Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

NAPLEX RxPrep 2023 > Infectious Disease 3: Antifungals & Antivirals > Flashcards

Infectious Disease 3: Antifungals & Antivirals Flashcards

(55 cards)

Start Studying
1
Q

What are the 3 Fungal classifications?

Systemic Fungal Infections

A
  1. Yeasts
  2. Molds
  3. Dimorphic species ~ mold in cold, yeast in heat

RxPrep p 389

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Mucormycosis is an invasive fungal disease

What species causes Mucormycosis?

Systemic Fungal Infections

A

Zygomycetes ~ mold fungi made up of Mucor & Rhizopus species

RxPrep p 389

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What species are classified as Yeast?

Fungal Classifications

A
  1. Candida species
  2. Cryptococcus neoformans

C. albicans, tropicalis, parapsilosis, glabrata, krusei

RxPrep p 389

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What species are classified as Molds?

Fungal Classifications

A
  1. Aspergillus species
  2. Zygomycetes (Mucor & Rhizopus)

AZMR

RxPrep p 389

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What fungi are classified as Dimorphic?

Fungal Classifications

A
  1. Histoplasma capsulatum
  2. Blastomyces dermatitidis
  3. Coccidioides immitis

HBC ~ mold in the cold, yeast in the heat

RxPrep p 389

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is Amphotericin B active against?

Ergosterol Binder

A
  1. Broad Spectrum; used for initial treatment
  2. Active against almost all fungi
  3. Cryptococcus neoformans & Aspergillus

Yeast & Mold

RxPrep p 390

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Which Amphotericin B formulation has fewer toxicities?

Ampho B deoxycholate vs. Ampho B lipid formulations

A
  1. Lipid formulations - less infusion rxns & less nephrotoxicity

Ampho B deoxycholate is conventional formulation & more toxic

RxPrep p 390

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the Brand Name?

Liposomal Amphotericin B

Injection

A

AmBisome

Injection

RxPrep p 390

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are Boxed Warnings for Ampho B Deoxycholate & AmBisome?

Injections

A
  1. Cardiopulmonary Arrest
  2. Deoxycholate ~ NO > 1.5 mg/kg/day

Deoxycholate = Conventional Formulation

RxPrep p 390

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are Side Effects of Amphotericin B?

All Injection Formulations

A
  1. Infusion Reactions - fever, chills, headache, malaise, rigors
  2. low K, low Mg, nephrotoxicity

RxPrep p 390

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are key Prep & Admin notes for Amphotericin B?

Injections

A
  1. D5W compatibility only!
  2. lipids must be filtered during prep!
  3. Deoxycholate requires pre-meds for infusion risk!

Pre-meds: APAP or NSAID + Benadryl +/- Hydrocortisone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is Flucytosine converted to, and when is it usually indicated for?

Flucytosine, 5-FC (Ancoban)

A
  1. Converted to Fluorouracil
  2. Due to resistance, NOT used alone!
  3. Combo w/ Ampho B for invasive cryptococcal meningitis

SE: myelosuppression! (anemia, neutropenia, thrombocytopenia)

RxPrep p 390

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

3 Key Issues with Azole Antifungals

Class Effects

A
  1. Increase LFTs
  2. QT prolongation (except isavuconazonium)
  3. Drug Interactions (CYP3A4 inhibitors)

IV Administration: IV:PO ratio is 1:1 for ALL AZOLES!

RxPrep p 391

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Azole Antifungals decrease ergosterol synthesis

Fluconazole (Diflucan)

Activity, Dosing, & Drug-Specific Concerns

A
  1. C. krusei is fluconazole-resistant
  2. Nail-bed infxns (onychomycosis); oral & vaginal yeast infxns; oral thrush (candidiasis) w/ white, sore patches; fungal meningitis
  3. Vaginal candidiasis: 150 mg PO x 1 dose
  4. only azole that requires renal dose adjustment
  5. Inhibits CYP2C9: increased WARFARIN effects

PENETRATES CNS TO TREAT FUNGAL MENINGITIS

RxPrep p 391

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Azole Antifungals decrease ergosterol synthesis

Itraconazole (Sporanox capsules)

