Fungal Flashcards
(12 cards)
Aspergillosis
- Commonly affects the respiratory tract
- Immunocompromised patients it can become invasive affecting the skin, brain and heart
Treatment options for aspergillosis
First line - Voriconazole
Alternative - Amphotericin B
Itraconazole and posaconazole can be used when the above cannot be used
Candidiasis
Vaginal candidiasis can be treated locally or with fluconazole. For oral candidiasis the same
Fluconazole resistant organisms give itraconazole
Invasive candidiasis treatment
An echinocandin (caspofungin) can be used. Fluconazole is an alternative.
Amphotericin B can be used in patients that cannot tolerate fluconazole or an echinocandin
Immunocompromised patients and fungal infections
More prone to infections and may receive anti fungal drugs prophylactically. Oral triazole antifungals are the drug of choice. Use fluconazole unless at risk of invasive aspergillosis then use intraconazole
Amphotericin B anaphylaxis
Can occur with IV amphotericin product. test dose before the first infusion and observe patient carefully for 30 mins
Prophylactic antipyretics or hydrocortisone should only be used in patients who have previously experienced acute adverse reactions
Is amphotericin B brand specific
yes
Itraconazole cautions
-Patients at high risk of HF (avoid in patients with ventricular dysfunction or hx unless infection is serious)
- Hepatotoxicity, discontinue if occur and avoid/caution if hx of hepatotoxicity with other drugs or in active liver disease
Voriconazole cautions
-Keep alert card
Hepatotoxicity: Discontinue if LFT abnormal or N+V, malaise, jaundice
Phototoxicity: Consider discontinuation. If continued monitor for skin lesions and discontinue if they occur. Avoid sunlight/UV
Voriconazole monitoring
Renal function + hepatic function before starting then at least weekly for 1 month then monthly during treatment
Ketoconazole MHRA
The CHMP has recommended that the marketing
authorisation for oral ketoconazole to treat fungal
infections should be suspended. The CHMP concluded
that the risk of hepatotoxicity associated with oral
ketoconazole is greater than the benefit in treating
fungal infections. Doctors should review patients who are
being treated with oral ketoconazole for fungal
infections, with a view to stopping treatment or choosing
an alternative treatment. Patients with a prescription of
oral ketoconazole for fungal infections should be referred
back to their doctors.
Oral ketoconazole for Cushing’s syndrome and topical
products containing ketoconazole are not affected by
this advice.
Ketconazole Monitoring
ECG
Adrenal function: Can cause adrenal insufficiency (fatigue, anorexia, vomiting, hypotension, hyponatraemia, hypoglycaemia)
Hepatic function: Signs of liver toxicity (severe abdominal pain, dark urine, jaundice, nausea, vomiting, fatigue)
