Term
| What are the two yeast species we are worried about? |
|
Definition
| Candida (albicans, glabrata, krusei) and cryptococcus neoformans |
|
|
Term
| What are the four endemic mycoses? They are also ____ ? |
|
Definition
| Histoplasma capsulatum, blastomyces dermatitidis, coccidioides immitis, and sporothrix schenckii; dimorphic |
|
|
Term
| What invasive molds have septated hyphae with 45 degree branching? |
|
Definition
| Aspergillus, and aspergillus like |
|
|
Term
| What invasive molds have nonseptated hyphae with 90 degree branching? |
|
Definition
|
|
Term
| What is another name for non-invasive molds? |
|
Definition
| Dermatophytes (EMT) - the tinea |
|
|
Term
| What is your main polyene antifungal? aka? |
|
Definition
| Amphotericin B (ampho B, AmBd) |
|
|
Term
| What are the other formulations of ampho B? Why use them? Why not? |
|
Definition
| Lipid formulations (ABLC, L-AmB, ABCD), less renal toxic, expensive |
|
|
Term
| What is the mechanism, spectrum, formulations, resistance and route for ampho B? |
|
Definition
| BINDS ergosterol, gold standard for yeast and molds except Pseudo. boydii, IV |
|
|
Term
| T/F Ampho B is the treatment of choice for fungal meningitis? |
|
Definition
| True - even though it doesn't penetrate CSF |
|
|
Term
| What are the half-lives for the two phases of ampho B? |
|
Definition
| 24 hours, 15 days - you treat by loading the body |
|
|
Term
| T/F ampho B (nephrotoxic) is adjusted for renal function? |
|
Definition
|
|
Term
| T/F Doses and duration of use for ampho B and lipid forms of ampho B are standard? |
|
Definition
| False - no one really knows what the best duration is |
|
|
Term
| What are the infusion-related problems with ampho B? Renal? Hematologic? |
|
Definition
| Fever and rigors (given too fast), creatinine rises to 2-3mg (switch to lipids), anemia (everyone @ 30% hct) |
|
|
Term
| Which is the drug of choice for mucormycosis/zygomycosis? |
|
Definition
| ampho B - even though posaconazole is now an option |
|
|
Term
| What drug is choice for candida infections (endocarditis, endophthalmitis, meningitis)? |
|
Definition
|
|
Term
| What drug is used for the initial therapy of cryptococcal meningitis, and histo/blasto meningitis? |
|
Definition
|
|
Term
| T/F ampho B can be used as an empiric treatment for persistent fever in a neutropenic (low neutrophils) patient? |
|
Definition
|
|
Term
| How is Flucytosine (5FC) given and when is it used? |
|
Definition
| oral drug, only used in combo with ampho B during the INITIAL therapy of cryptococcal meningitis |
|
|
Term
| What are the two classes of Azoles? What is their mechanism? |
|
Definition
| Imidazoles, triazoles; inhibit ergosterol synthesis |
|
|
Term
| T/F azoles are fungicidal for candida? |
|
Definition
| False - they are fungistatic! |
|
|
Term
| What are the four triazoles we use? |
|
Definition
| Flucoazole, Itraconazole, Voriconazole, and Posaconazole |
|
|
Term
| T/F Azoles may affect the metabolism of other drugs the patient is on? |
|
Definition
| True - they interfere with P450s |
|
|
Term
| T/F Fluconazole is active against mold and yeasts? |
|
Definition
|
|
Term
| What are the primary uses of Fluconazole? Limitations? Route? |
|
Definition
| Candida, cryptococcus; candida krusei, glabrata, and molds; oral or IV |
|
|
Term
| What is the drug of choice for Candida esophagitis? |
|
Definition
|
|
Term
| What drug replaces ampho B + 5FC after two weeks of cyptococcosis (meningitis)? |
|
Definition
|
|
Term
| What was the first azole that can treat aspergillus? |
|
Definition
|
|
Term
| What is the drug of choice for sporotrichosis? |
|
Definition
|
|
Term
| What is the drug of choice for aspergillus? |
|
Definition
|
|
Term
| T/F even though not proved superior, voriconazole is favored in persistant fever in neutropenic patients? |
|
Definition
|
|
Term
| What is a unique side effect of Voriconazole? |
|
Definition
| Visual disturbances (blurred vision, etc) |
|
|
Term
| What was the first azole to treat mucor species? |
|
Definition
|
|
Term
| What drug belongs to the Echinocandin class? Route? |
|
Definition
|
|
Term
| What is the mechanism, route, and metabolism of Capsofungin? |
|
Definition
| inhibits cell WALL synthesis; IV; liver |
|
|
Term
| T/F Caspofungin is dose adjusted for liver disease? |
|
Definition
|
|
Term
| T/F echinocandins are fungicidal? |
|
Definition
|
|
Term
| What are the two fungi that Capsofungin is used for? Route? |
|
Definition
| Candida and Aspergillus; IV only |
|
|
Term
| T/F echinocandins are given once daily and adjusted for renal function? |
|
Definition
| False - are given once daily, NOT adjusted for renal function |
|
|
Term
| T/F caspofungin is approved for empiric treatment for persistant fever in neurtropenic patient? |
|
Definition
|
|
Term
| Which antifungal exhibits dose-dependent pharmacokinetics (increase dose multiplies effect)? |
|
Definition
|
|
Term
| What drug: gold standard, almost all yeasts and molds, very toxic |
|
Definition
|
|
Term
| What drug? only with ampho B for initial treatment of cryptococcus |
|
Definition
|
|
Term
| What drug? great drug, oral or IV, once a day for candida and cryptococcus (yeast included cryptococcus) |
|
Definition
|
|
Term
| What drug? first azole that can treat aspergillus, also used for histo/blasto, sporotrichosis (good for endemic mycoses) |
|
Definition
|
|
Term
| What drug? drug of choice for aspergillus (can be switched from IV antifungal to oral) |
|
Definition
|
|
Term
| What drug? first azole that covers mucor |
|
Definition
|
|
Term
| What drug? only treats aspergillus, candida really useful – but IV for a long time (non-toxic drug) |
|
Definition
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