Activity, Dosing, & Drug-Specific Concerns

A
  1. Main use: Nail-bed infxns
  2. BBWs: HEART FAILURE; QT prolong & ventricular tachyarrhythmias (d/t increasing other drug plasma concentrations)
  3. Absorption requires an acidic gut (higher pH, lower absorption)

Capsules: take with food; Solution: take on empty stomach

RxPrep p 391

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Azole Antifungals decrease ergosterol synthesis

Ketoconazole Topical (Nizoral A-D OTC)

Activity, Dosing, & Drug-Specific Concerns

A
  1. BBW: Hepatotoxicity leading to liver transplants; QT prolongation; use PO only when other antifungal therapy is unavailable or not tolerated
  2. PO absorption requires acidic gut (higher pH, lower absorption) - if PPIs/H2RAs used, take with acidic bev (non-diet cola) to provide acidic environment

Tablet, cream, foam, gel, shampoo

RxPrep p 391

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Azole Antifungals decrease ergosterol synthesis

Voriconazole (Vfend)

Activity, Dosing, & Drug-Specific Concerns

A
  1. TOC for Aspergillus
  2. CrCl < 50 ~ IV vehicle SBECD accumulates, so PO preferred (monitor SCr with IV formulation)
  3. Hepatoxicity, visual disturbances (optic neuritis), phototoxicity, CNS toxicity (hallucinations), QT prolongation
  4. Take PO on empty stomach; caution driving at night; avoid direct sunlight

Tablet, suspension, injection - store reconstituted PO susp at room temp

RxPrep p 392

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Azole Antifungals decrease ergosterol synthesis

Posaconazole (Noxafil)

Acitivity, Dosing, & Drug-Specific Concerns

A
  1. CrCl < 50, IV vehicle SBECD accumulates, so PO preferred
  2. QT prolongation warning
  3. Tablet not equal to suspension dose; take both with food

DR tablet, suspension, injection

RxPrep p 392

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Azole Antifungals decrease ergosterol synthesis

Isavuconazonium Sulfate

Activity, Dosing, & Drug-Specific Concerns

A
  1. Prodrug to isavuconazole
  2. QT shortening! (not prolonging)
  3. Requires filter during admin d/t possible particulates

capsule, injection

RxPrep p 392

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Echinocandins

MOA, Activity, Dosing, & Class Concerns

A
  1. Inhibit synthesis of beta (1,3)-D-glucan within the fungal cell wall
  2. Effective against most Candida species
  3. Injections only! all given once daily with no renal dose adjustments required
  4. Histamine-mediated symptoms warning

Caspofungin, Micafungin, Anidulafungin

RxPrep p 393

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Caspofungin

Brand Name

A
  1. Cancidas
  2. SJS/TEN severe skin rxns

Echinocandin

RxPrep p 393

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Micafungin

Brand Name & Indication

A
  1. Mycamine
  2. Candidemia 100mg IV
  3. Esophageal candidiasis 150mg IV
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Antifungal Agent

Nystatin

Indications, Formulations, Counseling

Study These Flashcards
A
  1. Oral Thrush & Intestinal Infections
  2. Tablet & Suspension
  3. Suspension ~ swish in mouth and retain for as long as possible (several min) before swallowing; shake well before using!

RxPrep p 394

24
Q

Antifungal Agent

Griseofulvin

Indications, Contraindication, Side Effects, DDIs, & Counseling

Study These Flashcards
A
  1. Skin, Hair, & Nails infxns
  2. Contraindication: Pregnancy
  3. ADEs: Photosensitivity & Increased LFTs
  4. Take with fatty meal or at least food/milk

Increased metabolism of hormonal contraceptives - contraception failure!

