30 Questions
What is the recommended HPLC level of itraconazole associated with toxicity?
2-3 Mcg/mL
Why does itraconazole always require Therapeutic Drug Monitoring (TDM)?
Because of pharmacokinetic (PK) variability
How long should you wait before checking itraconazole levels after the dose?
1 hour
What is recommended to fix a subtherapeutic level of itraconazole?
Increase dosing frequency
How does Amphotericin B work?
Targets the cell membrane
How is voriconazole dosed?
Based on body weight
What is the purpose of 5-flucytosine in combination with Amphotericin B?
To target DNA synthesis
Which formulation of voriconazole is available for administration?
Oral and intravenous (IV)
Why is Amphotericin B formulated with sodium deoxycholate or phospholipids?
To reduce toxicities
What mammalian cells do polyenes like Amphotericin B target?
Kidney cells & erythrocytes
What is the MOA of Griseofulvin?
Binds to keratin in the keratin precursor
What types of rings can azoles contain?
6-membered rings
What is a counseling pearl needed for itraconazole capsules?
Consume acidic foods/beverages
What pharmacokinetic factor leads to the need for Therapeutic Drug Monitoring (TDM) in itraconazole?
Nonlinear PK variability and long half-life
Itraconazole is metabolized by ______________, inhibits ______________, and ____________.
CYP3A4, CYP2D6, P-gP
What does itraconazole metabolize into?
Hydroxy-itraconazole only
What happens when itraconazole interacts with CYP3A4 inducers?
Itraconazole levels decrease
Higher levels of itraconazole are associated with _____________ clinical outcomes.
Improved
What levels of Posaconazole have been associated with toxicity?
0.75 mg/mL
When should therapeutic drug monitoring (TDM) be performed for Posaconazole?
Treatment: always, Prophylaxis: Only if there's concern for toxicity
Where should levels be checked for Posaconazole?
Trough levels
When are peak concentrations for vancomycin typically drawn?
After the end of infusions
What is the purpose of AUC-based monitoring for vancomycin?
To compare vancomycin exposure to MIC of the pathogen
Why is AUC-based monitoring becoming more popular for vancomycin?
To lower total daily doses and reduce nephrotoxicity risk
What is the recommended trough-based vancomycin dosing typically based on?
Actual weight
Which type of infections are excluded from vancomycin AUC monitoring due to their unpredictable kinetics?
End-stage renal disease infections
What level of vancomycin AUC has been associated with increased nephrotoxicity?
400
For which bacteria is vancomycin typically not considered susceptible?
Pseudomonas
How is the loading dose of vancomycin calculated?
$25-30$ mg/kg based on actual weight
What is a potential adverse effect related to vancomycin infusion?
Redman syndrome
Test your knowledge on the usage of Amphotericin B and 5-flucytosine in treating Cryptococcal Meningitis. Learn about how each component works and how Amphotericin B is formulated to reduce toxicities.
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