ID Part 1 Flashcards
1
Q
Which of the following statements is correct regarding ceftriaxone?
A. It should be given with IV calcium in neonates.
B. It displays concentration-dependent bactericidal activity.
C. It has better Gram-negative activity than cefotetan.
D. It is available in both oral and intravenous formulations.
E. It requires dose adjustment in renal dysfunction.
A
It has better Gram-negative activity than cefotetan.
Ceftriaxone is a 3rd generation cephalosporin that has broader Gram-negative activity than the 2nd generation cephalosporins (e.g., cefotetan).
Similar to all beta-lactams, it displays time-dependent bacterial killing.
Ceftriaxone is only available IV and does not require dose adjustment in renal dysfunction.
Ceftriaxone is contraindicated in neonates (causes biliary sludging, kernicterus) and concurrent use with IV calcium in neonates is contraindicated.
2
Q
Cephalosporins
1st Generation
Meds & Coverage
A
IV: Cefazolin (Ancef), PO: Cephalexin (Keflex), cefadroxil (Duricef)
Staphylococci (MSSA), Streptococci, PEK, mouth anaerobes (Peptostreptococci)
3
Q
Which generation cephalosporins is preferred for MSSA?
A
1st Gen
4
Q
Cephalosporins
1st Generation Uses
Inpatient
A
Cefazolin (Ancef)
Surgical PPx
5
Q
Cephalosporins
1st Generation Uses
Outpatient
A
Cephalexin (Keflex)
Strep throat, MSSA skin infections
6
Q
Cephalosporins
2nd Generation
Meds & Coverage
A
IV/IM/PO: Cefuroxime (Ceftin, Zinacef)
Staphylococci
Better Gram-negative activity (HNPEK) than 1st gen
IV/IM Cefotetan (Cefotan) and Cefoxitin (Mefoxin)
Additional gram (-) anaerobic activity (B. fragilis)
PO: Cefaclor, Cefprozil (Cefzil)
7
Q
Cephalosporins
2nd Generation
Inpatient
A
Cefotetan (Cefotan) and Cefoxitin (Mefoxin)
Surgical PPx (GI procedures)
Anaerobic activity (B. fragilis)
8
Q
Which cephalosporin has a disulfiram-like reaction?
A
Cefotetan (Cefotan)
9
Q
Cephalosporins
2nd Generation
Outpatient
A
Cefuroxime (Ceftin)
Acute OM, CAP, sinus infections
10
Q
Cephalosporins
3rd Generation
Meds & Coverage
A
Group 1: IV Ceftriaxone, Cefotaxime
PO Cefdinir (Omnicef), Cefixime (Suprax), Cefpodoxime
Resistant Streptococci (S. pneumonaiae & viridans)
Staphylococci (MSSA)
Gram (+) anaerobes
Resistant strains of HNPEK
Group 2: IV Ceftazidime (Fortaz, Tazicef), Ceftazidime/Avibactam (Avycaz)
Lacks gram (+) activity
Pseudomonas
11
Q
Cephalosporins
3rd Generation Uses
Outpatient
A
Cefdinir (Omnicef)
CAP, sinus infections
12
Q
Cephalosporins
3rd Generation Uses
Inpatient
A
Ceftriaxone, Cefotaxime (Claforan)
CAP, meningitis, spontaneous bacterial perionitis (SBP), pyelonephritis
13
Q
Which cephalosporin does not required renal adjustment?
A
Ceftriaxone
14
Q
Which cephalosporins is not used in neonates?
A
Ceftriaxone
15
Q
Cephalosporins
4th Generation
Meds & Coverage
A
IV: Cefepime (Maxipime)
Broad-spectrum: Gram-positives (similar to ceftriaxone), HNPEK, CAPES, Pseudomonas
16
Q
Which cephalosporins covers Pseudomonas?
