Chapter 24: ID III - Antifungals & Antivirals

Question 1

What are the 3 types of fungal classification?

Answer 1

Yeasts, molds, or dimorphic

Question 2

Invasive disease with Zygomycetes (Mucor species and Rhizopus species) is commonly referred to as?

Answer 2

Mucormycosis

Question 3

Which fungi are yeasts?

Answer 3

The candida species:

C. albicans
C. tropicalis
C. parapsilosis
C. glabrata
C. krusei
Cryptococcus neoformans

Question 4

Which fungi are molds?

Answer 4

Aspergillus species

Zygomycetes (Mucor and Rhizopus species)

Question 5

Which fungi are dimorphic?

Answer 5

Histoplasma capsulatum
Blastomyces dermatitidis
Coccidioides immitis

Question 6

What is the conventional form of Amphotericin B?

Answer 6

Amphotericin B deoxycholate (many toxicities)

Question 7

The lipid formulations of Amphotericin B are used clinically because?

Answer 7

they have fewer toxicities (decreased infusion reactions, decreased nephrotoxicity)

Question 8

Amphotericin B is active against?

Answer 8

Yeasts: Cryptococcus neoformans
Mold: Aspergillus spp
Dimorphic fungi

Question 9

Amphotericin B deoxycholate and liposomal Amphotericin B formulation?

Answer 9

Injection

Question 10

Conventional Amphotericin B for injection doses should not exceed ___ mg/kg/day d/t risk of ____?

Answer 10

1.5 mg/kg/day

Cardiopulmonary arrest

Question 11

Amphotericin B SE?

Answer 11

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

Other: ↓ K & Mg, nephrotoxicity

Question 12

Amphotericin B must be diluted in ___ only, & lipid formulations must be ___ during preparation?

Answer 12

D5W

filtered

Question 13

Amphotericin B deoxycholate (conventional formulation) requires ___ to reduce infusion-related reactions?

Answer 13

Premedication with APAP or NSAID + Benadryl and/or hydrocortisone

Question 14

Liposomal Amphotericin B brand name?

Answer 14

AmBisome

Question 15

What is Flucytosine converted to inside fungal cells?

Answer 15

Fluorouracil

Question 16

Why should Flucytosine not be used alone?

Answer 16

Due to development of resistance

Question 17

With which drug is Flucytosine recommended for use in treatment?

Answer 17

Amphotericin B

For Invasive Cryptococcal (meningitis)

Question 18

What are the side effects of Flucytosine?

Answer 18

Myelosuppression

Question 19

What is the mechanism of action (MOA) of azole antifungals?

Answer 19

Decreases ergosterol synthesis and cell membrane formation

Question 20

What are azoles in relation to the CYP450 system?

Answer 20

Inhibitors

Question 21

Fluconazole has limited efficacy against which organism due to resistance?

Answer 21

C. glabrata

Question 22

Which organism is considered fluconazole-resistant?

Answer 22

C. krusei

Question 23

What infections can fluconazole be used for?

Answer 23

Yeast infections and nail bed (onychomycosis) infections

Question 24

What is the primary use of itraconazole?

Answer 24

Nail bed infections (onychomycosis)

Question 25

What is the treatment of choice for Aspergillus?

Answer 25

Voriconazole ## Footnote Remember: V looks like upside down A

Question 26

What can all azole antifungals cause?

Answer 26

Increased LFTs, risk for QT prolongation, and many drug interactions.

Question 27

What is the only azole that requires renal dose adjustment?

Answer 27

Fluconazole.

Question 28

Hepatotoxicity with which azole has led to liver transplantation?

Answer 28

Ketoconazole.

Question 29

Which azole can cause heart failure?

Answer 29

Itraconazole.

Question 30

Which azole can cause visual changes and phototoxicity?

Answer 30

Voriconazole.

Question 31

Which azole should be taken with food?

Answer 31

Posaconazole

Question 32

What is the IV:PO ratio for all azoles?

Answer 32

1:1.

Question 33

Which azoles have SBECD vehicle?

Answer 33

Voriconazole and posaconazole.

Question 34

What formulations does fluconazole come in?

Answer 34

IV and PO

Question 35

What is the fluconazole dose for vaginal candidiasis?

Answer 35

150 mg PO x1