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60 Cards in this Set
- Front
- Back
What are the common opportunistic fungi? |
1) Candida species 2) Aspergillus Species 3) Cryptoccus species 4) Mucer Species |
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What are the common endemic geographically restricted fungi? |
1) Blastomyces species 2) Coccidoides species 3) Histoplasma species |
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What are the common newly emerging fungi? |
1) Fusarium 2) Scedosporidum 3) Trichosporin |
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What are the medically important fungi yeasts? |
1) Candida species 2) Cryptococci species 3) Trichosporon |
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What are the medically important fungi molds? |
1) Asergillus species 2) Fusarium species 3) Pseudoallesceria boydii 4) Zygomycetes species |
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"Candida and Aspergillus account for 76% of invasive fungal infections" True or False? |
TRUE |
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Which group of patients is most susceptible to Cryptococcus? |
HIV patients (can cause meningits) |
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What are the Innate Antifungal Host Defences? (5) |
1) Macrophages 2) Monocytes 3) Natural Killer Cells 4) Dendritic Cells 5) Solution factors |
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What are the Adaptive Antifungal Host Defences? (3) |
1) T and B lymphocytes 2) Activated Phagocytes 3) Soluble Factors |
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What are the Anatomical Antifungal Host Defences?(3) |
1) Mucosal Surfaces 2) Cutaneous Structures 3) Respiratory Tract Tissue |
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What are the risks factors of Invasive Fungal Infections? (11) |
1) Broad Spectrum Antibiotics 2) Immunosupression/Corticosteroids 3) Neutropenia (Bone Marrow/Solid Organ Transplant) 4) Prolonged Hospitalization (ICU) 5) TPN (Intravascular Catheter Use) 6) Hemodialysis/Acute Renal Failure 7) Diabetes Mellitus 8) Mechanical Ventilation 9) Recent GI/Cardiac Surgery 10) Colonization 11) Burns |
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How do we get a definitive diagnosis of fungal infections? |
Culture & Sensitivity Test {Yeast can take up to 4-6weeks} |
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When do we treat fungal infections? (5) |
1) Symptomatic patients 2) Positive Blood Culture 3) Critically ill in ICU 4) Post Renal Transplant/Neutropenia 5) Low Birth Weight Infant |
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What are the treatment options for Urinary Candidiasis? |
Remove Catheter if possible. DO NOT use lipid formulations or eichinocandins or non-fluconazole due to low renal tissue conc |
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What are the treatment options for Invasive Candidiasis? |
Remove Catheter is possible. 1) Hemodynamically stable, and no azoles in past 3months; -> Use Fluconazole
2) Hemodynamically stable, azoles in past 3months; -> Use Echinocandins |
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What are the monitoring parameters for Urinary Candidiasis? |
Repeat urine culture before and after antifungal treatment. CT scan kidneys to rule out structural abnormalities or abscess |
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What are the monitoring parameters for Invasive Candidiasis? |
Repeat urine culture before and after antifungal treatment. CT scan kidneys to rule out structural abnormalities or abscess |
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What are the generic names of Azoles?(4) |
1) Itraconazole 2) Fluconazole 3) Voriconazole 4) Posaconazole |
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Which Azoles are given both PO and IV? |
Itraconazole, Fluconazole and Voriconazole |
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Which Azoles are given PO only? |
Posaconazole |
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What is the MOA for Azoles? |
Inhibits ergosterol synthesis (sterol synthesis) {Fungistatic} |
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What are the adverse effects of Azoles?(4) |
1) Headaches 2) Increased QT interval 3) N/V/D 4) Elevated liver functional tests |
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What are the generic names of Polyenes? |
Amphotericin B (and lipid formulations) |
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"Polyenes are given PO only" True or False? |
False, They are given IV only |
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Whar is the MOA for Polyenes? |
Binds to Ergosterol creating pores in the cell membrane {Fungicidal} |
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What are the adverse effects of Polyenes?(3) |
1) Nephrotic + Hepatic failure 2) Histamine type of infection 3) Electrolyte abnormalities |
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What are the generic names of Echinocandins?(3) |
1) Caspofungin 2) Micafungin 3) Anidulafungin |
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"Echinocandins are given IV only" True or False? |
TRUE |
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What is the MOA for Echinocandins? |
Inhibits cell wall synthesis {Fungicidal} |
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What are the adverse effects of Echnocandins?(1) |
1) Histamine mediated infusion reactions |
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What are the generic names of Allyamines?(1) |
1) Terbinafine |
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"Terbinafine is given Topically" True or False? |
TRUE |
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What is the MOA for Allyamines? |
Inhibits sterol synthesis |
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What is the recommended drug therapy for Urinary Candidiasis? |