RxPrep p 394

25
# Antifungal Agent Terbinafine (Lamisil AT) | Warning, Side Effects, Formulations, & Counseling
1. Hepatotoxicity! 2. ADEs: Headache & increased LFTs 3. Counseling: may take months after treatment to see full benefit *(takes time for healthy nails to grow)* | **Tablet Rx; Topical Rx & OTC** ## Footnote RxPrep p 394
26
# Antifungal Agent Clotrimazole | Indication & Formulation
1. Oropharyngeal Candidiasis 2. 10 mg **troche / lozenge** & topical/vaginal forms ## Footnote RxPrep p 394
27
# Antifungal Agent Miconazole | Indication & Formulations
1. Oropharyngeal Candidiasis 2. Buccal, Topical, & Vaginal ## Footnote RxPrep p 394
28
# Preferred Empiric Regimens Candida Albicans ~ Oral Thrush | Oropharyngeal Infection
Mild: Topical antifungals (**Clotrimazole, Miconazole**) Severe or **HIV+**: Fluconazole ## Footnote RxPrep p 395
29
What are other QT-prolonging drugs to be cautiously aware of? | Azole Antifungal DDIs
Antiarrhythmics, quinolones, macrolides, antidepressants, antipsychotics, 5HT-3 receptor antagonists ## Footnote RxPrep p 393
30
# Preferred Empiric Regimens Candida albicans | Esophageal Infections
1. **Fluconazole** 2. Echinocandins (*Cancidas, Mycamine*) ## Footnote RxPrep p 395
31
# Preferred Empiric Regimens C. krusei & C. glabrata | All Candida Species Bloodstream Infections
1. Echinocandins (*Caspofungin, Micafungin*) 2. **Amphotericin B** | Remember: these strains are Fluconazole-Resistant! ## Footnote RxPrep p 395
32
# Preferred Empiric Regimens Aspergillus | Invasive Mold
1. **Voriconazole** 2. Amphotericin B 3. Isavuconazonium ## Footnote RxPrep p 395
33
# Preferred Empiric Regimens Cryptococcus neoformans | CNS Meningitis
**Amphotericin B + Flucytosine (5-FC)** ## Footnote RxPrep p 395
34
# Preferred Empiric Regimen Dermatophytes | Nail Bed Infection
1. **Terbinafine or Itraconazole** 2. Fluconazole ## Footnote RxPrep p 395
35
# Antifungals & Antivirals What are the 2 strains of Influenza? What common diagnostic tests are used?
1. Influenza A & B 2. Antigen detection test 3. Rapid test ~ *nasopharyngeal swab* | Fever, chills, fatigue, myalgia ## Footnote RxPrep p 396
36
# Antivirals for Influenza Neuraminidase Inhibitors | Drugs, Indication, & MOA
1. **Oseltamivir (Tamiflu) & Zanamivir** (Relenza Diskhaler) 2. Inhibits enzymes that enable new viral particles to release from infected cells 3. Decrease symptoms by ~1 day & reduce complications 4. **Start within 48 hours of illness onset!** ## Footnote RxPrep p 396
37
# Antivirals for Influenza Endonuclease Inhibitors | Drug & Indication
1. **Baloxavir marboxil** 2. Influenza treatment & post-exposure prevention (12+ age) 3. **Single dose regimen** & start within 48 hours of symptom onset! ## Footnote RxPrep p 397
38
# Antivirals for Influenza Oseltamivir (Tamiflu) | Neuraminidase Inhibitor ~ Formulations, Dosing, Warning, & Side Effects
1. Treatment & Prophylaxis (12+ age) - **Capsules & Suspension** 2. Treatment: 75 mg BID x **5 days** 3. Prophylaxis: 75 mg **Daily** x 10 days 4. Warning: *Neuropsychiatric Events!* - "may cause delirium" | Side Effects: headache, N/V ## Footnote RxPrep p 397
39
# Antivirals for Influenza Zanamivir (Relenza Diskhaler) | Indications & Warnings
1. Influenza treatment ~ 7+ age 2. Influenza prophylaxis ~ 5+ age 3. Warnings: bronchospasms, breathing problems - DON'T use in asthma/COPD | Inhalations ## Footnote RxPrep p 397
40
SARS-CoV-2 Testing & Treatment | Guideline Agencies & Diagnostic Testing
1. CDC, NIH, & IDSA 2. PCR test - nasopharyngeal swab 3. Rapid antigen test ## Footnote RxPrep p 398
41