A
Ceftazidime (Fortaz, Tazicef)
Cefepime (Maxipime)
Ceftolozane/tazobactam (Zerbaxa)
Cefiderocol (Fetroja)
17
Q
Cephalosporins
5th Generation
Meds & Coverage
A
IV Ceftaroline (Teflaro),
Gram (-) similar to ceftriaxone
Broad gram (+) MRSA coverage
18
Q
Cephalosporins combo
Meds & Coverage
A
ceftazidime/avibactam (Avycaz)
ceftolozane/tazobactam (Zerbaxa)
Similar spectrum to ceftazidime
Added activity against MDR gram (-) rods
19
Q
Siderophore Cephalosporin
Meds & Coverage
A
IV cefiderocol (Fetroja)
PEK
Enterobacter
Pseudomonas
20
Q
What cephalosporin covers MRSA?
A
Ceftaroline (Teflaro)
21
Q
Cephalosporins do not cover?
A
Enterococcus
Atypicals
22
Q
Cephalosporins Class Effects
A
Betam-lactam allergy
Risk of seizures
23
Q
BV is a 42-year-old male who comes to his primary care provider with a 2-day history of new-onset shortness of breath, fever, chills, fatigue, and persistent cough. He has no other health issues and no known drug allergies. A chest x-ray confirms pneumonia. The local antibiogram shows Streptococcus pneumoniae is 60% susceptible to macrolides. What is the most appropriate antibiotic therapy for this patient?
A. Amoxicillin for 10 days
B. Azithromycin for 5 days
C. Azithromycin for 10 days
D. Doxycycline for 5 days
E. Doxycycline for 10 days
A
Doxycycline for 5 days
The recommended treatment options for outpatient community-acquired pneumonia in healthy patients with no comorbidities include monotherapy with amoxicillin, doxycycline, or a macrolide (if local pneumococcal resistance is less than 25%).
The typical duration of treatment is 5 to 7 days.
Longer durations of treatment offer no benefit and increase the risk of adverse effects.
24
Q
Community Acquired Pneumonia (CAP) Tx
Outpatient - no comorbidities
A
Amoxicillin 1 g TID
Doxycycline
Macrolide (azithromycin or clarithromycin)
For 5 to 7 days
Macrolid - only rec in healthy pts if local pneumococcal macrolide resistance is < 25%
25
Community Acquired Pneumonia (CAP) Tx
| Outpatient - w/ comorbidities
## Footnote
Comorbidities:
* Chronic heart, lung, liver, or renal disease
* Diabetes
* Alcohol use disorder
* Malignancy
* Asplenia
Beta-lactam (amoxicillin/clavulnate, cefpodoxime [Vantin, 3rd], or cefuroxime [Ceftin, 2nd])
+
Doxycycline or Macrolide (azithromycin or clarithromycin)
Respiratory fluroroquinolone (moxifloxacin [Avelox], levofloxacin, or gemifloxacin [Factive])
| For 5 to 7 days
## Footnote
Macrolid - only rec in healthy pts if local pneumococcal macrolide resistance is < 25%
26
Respiratory fluroquinolone Mnemonic
**M**y **G**ood **L**ung **D**ied
* Moxifloxacin (Avelox)
* Gemifloxacin (Factiv)
* Levofloxacin
* Delafloxacin (Baxdela)
27
Antiviral agents active against cytomegalovirus (CMV) include which of the following:
A. Valganciclovir, valacyclovir, acyclovir
B. Atazanavir, valganciclovir, foscarnet
C. Foscarnet, acyclovir, cidofovir
D. Valganciclovir, foscarnet, cidofovir
E. Acyclovir, valacyclovir, ganciclovir
Valganciclovir (Valcyte), foscarnet (Foscavir), cidofovir
## Footnote
Ganciclovir, valganciclovir, foscarnet and cidofovir are indicated for CMV.
Others listed are indicated for HSV (acyclovir, valacyclovir) or HIV (atazanavir).
28
GP is receiving amphotericin B deoxycholate for the treatment of mucormycosis. Which of the following side effects are most likely to occur with treatment?
A. Hyponatremia, hypocalcemia, hypokalemia
B. Hyponatremia, hypokalemia, chest tightness
C. Hypocalcemia, hyperkalemia, leukopenia
D. Hypomagnesemia, hypokalemia, rigors
E. Hyperkalemia, hypermagnesemia, hypotension
Hypomagnesemia, hypokalemia, rigors
## Footnote
Common side effects associated with amphotericin B deoxycholate include
* hypokalemia
* hypomagnesemia,
* hypotension
* fever,
* chills,
* rigors,
* headache,
* nephrotoxicity.
