DOC= Nystatin swish and spit--- if not compliant than PO Fluconazole PO Fenoconazole PO Clotrimazole pouches Nystatin-swish and spit/swallow

GYN/Final: drugs & tx Flashcards by Caroline Bouillon

Severe life threatening infections

IV amphotericin B–>DOC

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Leishmaniasis

IV amphotericin B

PO and IV Fluconazole

Pentamidine –alternative

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systemic mycoses infection

Amphotericin B

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Candida Albicans

**Amphotericin B– severe infections only

*fluconazole (PO, IV) esp good if candidemia

IV caspofungin

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Aspergillus

doc
second line

*Amphotericin B– severe infections only

DOC: Voriconazole

IV Caspofungin SECOND line after failing or intolerant to azole or amphotericin B

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Blastomyces

-doc?

*Amphotericin B– severe infections only

**DOC=Itraconazole

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Cryptococcus

initial tx
maintenance tx

Amphoterin B (+/-) flucytosine (5-FC) THEN change to fluconazole

Maintenance: fluconazole 6-12 MO in pt with or without AIDS
*Amphotericin B– severe infections only

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Histoplasmosis

DOC
others

DOC for severe requiring hospitalization=Amphotericin B IV–>then switch to itraconazole once stable and afebrile

FOR EXAM: ALWAYS ANSWER ITRACONAZOLE

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Candidiasis-

first line for invasive?
cutaneous?
esophageal–DOC?
thrush/oral
systemic/invasive

oral, esophageal and cutaneous— **Nystatin (oral suspension, cream, ointment, powder)

*clotrimazole=PO, cutaneous and vaginal

**DOC for esophageal=FLuconazole

*Miconazole=oral and vaginal

INVASIVE INFECTION IN IMMUNO COMP PT=IV caspofungin–DOC **

esophageal in immuno comp use IV caspofungin first line

Cutaneous=Ciclopirox–cream, gel, suspension

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thrush
DOC
others

DOC= Nystatin swish and spit— if not compliant than PO

Fluconazole PO
Fenoconazole PO
Clotrimazole pouches

Nystatin-swish and spit/swallow

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Coccoides

*fluconazole PO or IV

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Candida glabrata

Voriconazole

IV caspofungin

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Candida Krusei

Voriconazole

IV caspofungin

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Tinea spp.

Clotrimazole

Miconazole

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Trichophyton rubrum

Efinaconazole x48 weeks

PO terbinafine X3MO

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Trichophyton mentagrophytes

Eficonazole x48 weeks

PO terbinafine x30MO

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Dermatophyte onychomycoses

doc
other options

DOC=PO terbinafine*******

Ciclopirox nail lacquer formation

PO Griseofulvin for 6-12MO

topical Tavaborole

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Tinea Capitis

PO terbinafine
Topical terbinafine

Ciclopirox–cream, gel, suspension

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Tinea cruris

Topical terbinafine

Ciclopirox–cream, gel, suspension

topical Tavaborole

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Tinea versicolor

topical terbinafine

Ciclopirox–cream, gel, suspension

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tinea pedis

topical terbinafine

Ciclopirox–cream, gel, suspension

topical Tavaborole

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neutropenic fever

IV caspofungin

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fluconazole resistant Candida glabrata and C. krusei

Echinocandins aka Caspofungin

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Cryptococcal meningitis

Amphotericin B + 5-FC (Flucytosine)

INTRA-FECAL ONLY** cannot do IV because amphotericin does not cross CNS IV

*Fluconazole IV

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Candiduria

* **pharmacotx if persistent*** - ->fluconazole PO 7-14 days OTHER: 5-FC/Flucytosine

chromoblastomycosis

5-FC | Flucytosine

dermatophytosis of scalp + hair

Griseofluvin

Seborrheic dermatitis

Ciclopirox shampoo

tinea corporis

topical Tavaborole Imidazoles * clotrimazole * miconazole * Efinaconazole

Esophageal candidiasis

* Fluconazole daily x14-21 days * Fluconazole IV or Caspofungin for interolerance to PO therapy *use PO itraconazole, PO/IV Voriconazole or Caspofungin for strains refractory to fluconazole

Vulvovaginal Cadidiasis

* Fluconazole PO * Clotrimazole vaginally * miconazole vaginally PO is the same as above

Candidemia 1st line -other -when to discontinue tx?

1st line: Echinocandin-->Caspofungin IV others: * Fluconazole PO/IV for less severe disease ***tx should continue 2 weeks after last positive blood culture and s/s resolution

Bacterial vaginosis

metronidazole

Gardnerella vaginalis

metronidazole

Bacteriodes fragilis

metronidazole

CLostridium perfinges

metronidazole

C. Diff (not first line)

metronidazole

H. pylori

metronidazole

Ambeiasis-entamoeba histolytica

metronidazole | tinidazole

Giardiasis

metronidazole | tinidazole

amebic liver abscess

Tinidazole *****metronidazole + Chloroquine******

trichomonas

Tinidazole | Metronidazole

invasive intestinal or extraintestinal amebic dz

Tinidazole Metronidazole aka the mixed agents

Asymptomatic colonization state of amebic dz

LUMINAL drugs: Iodoquinol or Paromycin

E. Histolytica

Mixed: metronidazole or Tinidazole THEN use a luminal agent----> Iodoquinol or Paromycin If its extraintestinal infection or intestinal wall infection-- need a systemic amebicide--> Chloroqine or dehydroemetine

extraintestinal amebiasis and/or intestinal wall infeection

SYSTEMIC drugs-- chloroquine or dehydroemetine

Malaria prophylaxis -DOC

sensitive area=Primaquine Resistant areas=Mefloquine

Malaria * general drugs to use * P. vivax * P. ovale * P. falciparum - sensitive areas DOC - resistant areas DOC

-Primaquine - Chloroquine--does NOT eradicate hepatic stages * *use with Primaquine for Plasmodium vivax and P. ovale Atovaquone-proguanil for resistant strains P. falciparum (erythrocytic and hepatic stages) **can be used for tx and prevention** Mefloquine Artemisinins--multi drug resistance of P. falciparum Pyrimethamine + Sulfadoxine sensitive area DOC=Chloroquine Resistant areas DOC= Atovaquone-Proguanil

Plasmodium falciparum DOC | *others

Chloroquine--DOC Atovaquone-proguanil for chloroquine resistant strains (erythrocytic and hepatic stages) Quinine-- not first line

Liver forms of plasmodia DOC

Primaquine

Prevention of relapse for P. vivax and P. ovale

Primaquine

Babesia

Atovaquone-proguanil

Pneumocystis jirovecci

Atovaquone-proguanil Pentamidine--- used as alternative when sulfa allergy present

malaria prophylaxis - sensitive area - resistant area

sensitive area=Primaquine Resistant area=Methloquine

multi-drug resistant P. falciparum

Artemisinins + another agent ----->DOC

Toxoplasmosis Gondii

Pyrimethamine + Sulfadiazine

early stages of African Sleeping Sickness

Suramin IV Pentamidine IV, IM, Neb

Late stage of African sleeping sickness

Melosoprol

Chagas dz

1. Benznidazole-- better tolerated | 2. Nifurtimox

Respiratory viruses - pref tx - others

* vaccination is preferred method* | * other: Neuraminidase inhibitors

Influenza A, B, **** | and RSV

Neuraminidase inhibitors - Oseltamivir - Zanamivir * ****has to be within 48 hrs of s/s******

RSV

Ribavirin--PO or INH

Active Acute Hep B

Nucleoside Reverse Transcript Inhibitors (NRTIs) **Lamivudine Tenofovir Entecavir Ribavirin

Chronic Hep B

* *Interferons: alpha, beta, gamma and pegylated**** - -> Peginterferon alfa-2 NRTIs: Tenofovir (NRTI) Entecavir Ribavirin

Lamivudine resistant strains of HBV infection

Entecavir

Hep C

Ledipasvir-Sofobuvir NS5A replication complex inhibitor + Protease inhibitor Ribavirin and Interforn are older txs

Chronic Hep C

Ribavirin

Herpes Viruses in general

* Acyclovir * Cidofovir * Foscarnet * ganciclovir

HSV encephalitis | -TOC

TOC= acyclovir

Genital Herpes

MC used=Acyclovir

CMV retinitis in pts with AIDS | -other immunocomp

* Cidofovir--AIDS | * Foscarnet--other immunocomp

how to decr incidence rate of nephrotoxicty with IV Cidofovir

IV NSS + PO probenecid

Acyclovir HSV infections

Foscarnet

CMV - greatest efficacy? - others

Ganciclovir (>>>>efficacy) Acyclovir OTHERS * Cidofovir---AIDS + CMV * Foscarnet--OTHER IMMUNO + CMV

CMV prophylaxis in transplant PT

Ganciclovir

TX for AIDS in NAIVE patients 1st line 2nd line

1st= 2 diff NRTIs + INSTI and CD4 monitoring 2nd= PI + 2 NRTIs

DOC esophageal candida

Fluconazole

DOC for a non-compliant pt with vaginal candida

one dose fluconazole PO

Candidemia (candida in blood) 1st and 2nd choices

IV caspofungin ****** first choice second choice=fluconazole IV

PT wanting an OCP but has acne

combination estrogen + prgesterones of either Norgestimate or Drospirenone

termination of pregnancy

PO---Combo of 1. Mifepristone (progesterone antag) 2. Misoprostol (prostaglandin analog)-- causes uterine contractions

BCA

Tamoxifen

BCA prophylaxis in high risk PT

Tamoxifen

post-menopausal osteoporosis

Raloxifene

anovulation

Clomiphene

BPH

Finasteride

Prostate CA

FLutamide

GYN/Final: drugs & tx Flashcards

(87 cards)