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Pulmonary Block > Pharmacology Funal and Viral Pneumonia > Flashcards

Pharmacology Funal and Viral Pneumonia Flashcards

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1
Q

Treatment for Candida albicans

A

amphotericin B (IV) and fluconazole

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2
Q

Treatment for Cryptococcus neoformans

A

CNS: amphotericin B (IV) and flucytosine (PO)

Non-CNS: Fluconazole (PO)

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3
Q

Treatment for Aspergillus

A

Voriconazole IV (step down PO)

2nd: amphotericin B (step down Posconazole PO)

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4
Q

Treatment forBlastomyces dermatitidis

A

1st line: Fluconazole IV or Amph B IV (step down: voriconazole, itraconazole, fluconazole)
2nd line: amph B IV (step down voriconazole or fluconazole PO)

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5
Q

Treatment for Histoplasma capsulatum

A

Severe/Immunocompromised: amphotericin B IV followed by Itraconazole PO

Mild/Moderate: Voriconazole or Posaconazole or Fluconazole PO

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6
Q

Treatment for Coccidioides immitis

A

Severe/Immunocompromised: amphotericin B IV followed by Itraconazole or fluconazole PO

Mild/Moderate: Voriconazole or Posaconazole PO

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7
Q

Amphotericin B issues

A

nephrotoxicity (try to avoid by putting in lipid medium), hypokalemia

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8
Q

Flucystine issues

A

hematotoxic - anemia, blood dyscrasias, agranulocytosis

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9
Q

Azole metabolism

A

CYP2C9, CYP2C19, CYP3A4

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10
Q

Antifungal that crosses blood brain barrier

A

Fluconazole

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11
Q

Absorption of Itraconazole

A

oral absorption is low and variable from patient to patient so newer azoles are recommended more

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12
Q

Primary first line antifungals

A

Azole or Amphotericin B

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13
Q

Indication for Flucytosine

A

Cryptococcal infections

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14
Q

Reason for Aspergillus resistance to Azoles

A

mutations in the promoter region of CYP51A which encodes lanosterol 14alpha sterol demthylase activity (the drug target of azoles)

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15
Q

Antifungals that do not undergo hepatic metabolism

A

Amphotericin B and Flucytosine

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16
Q

Variables suggesting viral cause of pneumonia

A

younger than 5yo, ongoing epidemic, slow onset, rhinitis, wheezing, normal WBC, low CRP, low pro calcitonin, sole interstitial bilateral infiltrates on CXR, slow/non-responsive to ABX

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17
Q

Treatment for Influenza A and B virus

A

Oseltamivir (PO) or Zanamivir (inhalation)

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18
Q

Prevention for influenza A and B

A

Vaccines (inactivated, live); oseltamivir, zanamivir

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19
Q

Treatment of Influenza A virus

A

Amantadine (PO) or Rimantadine (PO)

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20
Q

Treatment of RSV

A

Ribavirin (inhalation, IV)

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21
Q

Prevention of RSV

A

Palivizumab (intramuscular)

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22
Q

Treatment of Adenovirus

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A

Cidofovir (IV)

23
Q

Prevention of Adenovirus

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A

Vaccine for types 4&7

24
Q

Prevention of Rhinovirus

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A

Alfa interferon (intranasal); Ribavirin

25
Treatment/Prevention of Enteroviruses
None
26
Treatment of human metapneumovirus
Ribavirin (IV)
27
Treatment of Hantavirus
Ribavirin (IV)
28
Treatment of Varicella-Zoster virus
Acyclovir (IV) or Valacyclovir (PO)
29
Prevention of Varicella-Zoster virus
vaccine
30
Acyclovir MOA
inhibition of viral DNA synthesis (DNA polymerase inhibition)
31
Amantadine MOA
inhibition of viral entry or uncoating
32
Cidofovir MOA
inhibition of viral DNA synthesis
33
Oseltamavir MOA
inhibition of release of influenza virus from infected cell
34
Ribavirin MOA
inhibition of viral nucleic acid synthesis
35
Rimantadine MOA
inhibition of viral entry or uncoating
36
Valacyclovir MOA
pro-drug from acyclovir
37
Zanamivir MOA
inhibition of release of influenza virus from infected cell
38
Acyclovir metabolism
Viral cells transform acyclovir to its active triphosphate form; systemic elimination unchanged by glomerular filtration and tubular secretion
39
Amantadine metabolism
systemic elimination unchanged by glomerular filtration and tubular secretion
40
Cidofovir metabolism
metabolized via pyriminidine nucleoside monophosphate kinase to mono and then diphosphate analogs and finally to the monophosphate choline; systemic elimination by glomerular filtration and tubular secretion
41
Oseltamavir metabolism
hepatically metabolized to the carboxylate active form of the drug; systemic elimination by glomerular filtration and tubular secretion
42
Ribavirin metabolism
undergoes non-CYP metabolism in nucleated cells with systemic elimination of drug and products in the urine
43
Rimantadine metabolism
extensive hepatic metabolism with renal elimination of drug and metabolites
44
Valacyclovir metabolism
Converted ot acyclovir and L-valine by 1st pass metabolism; systemic elimination of acyclovir by glomerular filtration and tubular secretion
45
Zanamivir metabolism
renal elimination unchanged
46
Acyclovir toxicities
HA, nausea, elevated hepatic enzymes, nasopharyngitis, neutropenia; maintain hydration to prevent renal precipitation; se cautiously in renal impairment or with reno-toxic drugs
47
Amantadine toxicities
Neurologic, nausea, orthostatic hypotension, contra in narrow angle glaucoma and with breast feeding
48
Cidofovir toxicities
neurologic, hematologic and tubular damage; Black box warning for renal impairment/toxicities
49
Oseltamavir toxicities
minimal; potential for fatal neuropsychiatric adverse effects in flue patients; serious skin reaction reported rarely
50
Ribavirin toxicities
fatigue, headache, myalgia, nausea, fever; Black Box - hemolytic anemia and M/F teratogenicity
51
Rimantadine toxicities
Minimal adverse effects
52
Valacylovir toxicities
HA, nausea, elevated hepatic enzymes, nasopharyngitis, neutropenia; hydrate to avoid renal precipitation; use cautiously in patients with renal impairment or renal toxic drugs
53
Zanamivir toxicities
HA, throat/tonsil pain, cough, viral infection, NOT to be used with underlying pulmonary disease due to Fatal Bronchospasm

Pulmonary Block (8 decks)

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