29
ART unchanged for 5 years with good virologic response; elevated serum creatinine; switch ART to Biktarvy and refer to nephrology
Which medication is most likely contributing to the abnormal laboratory test identified today?
A. Emtricitabine
B. Hydrochlorothiazide
C. Pitavastatin
D. Raltegravir
E. Tenofovir disoproxil fumarate
Tenofovir disoproxil fumarate
## Footnote
Tenofovir disoproxil fumarate (TDF), a nucleoside reverse transcriptase inhibitor, can cause nephrotoxicity (evident by an elevated serum creatinine) with long-term use.
Tenofovir alefenamide (TAF) has a lower risk of nephrotoxicity; switching from TDF to TAF is associated with improvement in TDF-associated renal dysfunction.
30
Nucleoside reverse transcriptase inhibitors (NRTIs) Meds
Zidovudine (Retrovir)
Lamivudine (Epivir)
Abacavir (Ziagen)
Tenofovir disoproxil fumarate, TDF (Viread)
Tenofovir alafenamide, TAF
* Only in combination products for HIV;
* Vemlidy is a single-entity product for HBV
Emtricitabine (Emtriva)
No longer recommended:
* Didanosine
* Stavudine
31
Nucleoside reverse transcriptase inhibitors (NRTIs) MOA
Competitively inhibit the reverse transcriptase enzyme, preventing the conversion of **HIV RNA to HIV DNA** in **stage 3 (reverse transcription)** of the HIV life cycle
32
NRTIs Mnemonic
ZDS LATTE
**Zidovudine** (**Retrovir**)
Didanosine
Stavudine
**Lamivudine** (**Epivir**)
**Abacavir** (Ziagen)
**Tenofovir disoproxil fumarate**, TDF (**Viread**)
**Tenofovir alafenamide**, TAF (Vemlidy)
**Emtricitabine** (Emtriva)
33
NRTIs Effects
Lactic acidosis
Hepatomegaly with steatosis (fatty liver)
Nausea, diarrhea
34
Abacavir (Ziagen)
| What do you need to test for?
Risk of HSR if positive for HLA-B 5701 (abacavir contraindicated)
Patients should carry warning card listing HSR symptoms
35
Which NRTIs is use for HBV/HIV coinfection?
Tenofovir, emtricitabine (Emtriva) & lamivudine (Epivir)
| Abrupt discontinuation can cause acute HBV exacerbation
## Footnote
TDF (Viread)
TAF (Vemlidy)
36
Which NRTI causes hyperpigmentation of palms (hands) & soles of feet
emtricitabine (Emtriva)
37
Tenofovir
| Common Toxicities
Two salt forms: TAF & TDF
Common toxicities (TDF > TAF)
* Nephrotoxicity (including Fanconi syndrome, a rare renal disorder)
* ↓ BMD (ie, osteopenia, osteoporosis)
Lipid abnormalities (primarily with TAF)
38
Which NRTI causes hematologic toxicity?
Zidovudine (Retrovir)
| neutropenia & anemia (↑ MCV is sign of adherence)
39
Biktarvy
bictegravir
emtricitabine
TAF
40
Admit to labor and delivery and start HIV perinatal prophylaxis STAT.
Based on the assessment and plan, the pharmacist should expect to receive orders for which medication?
A. Intramuscular cabotegravir
B. Intravenous ibalizumab
C. Intravenous zidovudine
D. Oral darunavir boosted with ritonavir
E. Oral emtricitabine/tenofovir alafenamide
Intravenous zidovudine
## Footnote
Intravenous zidovudine is recommended to prevent perinatal (mother-to-child) HIV transmission in mothers with a new or unknown HIV diagnosis and/or an HIV viral load greater than 1,000 copies/mL.
