Infectious Diseases III: Antifungals & Antivirals

Question 1

Flucytosine, 5-FC (Ancobon)

Answer 1

-renal dysfunction
- myelosuppression

Question 2

Amp B (deoxycholate)

Answer 2

• Conventional
• Dosage: 1.5 mg/kg/day
• Pre-med: APAP, NSAID, Diphenhyd.

Question 3

Amp B (Albecet)

Answer 3

-lipid complex
- less infusion rxn & nephrotox

Question 4

Amp B ( Ambisome)

Answer 4

• Liposomal

Question 5

Amp B

Answer 5

• binds ergosterol ➡️ cell death
• Overdose: cardiopulmonary arrest
• fever, chills, HA, rigors
• ⬇️ K, Mg
• Nephrotox

Question 6

Ketoconazole

Answer 6

• Anti-androgen
• QT prolong, Hepatotoxic
• PO last resort

Question 7

Fluconazole ( Diflucan)

Answer 7

• Dose: 150 mg x 1
• NOT for Pregnancy
• CrCl < 50: ⬇️ dose 50%

Question 8

Itraconazole

Answer 8

• C/I:
  onychomycosis in HF ➡️ QT, arrhythmias

Question 9

Voriconazole ( Vfend)

Answer 9

• po preferred
• IV: SBECD accumulates ➡️ monitor SCr
• Visual disturbance,
• liver damage,
• photosensitivity

Question 10

Posaconazole ( Noxafil)

Answer 10

• Tabs: QD w. Food
• Susp: ⬇️ bioavailability
• eGFR < 50: SBECD accumulates

Question 11

Isavuconazonium ( Cresemba)

Answer 11

• prodrug of Isavu
• requires a filter

Question 12

Azoles

Answer 12

• ⬇️ ergosterol synthesis
• inhib. Fungal CYP 450
• ⬆️ LFTs, QT prolong ( not isavu)
• flu, vori: treats fungal meningitis
• keto, itra: w/ cola ➡️ better absorp.

Question 13

Caspofungin (Cancidas)
Mycamine (Mycamine)

Answer 13

• inhib. B, 1-3 glucan
• Histamine related symptoms
• infuse over 1 hour
• QD injections

Question 14

Griseofulvin

Answer 14

• C/I: pregnancy
• fatty meal ⬆️ absorption
• food to avoid GI upset
• contraceptive failure
• photosensitivity
• ⬆️ LFTs

Question 15

Terbinafine (Lamisil)

Answer 15

• inhib. Squalene epoxidase
• HA
• hepatotoxic

Question 16

Clotrimazole (Mycelex)

Answer 16

• lozenge
• hepatotoxic, nausea, dysguesia

Question 17

Nystatin (Bio-statin)

Answer 17

• suspension or tab
• N/V/D
• stomach pain

Question 18

Oseltamivir (Tamiflu)

Answer 18

-Neuraminidase inhibitors
- preferred in Pregnancy
- Treatment: 75mg BID x 5
- Px: 75 mg QD x 10

Question 19

Zanamivir (Relenza Diskhaler)

Answer 19

• Tx: > 7 yr: 2, 5mg inhalations BID x 5d
• Bronchospasm

Question 20

Peramivir

Answer 20

• IV 1x dose

Question 21

Neuraminidase inhib

Answer 21

• initiate < 48hr of onset
• neuropsych events

Question 22

Baloxavir

Answer 22

• endonuclease inhib
• single dose w/i 48hr of symptoms
• avoid admin. w. Dairy

Question 23

Rimantidine

Answer 23

• Adamantine
• not recommend. due to resistance
• seizures
• psychosis

Question 24

Influenza

Answer 24

• peak activity Nov - Mar

Question 25

Acyclovir (Zovirax)

Answer 25

- Apply 5x daily for 4 days - initiate w/i 24 hr of symptoms - always use IBW - 5mg/kg acyclovir (IV) = 1gm valacyclovir (P.O.)

Question 26

Valacyclovir

Answer 26

- prodrug of acyclovir

Question 27

Famciclovir

Answer 27

- prodrug of penciclovir

Question 28

Penciclovir

Answer 28

- apply q 2 hr x 4 days

Question 29

Docosanol (Abreva)

Answer 29

- OTC - 5x daily

Question 30

Herpes Simplex Virus 1

Answer 30

- oropharyngeal herpes

Question 31

HSV 2

Answer 31

- genital herpes

Question 32

VZV

Answer 32

- chickenpox➡️ shingles

Question 33

Shingles

Answer 33

- initiate to w/i 72 hr x 7 days - >50: Shingrix - >60: Zostavax

Question 34

Shingles Pain

Answer 34

- Lidoderm

Question 35

Shingles Neuropathic pain

Answer 35

- anti epileptics - anti depressants - NSAIDs - opioids

Question 36

Ganciclovir Valganciclovir (prodrug)

Answer 36

- prepare in sterile water (NOT bacteriostatic) - refrigerate suspension - myelosuppresion

Question 37

Cytomegalovirus

Answer 37

- retinitis - colitis - esophagitis