Term
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Definition
| Candida Sp; Cryptococcus Sp |
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Term
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Definition
| Aspergillus Sp; Agents of mucormycosis (aka Zygomycetes); Fusarium |
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Term
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Definition
| Coccidoioides Sp; Histoplasmosis Sp; Blastomycosis Sp |
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Term
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Definition
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Term
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Definition
| Ketoconazole, Fluconazole, Itraconazole, Voriconazole, Posaconazole |
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Term
| Altered or increased C-12alpha demethylase; increased drug efflux |
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Definition
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Term
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Definition
| usually well tolerated; increased transaminases, QT prolongation; |
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Term
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Definition
| visual changes; sulfobutyle ether beta-cyclodextrin (SBECD)- IV formulation only; accumulates in renal insufficiency |
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Term
| Systemic Azoles drug interactions |
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Definition
| CYP450 substrates; inducers: cause significant decreases in azole levels; increase serum levels medications |
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Term
| Fluconazole spectrum of activity |
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Definition
| candida sp (not active against C. krusei); histoplasma capsulatum; Cryptococcus neoformans; coccidioides immitis; NOT active against molds |
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Term
| Fluconazole drug interactions |
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Definition
| strongly inhibits CYP2C9 and 2C19; moderately inhibits CYP3A4 |
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Term
| Therapeutic uses of Fluconazole |
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Definition
| localized and systemic fungal infections (sensitive yeast infections, Cryptococcus neoformans (meningitis), coccidioides immitis (AKA "valley fever")... Antifungal prophylaxis |
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Term
| Itraconazole Spectrum of activity |
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Definition
| candida sp (variably active against fluconazole resistant strains), BLastomyces dermatitis, Cryptococcus neoformans, coccidioides immitis, histoplasma capsulatum; active against Aspergillus |
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Term
|
Definition
| candida sp (rare cross resistance reported), blastomyces dermatidids, Cryptococcus neoormans, coccidioides immitis; aspergillus sp; scedosporium apiospermum |
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Term
| Voriconazole drug interactions |
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Definition
| substrate of CYP2A19 and CYP2A9; moderately inhibits CYP3A4 |
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Term
| Voriconazole dose adjustment |
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Definition
| hepatic dysfunction: CHild PUgh A-B (mild-mod) reduce dose 50% |
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Term
| Voriconazole therapeutic uses |
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Definition
| localized and systemic fungal infections: 1st line therapy for invasisve aspergillosis, first line therapy for Scedosporium sp. infections; antifungals prophylaxis |
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Term
|
Definition
| active against yeasts and molds; only azole with spectrum including zygomycete |
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Term
| Posaconazole drug interactions |
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Definition
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Term
| Posaconazole therapeutic uses |
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Definition
| localized and systemic fungal infections; salvage therapy of refractory invasive fungal infections; antifungal prophylaxis |
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Term
|
Definition
| Caspofungin; Micafungin; Anidulfungin |
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Term
|
Definition
| inhibit the synthesis of beta (1,3)-D-glucan; essential fungal cell wall component |
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Term
|
Definition
| yeasts and molds; Generally fungicidal against all Candida spp; Active against Aspergillus spp; |
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Term
| Echinocandins therapeutic uses: First line |
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Definition
| non-albicans sp. infections: candidemia and invasive candida infections |
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Term
| Echinocandins therapeutic uses: second line: |
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Definition
| invasive aspergillosis; esophageal candidiasis |
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Term
|
Definition
| febrile neutropenic patients with suspected fungal infection; antifungal prophylaxis in hematopoietic stem cell transplant patients |
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Term
| Amphotericin B Classification |
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Definition
| amphoteric polyene macrolide |
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Term
|
Definition
| binds to ergosterol in fungi; cell membrane component fungi, alters cell permeability causing intercellular leakage and death --> fungicidal |
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Term
|
Definition
| yeasts and molds; most candida sp; Cryptococcus neoformans; aspergillus fumigatus, zygomycetes; cocciidioides immitis |
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Term
| amphotericin B Resistance |
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Definition
| rare over all; reduction in ergosterol biosynthesis; production of alternative sterols; fungi w/ primary resistance: scedosporium apiospermum, aspergillus terrus, candida lusitaniae (Variable resistance) |
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Term
| amphotericin therapeutic uses |
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Definition