41
# Management of pregnant patients with HIV infection
During pregnancy
Continue ART if already taking
Start ART as soon as possible (if not already taking); preferred regimens include:
* Darunavir/ritonavir (Prezista) or dolutegravir (Tivicay), PLUS
* Two NRTIs (eg, emtricitabine/tenofovir or abacavir/lamivudine [Epzicom])
## Footnote
emtricitabine/tenofovir Brand:
TAF - Descovy,
TDF - Truvada
42
# Management of pregnant patients with HIV infection
During delivery
Prevent perinatal (mother-to-child) transmission if new/unknown HIV infection and/or HIV viral load >1,000 copies/mL
Administer IV **zidovudine** (Retrovir) to the mother prior to delivery
43
# Management of pregnant patients with HIV infection
After delivery
Neonatal ART prophylaxis (regimen and duration depending on risk)
Replacement feeding (eg, formula, donor milk) eliminates the risk of postnatal HIV transmission and may be preferred over breastfeeding
44
An 85-year-old man is hospitalized with a fungal infection. He has CKD stage 3 and chronic pain (on methadone). Micafungin 100 mg intravenous is given. During the infusion, the man develops a drop in blood pressure, pruritis and flushing. What is the most likely cause of this reaction?
A. The micafungin dose should have been renally adjusted.
B. Micafungin is causing a histamine-release reaction.
C. Micafungin increased the methadone levels, resulting in an adverse reaction.
D. Acetaminophen and meperidine should have been given prior to micafungin.
E. It is unlikely that this reaction is due to methadone or micafungin.
Micafungin is causing a histamine-release reaction.
## Footnote
Micafungin, an echinocandin, can cause histamine-mediated symptoms such as rash, pruritus, facial swelling, flushing and hypotension. To decrease the potential of a histamine reaction, infuse over 1 hour.
45
# Empiric Treatment For Select Fungal Pathogens/Infections
Candida albicans
| Oropharyngeal infection (thrush)
Mild disease: topical antifungals (clotrimazole [Mycelex troche], miconazole)
Moderate-severe disease or HIV+: fluconazole
Alternative: Nystatin
## Footnote
Nystatin - Swish and swallow
46
# Empiric Treatment For Select Fungal Pathogens/Infections
Candida albicans
| Esophageal infection
Fluconazole
Alternative: Echinocandin
47
# Empiric Treatment For Select Fungal Pathogens/Infections
Candida krusei and glabrata
| All Candida species bloodstream infections
Echinocandin
Alternative: Amphotericin B, high-dose fluconazole (susceptible isolates only)
48
# Empiric Treatment For Select Fungal Pathogens/Infections
Aspergillus
| Invasive
Voriconazole
Alternative:Amphotericin B, isavuconazonium
49
# Empiric Treatment For Select Fungal Pathogens/Infections
Cryptococcus neoformans
| Meningitis
Amphotericin B + flucytosine (5-FC)
Alternative: High-dose fluconazole + flucytosine (5-FC)
50
# Empiric Treatment For Select Fungal Pathogens/Infections
Dermatophytes
| Nail bed infection
Terbinafine or itraconazole (confirm fungal infection prior to treatment)
Alternative: Fluconazole
51
The pharmacist is on rounds with the internal medicine team. They are discussing a patient who has oral candidiasis due to a recent chemotherapy treatment. The infection is very painful for the patient and is considered moderate to severe. Which of the following is the best regimen to recommend for this patient?
A. Clotrimazole troches 10 mg PO 5 times per day
B. Fluconazole 200 mg IV daily
C. Posaconazole 400 mg PO BID
D. Amphotericin B 15 mg/kg IV BID
E. Itraconazole 200 mg PO daily
Fluconazole 200 mg IV daily
## Footnote
Patients with severe and painful oral candidiasis will not tolerate taking medications orally without analgesics.
Localized treatment with clotrimazole is used for mild infections only, in patients without immunosuppression.
The most appropriate therapy would be an antifungal given intravenously until oral medications are tolerated.
Fluconazole has appropriate activity and the amphotericin dosing is too high.
52
Which of the following statements is correct regarding nafcillin?
A. Nafcillin is active against MRSA.
B. Nafcillin is a vesicant.
C. Nafcillin should be dose adjusted in renal impairment.
D. Nafcillin is compatible with NS only.
E. Nafcillin cannot be used in a sulfa allergic patient.
Nafcillin is a vesicant.
## Footnote
Nafcillin is a vesicant (blistering). If extravasation occurs, use cold packs and hyaluronidase injections to treat.
Ampicillin, ampicillin/sulbactam and ertapenem are compatible with NS only.
Extravastion: leakage of blood, lymph, or other fluid, such as an anticancer drug, from a blood vessel or tube into the tissue around it
53
Which beta-lactams are complatible w/ NS only?
Ampicillin, ampicillin/sulbactam and ertapenem
54
Natural Penicillins
PO : Penicillin V Potassium
IV: Penicillin G Aqueous
IM: Penicillin G Benzathine (Bicillin L-A)
Covers Gram-positive cocci, Gram-positive anaerobes
55
Aminopenicillins
PO Amoxicillin (Moxatag),
IV: Ampicillin
Adds Gram-negative coverage (HNPEK)
56
Aminopenicillin + Beta- Lactamase Inhibitor
PO: Amoxicillin/clavulanate (Augmentin)
IV : Ampicillin/sulbactam (Unasyn)
Adds MSSA, more resistant strains of HNPEK, Gram- negative anaerobes (B. fragilis)
57
Extended Spectrum + Beta- Lactamase Inhibitor
IV: Piperacillin/tazobactam (Zosyn)
Adds CAPES, Pseudomonas
## Footnote
CAPES:
Citrobacteer
Acinetobacter
Providencia
Enterobacter
Serratia
58
Antistaphylococcal
Nafcillin, oxacillin
Covers MSSA and Streptococci only
59
Penicillin Class coverage
All cover Eenterococcus (exceptt antistaphylococcal PCNs)
Do not cover atypicals or MRSA
60
Penicillin Class Effect
Beta-lactam allergy
Risk of seizures
61
# Outpatient (Oral)
Penicillin VK
A first-line treatment for pharyngitis ("strep throat")
Mild nonpurulent skin infections (no abscess)
62
# Outpatient (Oral)
Amoxicillin (Moxatag)
First-line treatment for acute otitis media (pediatric dose: 80-**90** mg/kg/day)
Drug of choice for infective **endocarditis** prophylaxis before dental procedures (2 grams PO x 1, 30-60 minutes before procedure)
Used in H. pylori treatment*
63
# Outpatient (Oral)
Amoxicillin/Clavulanate (Augmentin)
First-line treatment for acute otitis media (pediatric dose: **90** mg/kg/day) and bacterial sinusitis (if antibiotics indicated)
Use the lowest dose of clavulanate to↓ diarrhea
64
# Outpatient (Oral)
Dicloxacillin
Covers MSSA only (no MRSA)
No renal dose adjustment needed
65
# Inpatient (Parenteral)
Penicillin G Benzathine (Bicillin L-A)
Drug of choice for syphilis (2.4 million units IM x 1)
Not for IV use; can cause death
66
# Inpatient (Parenteral)
Nafcillin and Oxacillin
Covers MSSA only (no MRSA)
No renal dose adjustment needed
67
# Inpatient (Parenteral)
Piperacillin/Tazobactam (Zosyn)
Only penicillin active against Pseudomonas
Extended infusions (4 hours) can be used to maximize T > MIC
68
A 32-year-old female who is receiving chemotherapy for acute leukemia is diagnosed with mucormycosis via tissue culture and will begin therapy with IV isavuconazonium. The nurse contacts the pharmacist asking what he needs to know, as he has never administered the drug before. Which of the following is an important point regarding this medication?
A. This medication requires light protection during administration.
B. This medication is not compatible with PVC containers and will be supplied in a glass bottle.
C. This medication requires a filter for administration.
D. This medication requires PTT monitoring.
E. This medication can prolong the QT interval.
This medication requires a filter for administration.
## Footnote
Isavuconazonium (Cresemba) is a prodrug of isavuconazole.
