazole, Nystatin

Fluconazole, Remove catheter

Second line is typically Amphotericin and treatment is typically for 14 days

Front 9

If you find out that the pathogen is susceptible to azoles, what is your course of action?
What do you do if the pathogen is intermediate or resistant to azoles?

Back 9

De-escalate from the echinocandin and choose the more narrow spectrum azole

Continue the echinocandin and consider a higher dose of the azole.

Front 10

What is prophylaxis for Aspergillosis?

Back 10

Voriconazole
Posaconazole

Front 11

What is the preferred treatment for Aspergillosis neutropenic fever.

Back 11

Voriconazole (if not used for prophylaxis)
Amphotericin
Echinocandins

Front 12

What is the preferred treatment for Aspergillosis invasion pulmonary/sinus infection?

Back 12

Voriconazole

Front 13

What is your course of action if the patient has confirmed Aspergillosis?

Back 13

Voriconazole

Front 14

What is your course of action is Aspergillosis vs. Zygomycetes is suspected but not confirmed?

Back 14

Use Posaconazole or Amphotericin