| severe systemic and CNS infections of susceptible fungi; local administration: fungal cystitis, had been used for cases of resistant thrush but this currently is rarely utilized |
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Term
| amphotericin infused related adverse effects: immediate reaction |
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Definition
| fever, chills, rigors, hypotension |
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Term
| amphotericin infused related adverse effects: premedicate |
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Definition
| 30 min prior to infusion; Antipyretics: acetaminophen, Antihistamines: diphenhydramine, Steroids: hydrocortisone; Rigors during infusion: memperidine |
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Term
| Amphotericin Nephrotoxicity Risk Factors |
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Definition
| pretexting renal insufficiency; concomitant nephrotoxins; prolonged accumulative duration; volume depletion |
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Term
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Definition
| pyrimidine analogue: converted intercellularly 5-fluorouracil, interferes with the fungal DNA and RNA synthesis |
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Term
|
Definition
| loss of enzymes for conversion to active form, decreased penetration of fungal cell membrane, develops rapidly with monotherapy |
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Term
| Flucytosine active against |
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Definition
| candida sp., C neoformans |
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Term
|
Definition
| cryptococcal infections; used in combination therapy with either Amphotericin B, Fluconazole; distributes well into CSF |
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Term
|
Definition
| dose related hepatotoxicity and bone marrow toxicity; renal dysfunction patients: use with EXTREME caution |
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Term
| Yeasts: non-invasive disease |
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Definition
| thrush, esophagitis, vaginitis |
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Term
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Definition
| candidemias and complex device related infections |
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Term
|
Definition
| was the most commonly isolated species |
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Term
| Yeasts:: C. Glabrata, C. Krusei, C. Tropicalis |
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Definition
| increasing frequency due to selective pressure |
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Term
| Yeasts: Cryptococcus neoformans |
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Definition
| meningitis in the immunosuppressed (AIDS patients) |
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Term
| most common cause of invasive fungal infection |
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Definition
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Term
| 4th most common cause of nosocomial bloodstream infections; 5th for all types of device/procedure infections |
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Definition
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Term
| Risk factors for invasive candidiasis |
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Definition
| impaired immune function; structural (physical); ecological |
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Term
| prophylaxis of candidemia |
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Definition
| azoles, echinocandins, ampho b |
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Term
| candidemia: non-neutropenic |
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Definition
| treat for 14 days after; high dose fluconazole --> for sensitive species; echinocandin: severe illness, recent azole exposure; alternatives: liposomal ampho B; ampho B; voriconazole |
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Term
|
Definition
| primary therapy: drug of class choice: echinocandin; AMB, LAMB, ABLC; Fluconazole; Voriconazole |
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Term
|
Definition
| asymptomatic cystitis, symptomatic cystitis |
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Term
|
Definition
| treatment not usually recommended; potentially for high risk patients: neonates, neutropenic, or undergoing urologic procedures |
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Term
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Definition
| primary: fluconazole 200 mg daily 7-14 days; alternative therapy: amph B, flucytosine, ampho B irrigation (generally not recommended) |
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Term
| pyelonephritis candidiasis |
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Definition
| most broad spectrum antifungal: low urinary excretion of active drug |
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Term
| pyelonephritis candidiasis primary therapy |
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Definition
| fluconazole 200-400 mg/day x 14 days |
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Term
| pyelonephritis candidiasis fluconazole resistant |
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Definition
| ampho b +/- flucytosine, flucytosine monotherapy, may consider echinocandin or voriconazole (no other choice, low urine conc + limited data) |
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Term
|
Definition
| ubiquitous mold: soil, water, organic debris; Clinical syndrome (allergic, saprophytic, invasive) |
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Term
|
Definition
| associated w/ protals of entry (respiratory tract (pneumonia, sinusitis); systemic dissemination (CNS, cardiovascular) |
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Term
| invasive aspergillosis primary therapy |
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Definition
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Term
| invasive aspergillosis alternative thearpy |
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Definition
| liposomal amph b, ampho b lipid complex |
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Term
| invasive aspergillosis salvage therapy |
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Definition
| echinochandins; posaconazole |
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Term
| invasive aspergillosis combination therapy |
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Definition
| controversial; may have a role in salvage therapy |
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