It does not contain a solubilizing agent as with voriconazole and posaconazole, so a filter is required for administration to prevent any particulates (undissolved drug) from entering a patient's bloodstream.
This agent can **shorten** the QT interval, which is unique within the azole class (all of the other agents are associated with prolonged QT).
69
Quinolones Boxed warnings
| Concentration-dependent killing
Tendon rupture achilles
Peripheral neuropathy long-lasting
CNS effects (including seizures)
Use last-line (only if no alternatives)
70
Quinolones Warnings
| Concentration-dependent killing
QT prolongation
Hypo and hyperglycemia
Psychiatric disturbances
Photosensitivity
Avoid use in children (risk vs. benefit)
71
Quinolones Interactions
Chelation with divalent cations
72
Quinolones Common Uses
Can vary by agent: pneumonias, UTIs, intra-abdominal infections, travelers' diarrhea
73
Antipseudomonal Quinolones
Ciprofloxacin, levofloxacin
74
Only quinolone that is not renally adjusted
Moxifloxacin
| Do not use for UTIs
75
Quinolones where IV to PO Ratio 1:1
Levofloxacin and moxifloxacin
76
Quinolones Profile Review Tips
Caution with CVD, ↓ K/Mg and with other QT-prolonging drugs (e.g., azole antifungals, antipsychotics, methadone, macrolides)
Avoid in patients with a seizure history or if using seizure drugs
Avoid in children
77
Quinolones Counseling
Avoid sun exposure, separate from polyvalent cations, monitor blood glucose (in diabetes)
Watch for tendon rupture, neuropathy, CNS or psychiatric side effects
78
An otherwise healthy patient presents with a foot infection that developed 1 week after stepping on a child's toy. The wound culture is growing Gram-positive and Gram-negative bacteria; Pseudomonas is not suspected. The physician would like to use a cephalosporin for treatment of the patient's infection. Which of the following statements regarding cephalosporins is correct?
A. Cefazolin is an oral cephalosporin that is considered to be the most effective therapy for mild-moderate Gram-negative foot infections.
B. Cefixime is the only oral cephalosporin with Gram-negative and enteric anaerobic coverage.
C. Cephalexin is an oral, second-generation cephalosporin with sufficient Gram-negative and Gram-positive coverage for moderate severity foot infections.
D. Cefuroxime is an oral, second-generation cephalosporin with adequate Gram-negative and Gram-positive coverage for mild-moderate foot infections.
E. Cefpodoxime is an intravenous, third-generation cephalosporin with adequate Gram-positive and Gram-negative coverage for severe foot infections.
Cefuroxime is an oral, second-generation cephalosporin with adequate Gram-negative and Gram-positive coverage for mild-moderate foot infections.
## Footnote
Cefazolin is an intravenous cephalosporin.
Cefixime is not effective for enteric anaerobes.
Cephalexin is a first generation cephalosporin and cefpodoxime is an oral, third-generation cephalosporin.
Cefuroxime is a second generation cephalosporin and is effective in treating Streptococci, MSSA and Gram-negative bacteria associated with mild-moderate foot infections.
79
A phlebotomist had an accidental needlestick injury while drawing a blood sample from an HIV-positive patient. Which drug combination is the preferred regimen for post-exposure prophylaxis?
A. Emtricitabine + tenofovir alafenamide
B. Efavirenz + tenofovir disoproxil fumarate + emtricitabine
C. Raltegravir + tenofovir disoproxil fumarate + emtricitabine
D. Dolutegravir + abacavir + lamivudine
E. Rilpivirine + emtricitabine + tenofovir alafenamide
Raltegravir + tenofovir disoproxil fumarate + emtricitabine
## Footnote
Post-exposure prophylaxis (PEP) guidelines recommend 28 days of Truvada (tenofovir disoproxil fumarate + emtricitabine) + Isentress (raltegravir).