1) Fluconazole: 200mg PO/IV daily x7-14 days 2) Amphotericin B: 0.3-0.6mg/kg/day x1-7 days |
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What is the recommended drug therapy for Invasive Candidiasis (Hemodynamically stable, no azoles in past 3 months)? |
1) Fluconazole: 800mg IV Loading Dose + 400mg IV/PO daily [minimum 14 days after first negative blood culture and the resolution of signs and symptoms] |
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What is the recommended drug therapy for Invasive Candidiasis (Hemodynamically unstable and Azoles in past 3months)? |
1) Any Echinocandin [minimum 14 days after first negative blood culture and the resolution of signs and symptoms] |
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What is the recommended drug therapy for Initial Invasive Aspergillus? |
1) Voriconazole IV then PO as stepdown 2) Amphotericin B |
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"Fluconazole is not recommended for Invasive Aspergillosis because it has no activity" True or False? |
TRUE |
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What is the recommended drug therapy for Refractory Invasive Aspergillus? |
1) Caspofungin 2) Micafungin |
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What are the drug interactions with Azoles? (3) |
1) Azoles inhibit metabolism of agents which undergo cytochrome P450 metabolism 2) Decreased Absorption 3) Azoles inhibit metabolism of drugs and therefore increases their concentration |
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What are the rankings of the azoles interactions? |
Ketoconazole>Itraconazole>Voriconazole>Posaconazole>Fluconazole |
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Which medications are contraindicated for Azoles? |
1) Cisapride 2) Ergot 3) Alcaloides 4) Pimozide 5) Quinidine 6) Efavirenz 7) Sirolimus {all of these medication have elevated conc due to azole interaction} |
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Which organisms are susceptible to AmB? |
1) All Asepergillus (except A.terreus) 2) All Candida (except C.lusitaniae) 3) Cryptococcus neoformans 4) Coccidioides species 5) Blastomyces 6) Histoplasma species 7) Fusarium species 8) Scedosporium apiospermum 9) Zygomycetes |
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Which organisms are resistant to AmB? |
1) Aspergillus terreus 2) Candida lusitaniae 3) Scedosporium prolificans |
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Which organisms are susceptible to Fluconazole? |
1) All Candida (except C.krusei) 2) Cryptococcus neoformans 3) Coccidioides species 4) Blastomyces 5) Histoplasma species |
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Which organisms are resistant to Fluconazole? |
1) All Aspergillus species 2) Candida krusei 3) Fusarium species 4) Scedosporium apiospermum 5) Scedosporium prolificans 6) Zygomycetes |
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Which organisms are susceptible to Itraconazole? |
1) All Aspergillus 2) All Candida 3) Cryptococcus neoformans 4) Coccidioides species 5) Blastomyces 6) Histoplasma species 7) Scedosporium apiospermum |
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Which organisms are resistant to Itraconazole? |
1) Fusarium species 2) Scedosporium prolificans 3) Zygomycetes |
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Which organisms are susceptible to Voriconazole? |
1) All Asepergillus 2) All Candida 3) Cryptococcus neoformans 4) Coccidioides species 5) Blastomyces 6) Histoplasma species 7) Fusarium species 8) Scedosporium apiospermum 9) Scedosporium prolificans |
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Which organisms are resistant to Voriconazole? |
1) Zygomycetes |
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Which organisms are susceptible to Posaconazole? |
1) All Asepergillus 2) All Candida 3) Cryptococcus neoformans 4) Coccidioides species 5) Blastomyces 6) Histoplasma species 7) Fusarium species 8) Scedosporium apiospermum 9) Scedosporium prolificans 10) Zygomycetes |
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Which organisms are resistant to Posaconazole? |
None |
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Which organisms are susceptible to Anidulafungin? |
1) All Aspergillus 2) All Candida 3) Coccidoides species 4) Blastomyces species 5) Histoplasma species |
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Which organisms are resistant to Anidulafungin? |
1) Cryptococcus neoformans 2) Fusarium species 3) Scedosporium apiospermum 4) Scedosporium prolificans 5) Zygomycetes |
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Which organisms are susceptible to Caspofungin? |
1) All Aspergillus 2) All Candida 3) Coccidoides species 4) Blastomyces species 5) Histoplasma species |
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Which organisms are resistant to Caspofungin? |
1) Cryptococcus neoformans 2) Fusarium species 3) Scedosporium apiospermum 4) Scedosporium prolificans 5) Zygomycetes |
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Which organisms are susceptible to Micafungin? |
1) All Aspergillus 2) All Candida 3) Coccidoides species 4) Blastomyces species 5) Histoplasma species |
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Which organisms are resistant to Micafungin? |
1) Cryptococcus neoformans 2) Fusarium species 3) Scedosporium apiospermum 4) Scedosporium prolificans 5) Zygomycetes |
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Which organisms are susceptible to Flucytosine? |
1) All Candida species 2) Cryptococcus neoformans |
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Which organisms are resistant to Flucytosine? |
1) Coccidiodes species 2) Blastomyces 3) Histoplasma species 4) Fusarium species 5) Scedosporium apiospermum 6) Scedosporium prolificans 7) Zygomycetes |