Term
|
Definition
| Replaces ergosterol in fungal cytoplasmic membrane --> forms pores --> ions enter and depolarize the cell and it dies |
|
|
Term
| What is a major side effect of amphotericin? |
|
Definition
Nephrotoxicity- Cr rise of 2-3
Due to vasoconstriction in afferent arterioles
Renal tubular acidosis- wasting of K+, Mg++, HCO3- |
|
|
Term
| What medications exacerbate amphotericin nephrotoxicity? |
|
Definition
Solid organ transplant drugs (cyclosporine, tacrolimus)
Aminoglycosides |
|
|
Term
| How can we ameliorate the nephrotoxic effects of amphotericin? |
|
Definition
Saline loading before/after
Increase infusion time (24hrs rather than 6) |
|
|
Term
| How is amphotericin tolerated? |
|
Definition
Can cause fever/rigors (premedicate w/ acetaminophen/diphenhydramine, tx rigors w/ meperidine)
N/V
Anemia (long-term administration) |
|
|
Term
| Alternative to conventional ampho B? |
|
Definition
| Liposomal amphotericin (less nephrotoxic) |
|
|
Term
| Which causes less rigors: Ambisome or ABLC? |
|
Definition
| Ambisome (better tolerated) |
|
|
Term
| What formulation of ampho is best for brain infections? |
|
Definition
|
|
Term
| How well does ampho penetrate CSF? |
|
Definition
|
|
Term
|
Definition
| Inhibit enzyme that does C14 alpha demethylation of lanosterol to form ergosterol |
|
|
Term
| What candida species are resistant to fluconazole? |
|
Definition
|
|
Term
| Can we use fluconazole against aspergillus spp.? |
|
Definition
|
|
Term
| Effects on metabolism of fluconazole? |
|
Definition
| Moderate inhibitor of 3A4 |
|
|
Term
| How does fluconazole affect warfarin dose? |
|
Definition
| Increases INR- need to reduce warfarin levels |
|
|
Term
| What is the drug of choice for c. krusei infections? |
|
Definition
|
|
Term
| What trough level is the goal in Therapeutic Drug Monitoring (TDM) for voriconazole? |
|
Definition
|
|
Term
|
Definition
Transient vision changes
Rash
Periostosis due to fluoride toxicity |
|
|
Term
| Voriconazole's "claim to fame"? |
|
Definition
|
|
Term
| Drug of choice for histoplasmosis? |
|
Definition
|
|
Term
| Which formulation of itraconazole is preferred: oral cyclodextrin or capsules? |
|
Definition
| Oral cyclodextrin- not pH dependent, more bioavailable |
|
|
Term
| How should posaconazole be taken? |
|
Definition
| W/ a high fat meal to enhance absorption |
|
|
Term
| Which meds may tx some mucorales spp? |
|
Definition
| Posaconazole, isavuconazole |
|
|
Term
|
Definition
| Inhibit beta (1,3) D-glucan synthase --> inhibit fungal cell wall formation |
|
|
Term
| Where don't echinocandins penetrate? |
|
Definition
|
|
Term
| Which echinocandins are hepatically metabolized? |
|
Definition
|
|
Term
| Which echinocandin is metabolized by serum esterases? |
|
Definition
|
|
Term
| Indications for echinocandins? |
|
Definition
C. glabrata candidemia
Azole-resistant C. esophagatii |
|
|
Term
|
Definition
| Infusion-related histamin rxn- tx w/ diphenhydramine |
|
|
Term
| Which echinocandin interacts w/ cyclosporine, tacrolimus, rifampin? |
|
Definition
|
|
Term
| What is the vector for malaria? |
|
Definition
| Female anopheles mosquito |
|
|
Term
| What malaria species have a dormant liver stage called the hypnozoite? |
|
Definition
|
|
Term
|
Definition
Antierythrocytic
Inhibits heme polymerase (which protects parasite from iron) --> cell membrane damage |
|
|
Term
| What part of the world has not developed chloroquine resistance? |
|
Definition
| Caribbean/central america |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| What's the IV formulation of quinine? |
|
Definition
|
|
Term
|
Definition
Cinchonism (Headache, N/V, tinnitus)- reversible
Rare- rash, blackwater fever (hemolysis) |
|
|
Term
| Indication for mefloquine? |
|
Definition
| Anti-malarial prophylaxis, chloroquine-resistant P. falciparum |
|
|
Term
|
Definition
|
|
Term
|
Definition
| Neuropsychiatric effects, N/V, vivid dreams, cardiac conduction disturbances |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| Inhibits dihydrofolate reductase |
|
|
Term
|
Definition
| Hydroxynaphthoquinone- uncouples oxidative metabolism |
|
|
Term
| First line tx for intestinal nematodes? |
|
Definition
| Albendazole (broad spectrum of activity) |
|
|
Term
| Other indications for albendazole? |
|
Definition
echinococcis (liver hydatid cysts)
Neurocysticercosis |
|
|
Term
| Organism that causes Neurocysticercosis? |
|
Definition
| T. solium (pork tapeworm)- causes seizures |
|
|
Term
|
Definition
| Inhibits microtubule synthesis in nematodes |
|
|
Term
| Indications for ivermectin? |
|
Definition
Drug of choice for human onchocerciasis (causes river blindness)
DOC for strongyloidiasis
Ectoparasites (scabies) |
|
|
Term
|
Definition
| acts as an electron sink and causes free radical formation which damages the DNA of the organism directly. |
|
|
Term
|
Definition
| potentiates the opening of glutamate channels in the organism, such as nematodes and arthropods |
|
|
Term
|
Definition
Protozoans:
Entamoeba histolytica
Trichomonas vaginalis
Giardia lamblia |
|
|