80
Descovy
Emtricitabine + tenofovir alafenamide
81
Atripla
Efavirenz + tenofovir disoproxil fumarate + emtricitabine
82
Isentress
Raltegravir
83
Truvada
tenofovir disoproxil fumarate + emtricitabine
84
Triumeq
Dolutegravir + abacavir + lamivudine
85
Odefsey
Rilpivirine + emtricitabine + tenofovir alafenamide
86
All of the following statements regarding amphotericin B are correct EXCEPT:
A. Doses of conventional amphotericin B ≥ 1.5 mg/kg/day can cause cardiopulmonary arrest.
B. It is a fungicidal agent with broad antifungal spectrum of activity.
C. Lipid formulations have a greater risk for nephrotoxicity than conventional formulations.
D. The conventional formulation requires premedication to reduce infusion-related reactions.
E. All formulations can cause hypomagnesemia and hypokalemia.
Lipid formulations have a greater risk for nephrotoxicity than conventional formulations.
## Footnote
Lipid formulations of amphotericin B are associated with fewer toxicities (including decreased infusion reactions and decreased nephrotoxicity) compared to amphotericin B deoxycholate (also referred to as conventional amphotericin).
Lipid-based amphotericin B doses are higher than conventional, ranging from 3-6 mg/kg/day.
To help prevent dosing errors, amphotericin B deoxycholate (conventional) carries a boxed warning to confirm any dose exceeding 1.5 mg/kg/day.
87
Which of the following is the mechanism of action of Diflucan?
A. It binds to ergosterol in the cell membrane altering cell membrane permeability.
B. It interferes with fungal RNA and protein synthesis.
C. It inhibits the synthesis of beta (1,3)-D-glucan.
D. It decreases ergosterol synthesis and cell membrane formation.
E. It interferes with microtubule formation by binding tubulin.
It decreases ergosterol synthesis and cell membrane formation.
## Footnote
Diflucan is an azole. Azoles act by inhibiting the production of ergosterol, which decreases cell membrane formation.
88
Azoles Class Effects
↑ LFTS
QT prolongation (except isavuconazonium)
Many drug interactions
89
What is the only azole that requires renal dose adjustment?
Fluconazole
| CrCl ≤ 50: ↓ dose by 50%
90
What azole has hepatotoxicity has led to liver transplantation?
Ketoconazole
| Topical forms Brand: **Nizoral** A-D, Extina, Ketozole
91
What azole can cause heart failure?
Itraconazole (Sporanox)
92
What azole can cause visual changes and phototoxicity?
Voriconazole
93
Posaconazole
Noxafil
Tablet dose ≠ suspension dose (due to different bioavailability)
Take with food
94
Azol IV Administration
IV to PO ratio is 1:1 for all azoles
Drugs with sulfobutyl ether beta-cyclodextrin (SBECD) vehicle: voriconazole, posaconazole
95
# Primary PPx in Pts w/ HIV
CD4 < 200
## Footnote
Or Oropharyngeal candidiasis
Or other AIDS-defining illness
Pneumoncystis pneumonia (PCP)
96
# Primary PPx in Pts w/ HIV
Pneumoncystis pneumonia (PCP) Regimen
Preferred: SMX/TMP DS tab PO daily or SS tab PO daily
Alternative:
SMX/TMP DS tab 3x/week or
Dapsone or
Dapsone + pyrimethamine + leucovorin
Pentamidine (aerosolized)
Atovaquone
| CD4 < 200
## Footnote
Leucovorin is added to reduce myelosupression associated w/ pyrimethamine
97
# Primary PPx in Pts w/ HIV
CD4 < 100
Toxoplasma ondii encephalitis (Toxo)
| w/ (+) Toxoplasma IgG
98
# Primary PPx in Pts w/ HIV
Toxoplasma ondii encephalitis (Toxo)
Preferred: SMX/TMP DS tab PO daily
Alternative: SMX/TMP SS tab daily or 1 DS TIW
Dapsone + pyrimethamine + leucovorin
99
# Primary PPx in Pts w/ HIV
CD4 < 50
Mycobacterium avium complex (MAC)
| Must rule out active disseeminated MAC disease
100
# Primary PPx in Pts w/ HIV
Mycobacterium avium complex (MAC)
**Azithromycin** 1,200 mg PO 1x/week or 600 mg PO 2x/week
Clarithromycin 500 mg PO BID
