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44 Cards in this Set
- Front
- Back
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What is the spectrum of activity of amphotericin B?
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Aspergillus, candida, histoplasma, blastomyces, fusarium, zygomycetes
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What is a significant side effect of amphotericin B?
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Nephrotoxicity
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Which formulation of amphotericin B would you prefer for pulmonary Aspergillus?
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Lipid complex (ABLC)
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Which formulation of amphotericin B would you prefer for CNS Aspergillus?
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Liposomal (L-AmB)
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Which of the four azoles has the broadest spectrum?
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Voriconazole
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What is voriconazole's spectrum?
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Most candida
Aspergillus (DoC) Fusarium |
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What is the IV dosing for voriconazole?
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6 mg/kg Q12h x 2, then
4 mg/kg Q12h |
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What is the PO dosing for voriconazole?
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If > 40kg, then 200mg PO
If < 40kg, then 100mg PO |
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What is the spectrum for posaconazole?
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Aspergillus
Refractory candida Histoplasmosis Fusarium |
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What is the prophylaxis dosage for posaconazole?
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200mg TID
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What is the treatment dosage for posaconazole?
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200mg QID
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What is the spectrum for fluconazole?
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C. albicans
C. tropicalis (lesser extent, C. glabrata) |
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True or False - Fluconazole covers Aspergillus
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False
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True or False - Fluconazole has excellent CSF penetration
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True
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Which azoles have strong 3A4 inhibition?
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Voriconazole
Itraconazole |
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What is the spectrum for itraconazole?
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C. albicans
C. tropicalis C. glabrata Aspergillus |
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True or False - Itraconazole has excellent CSF penetration
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False - poor penetration
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True or False - Fluconazole is a strong 3A4 inhibitor
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False - it is a weak 3A4 inhibitor
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What is the spectrum for caspofungin?
(be sure to include which candida strains are not covered) |
Most candida (not really Krusei or Parapsilosis)
Aspergillus Histoplasma |
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What is the dosing for caspofungin?
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70mg IV LD, then 50mg IV daily
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What is the dosing of micafungin in...
Candidemia, disseminated candidemia? Esophageal candidiasis? Prophylaxis of candidiasis in HSCT? |
100mg IV daily
150mg IV daily 50mg IV daily |
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What is the DoC for C. albicans?
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Fluconazole
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What is the DoC for C. glabrata?
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Echinocandin (caspofungin)
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What is the DoC for C. parapsilosis?
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Fluconazole
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What is the DoC for C. tropicalis?
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Fluconazole
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What is the DoC for C. krusei?
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Echinocandin (caspofungin)
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What is the drug of choice in Aspergillus? Dose?
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Voriconazole
6 mg/kg IV Q12h for one day, then 4 mg/kg IV Q12h |
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What is the regular dose for LAMB?
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3-5 mg/kg/day
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What is the regular dose for ABLC?
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5 mg/kg/day
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What is the duration of therapy for Invasive Pulmonary Aspergillus?
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6-12 weeks
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Which organism has hyphae?
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Zygomycetes (mucormycosis, zygomycosis = rhizo)
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What is the treatment regimen for Zygomycetes?
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LAMB 5 mg/kg
+/- Posaconazole 200mg PO QID |
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Which azole has the poorest bioavailability?
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Itraconazole
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What type of environment does itraconazole require (capsules, solution)?
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Capsules - acidic
Solution - basic |
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What type of environment does posaconazole require for absorption?
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High fat, high acid
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Aspergillus terreus is resistant to what drug?
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Amphotericin
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What is an important side effect with voriconazole?
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Visual disturbances - seen within first few weeks of therapy
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What are target trough concentrations for voriconazole?
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> 2 mcg/mL
(less than this is associated with breakthrough infections) |
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Caution should be exercised when using IV voriconazole in patients with what clinical status and why?
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Renal failure (CrCl < 50) - the vehicle can cause further damage
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What are target trough concentrations with posaconazole?
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> 1.25 mcg/mL
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What is the dosing for treatment of mucormycosis?
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Posaconazole 200mg QID
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What is the dosing for prophylaxis of mucormycosis?
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Posaconazole 200mg TID
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Which amphotericin B formulation can be used in Aspergillus?
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Liposomal (L-AmB), and only after voriconazole
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What are the risk factors for fungal infections?
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Underlying host defects (neutropenia, T cell and B cell dysfunction, immunosuppression, transplantation, AIDS, diabetes), cytotoxic chemotherapy, high dose corticosteroids, GVHD, long-term broad-spectrum ABs, prolonged hospitalization (including catheters), burns
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