What disease is commonly associated with HSV-1? | Herpes Simplex VIrus 1
Oropharyngeal Disease ## Footnote RXPrep p 398
42
What disease is commonly associated with HSV-2? | Herpes Simplex Virus 2
Genital Disease
43
# Antivirals for HSV & VZV Zovirax | Generic, Warnings, & Dosing Pearls
1. Acyclovir 2. Caution: renal impairment, nephrotoxic drugs, & elderly 3. Based on IBW, even in obese patients! | capsule, tablet, buccal tablet, suspension, injection, topical ## Footnote RxPrep p 399
44
# Antivirals for HSV & VZV Valtrex | Generic, PK/PD Pearls, & Warnings
1. Valacyclovir - Prodrug of Zovirax 2. Caution in renal impairment, nephrotoxic drugs, & elderly | Tablet ## Footnote RxPrep p 399
45
# Herpes Simplex Labialis (Cold Sores) When is the optimal time to treat cold sores to reduce blister duration?
1. Prodrome ~ symptoms before the lesions appear ("eruption") 2. TIngling, itching, soreness ## Footnote RxPrep p 399
46
# Herpes Simplex Labialis (Cold Sores) What are common **topical** treatments for Herpes Labialis? | Drugs & Treatment Duration
1. Docosanol cream (*Abreva*) - OTC at first sign of outbreak, continue until healed 2. Acyclovir cream (*Zovirax*) - Rx **x 4 days** 3. Apply **5x** daily! ## Footnote RxPrep p 399
47
# Genital Herpes **When** should treatment for Genital Herpes be initiated? **What** are the treatment options?
1. Initiate within **1 day** of lesion onset (papules, vesicles that rapidly spread) 2. **Acyclovir** ~ least expensive; 5x daily dosing 3. **Valacyclovir** ~ reaches higher concentrations (prodrug); less frequent dosing to enhance adherence ## Footnote RxPrep p 400
48
# Invasive HSV Infections What is the most commonly identified disease caused by HSV? How is it treated?
1. Viral Encephalitis 2. Acyclovir IV (Zovirax) ## Footnote RxPrep p 400
49
# Varicella Zoster Virus (Chickenpox) How does the recurrence of chickenpox present? What are the main viral symptoms?
1. Herpes Zoster (**Shingles**) 2. **Unilateral manifestation**, band/cluster of fluid-filled blisters (itchy, tingly, & painful) ## Footnote RxPrep p 400
50
# Herpes Zoster (Shingles) 1. When should shingles antiviral therapy be initiated? 2. What is the duration for antiviral therapy? 3. What is the term for chronic pain associated with shingles?
1. 72 hours of zoster rash onset 2. Zovirax or Valtrex **x 7 days** 3. Postherpetic Neuralgia (**PHN**) ## Footnote RxPrep p 400
51
Shingrix Recommendations | Shingles Vaccine
1. Adults 50+ years 2. Immunosuppressed adults 19+ years ## Footnote RxPrep p 400
52
# Cytomegalovirus (CMV) What does CMV commonly cause? What are the treatment options for CMV?
1. Retinitis, colitis, or esophagitis (occurs in severly immunocompromised states, like AIDS & transplant) 2. **Ganciclovir or Valganciclovir (Valcyte)** | **Refractory Cases: Foscarnet & Cidofovir** ## Footnote RxPrep p 401
53
# CMV Ganciclovir & Valganciclovir | Boxed Warning & Admin/Prep Pearls
1. BBW ~ myelosuppression 2. Ganciclovir Injection ~ do **NOT** reconstitute in bacteriostatic water 3. Valcyte solution ~ refrigerate! | **Valcyte - Prodrug** of Ganciclovir! ## Footnote RxPrep p 401
54
What is Epstein-Barr Virus (EBV)?
1. "Mono" - mononucleosis 2. Spread by kissing, saliva, bodily fluids ## Footnote RxPrep p 402
55
What are key counseling points for Zovirax & Valtrex?
1. Does not cure herpes infections, so use safe sex practices 2. Start within 24 hours of symptom onset 3. Acyclovir ~ drink plenty of fluids; topical cream may burn/sting | Cold sores, chickenpox, shingles, genital herpes ## Footnote RxPrep p 402

NAPLEX RxPrep 2023 (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions