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Antifungals and Antivirals Flashcards

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1
Q

Fungi are classified as one of these 3 things?

A

Yeasts, molds or dimorphic fungi

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2
Q

What are examples of yeasts?

A

Candida species (glabrata, albiancs, tropicalis, parapsilosis, krusei), cryptococcus neoformans

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3
Q

What are examples of molds?

A

Aspergillus species, zygomycetes (Mucor species, rhizopus species)

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4
Q

What are examples of dimorphic fungi?

A

Histo, blasto, coccidio

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5
Q

Of the candida species, which one is most susceptible to drug therapy? Which 2 are generally more difficult to treat?

A

C. albicans is the most susceptible candida species

C. glabrata and C. krusei are generally harder to treat

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6
Q

Amphotericin B (both deoxycholate and all lipid formulations) are active against what and are generally reserved for what types of infections?

A

They are active against yeasts, molds and dimorphic fungi. The problem is side effects.
They are used as initial treatment for invasive infections like cryptococcal meningitits, histoplasmosis and mucormycosis.

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7
Q

BBW associated with amphotericin B

A

Verify product name and dosage. Doses should not exceed 1.5mg/kg/day for conventional formulation. Overdose could result in cardiopulmonary arrest

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8
Q

Side effects of amphotericin

A

Infusion related: fever, chills, HA, malaise, rigors

Others: HypoK, Hypo Mg, nephrotoxicity

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9
Q

Conventional amphotericin requires pretreatment to reduce infusion related reactions. What 4 medications do we normally treat with?

A

APAP or NSAID
Benadryl +/- hydrocortisone
Meperidine to reduce duration of severe rigors
NS bolus to decrease risk of nephrotoxicity

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10
Q

What is the mechanism of action of flucytosine, what drug do we use in combination with this drug and what are the 4 main side effects?

A

Flucytosine penetrates fungal cell walls and gets converted into fluorouracil which interferes with fungal RNA and protein synthesis. Used in combination with amphotericin B for cryptococcal and candida infections.
Side effects: Myelosuppression, increased SCr, increased BUN, hepatitis

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11
Q

Mechanism of action for azole antifungals? They are notorious for what?

A

They decrease ergosterol synthesis and therefore inhibit cell membrane synthesis.
Drug interactions

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12
Q

What is the only azole antifungal that requires renal dose adjustment?

A

Fluconazole

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13
Q

All azole antifungals cover this organism really well?

A

C. albicans, use fluconazole because it has a narrower spectrum compared to other azoles

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14
Q

What is the drug of choice for aspergillus? What do we monitor with this drug?

A

Voriconazole

Visual changes, phototoxicity

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15
Q

other than voriconazole, Which 2 azole antifungals are active against aspergillus and zygomycetes?

A

Posaconazole, isavuconazonium

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16
Q

Which 2 azole antifungals are not equivalent to the suspension dose? Why?

A

Posaconazole, different bioavailabilities in the formulations
Itraconazole (Sporanox)

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17
Q

Ketoconazole has a BBW for what?

A

Hepatotoxicity, use oral tablets only when other agents are unavailable/intolerable

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18
Q

Which azole antifungals are not safe in pregnancy?

A

Voriconazole, fluconazole

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19
Q

All azole antifungals cause which 2 main adverse effects?

A

QT prolongation, increased LFT’s

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20
Q

Voriconazole has activity against which organisms?

A

Aspergillus (first line)

Candida spp. (glabrata, krusei)

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21
Q

Voriconazole has what 4 main warnings associated with its use?

A
  1. Hepatotoxicity
  2. optic neuritis and papilledema
  3. embryofetal toxicity
  4. QT prolongation related to K, Ca, Mg disorders.
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22
Q

Which azole antifungals should be taken with food?

A

Itraconazole (only capsules and tablets, NOT THE SUSP), posaconazole (both susp and caps)

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23
Q

What is the brans name for isavuconazonium sulfate? Warnings and what size filter is used?

A

Cresemba is IV or PO
Warnings: Look for particulates
Requires 0.2-1.2 micron filter during administration not preparation

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24
Q

Which azole antifungals have pH dependent absorption?

A

Ketoconazole and itraconazole

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25
PPIs and cimetidine can decrease absorption of which azole? (drug and formulation)
Posaconazole suspension
26
What parameters describe the kinetics of voriconazole? Why is this is an issue?
First order, followed by zero order (non-linear kinetics). | Due to CYP interactions the concentration can increase greatly
27
Mechanism of action of echinocandins and their general spectrum of activity?
Inhibit synthesis of B 1,3-glucan which disrupts full cell wall production. Active against most candida species
28
Do echinocandins require renal dose adjustment?
NO and they are all once daily
29
What are the 3 echinocandins? Brand and Generic. Side effects?
``` All end in -fungin, all are IV Caspofungin (cancidas) Mycafungin (Mycamine) Anidulafungin Side effects: Increased LFTS, hypotension, hypoK, HypoMg ```
30
The one main Contraindication and side effect of griseofulvin?
Ctx: pregnancy | Side effect: Photosensitivity
31
2 main side effects associated with Lamisil?
Terbenafine | Ha, increased LFTs
32
Important drug interaction with griseofulvin?
Decreases efficacy of contraceptives. Recommend non-hormonal
33
First line treatment for C. albicans (thrush) in HIV+ or mod-severe infection? C. albicans esophageal? Bloodstream?
Thrush: PO fluconazole Esophageal: Fluconazole or echinocandin Candidemia: If neutropenic: echinocandin (fluconazole alternative) If not neutropenic: echinocandin, amphoterible, fluconazole (alternative)
34
Preferred treatment for C. glabrata or C. krusei
Echinocandin
35
Alternative treatments for aspergillus
Voriconazole is preferred, then liposomal ampho or Cresemba
36
Preferred treatment for cryptococcus
Amphotericin + flucytosine
37
Preferred treatment for coccidioides?
Fluconazole, itraconazole, amphotericin
38
PReferred treatment for histoplasma?
Liposomal amphoteicin + itrconazole
39
Preferred treatment for zygomycetes?
Amphotericin + posaconazole OR isavuconazonium
40
Preferred treatment for dematophytes (nail bed infections)
itraconazole, terbinafine, fluconazole
41
Which drugs are neuraminidase inhibitors? What is their mechanism of action? What types of infections are they active against? Ideally, when should they be started?
Oseltamivir, zanamivir, peramivir. They inhibit the enzyme responsible for release of new viral particles from infected cells. They are active against both Flu A/B and they decrease the symptoms by only 1 day and reduce risk of complications associated with flu. Ideally start within 48 hours to be most effective.
42
Which neuraminidase inhibitor is inhaled? which one is PO? which one is IV?
PO: Tamiflu Inhaled: zanamvir diskhaler (don't use in asthma/COPD) Injection: Peramivir: 600mg as single dose
43
Which antivirals are used for herpes simplex and herpes zoster?
Acyclovir Valacyclovir Famciclovir
44
How do we dose acyclovir in obese people?
IBW
45
Regarding genital herpes, when should treatment be initiated to gain full benefit?
Within 1 day of lesion onset or during prodrome period (symptoms appear hours-days before lesions appear)
46
If the virus is resistant to acyclovir, it is also resistant to? What should they be treated with instead?
Valacyclovir and famciclovir (generally) | Should be treated with foscarnet
47
Recommended treatment (drugs and dosages and duration) for initial episode of HSV infection?
Acyclovir: 400mg TID OR 200mg 5x daily Valacyclovir: 1 gram BID Famciclovir: 250 TID ALL 7-10 DAYS
48
Recommended treatment (drugs/dosages/duration) for recurrent episodes of HSV?
Acyclovir: 400mg TID X 5, 800mg BID X 5, 800mg TID X 2 Valacyclovir: 500mg BID X 3, 1gm daily X 5 Famciclovir: 125mg BID x 5, 500mg X 1 then 250mg BID x 2 days, 1 gram BID x 1 day
49
Drugs/dosages for chronic suppression of HSV?
Acyclovir: 400mg BID Valacyclovir: 500-1000mg daily Famciclovir: 250mg BID
50
Drugs/dosages/duration for treatment of initial episode of genital herpes?
Acyclovir: 200-400 daily x 5, 400mg TID X 7-10 Valacyclovir: 2 grams BID x 1 day
51
Drugs/dosages/durations to treat recurrent episodes of genital herpes?
Acyclovir: 200-400 5 times daily, 400 TID, 800 BID (all 5 days) Valacyclovir: 2grams BID x 1 day Famciclovir: 1.5gm X 1 dose
52
Drugs/dosages/ for chronic suppression of genital herpes?
Acyclovir only drug for this. 400mg BID
53
The shingles rash is cause by what? describe the rash | When should therapy be initiated in someone who develops shingles?
Caused by herpes zoster. Itchy, tingly and very painful (cluster, fluid filled) Ideally, we want to start therapy within 72 hrs to be most effective
54
Drugs/dosages/duration to treat shingles?
Acyclovir: 800mg 5x daily X 7-10 Valacyclovir: 1g TID x 7 Famciclovir: 500mg TID x 7
55
Which 4 drugs are approved to treat cytomegalovirus (CMV)? | Which 2 of these 4 are treatment of choice?
Ganciclovir* Valganciclovir* Cidofovir Foscarnet
56
What is the generic of Valcyte? Which drug is this drug a prodrug of?
Valgancyclovir, prodrug of ganciclovir
57
BBW, side effects of ganciclovir and valganciclovir?
BBW: Bone marrow suppression | Side effects: Thrombocytopenia, neutropenia, leukopenia, anemia
58
Which antiviral used to treat CMV comes in a suspension that requires refrigeration?
Valganciclovir (discard after 49 days)
59
Which antiviral is only approved in HIV patients with CMV retinitis? BBW with this drug?
Cidofovir | Nephrotoxicity
60
2 BBW and 1 major side effect with foscarnet?
BBW: Renal impairment, electrolyte imbalances | Side effects: increased SCr
61
EBV is another name for what? How is it transmitted? | What treatment is available?
Mononucleosis Transmitted by saliva, kissing sharing drinks etc. No drug treatment or vaccines

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