42 Questions
What is the loading dose for itraconazole?
200 mg three times daily for 3 days
What is the standard formulation of amphotericin B?
Amphotericin B with deoxycholate
What is the preferred agent for treating oropharyngeal and esophageal Candida?
Fluconazole
What is the recommended target trough drug level for voriconazole after 1 week of therapy?
1 to 5.5 mg/L
What is the mechanism of action of Amphotericin B?
It interacts with cell membrane sterols, resulting in toxic side effects in both human and fungal cells
What is the mechanism of action of echinocandins?
Inhibition of fungal cell wall glucan synthesis
What is the standard therapy for systemic mycoses and what are its drawbacks?
Amphotericin B, which has multiple toxicities
What is the spectrum of activity of Isavuconazole?
Active against all Candida species, Aspergillus, Paecilomyces, and Scedosporium apiospermum, with variable, but good, activity against Mucor spp.
What is the mechanism of action of flucytosine?
Flucytosine deaminates to 5-fluorouracil and incorporates into fungal RNA, leading to faulty protein synthesis and growth inhibition
What is the recommended dose of posaconazole for prophylaxis?
200 mg tid
What is the mechanism of action of triazoles?
They inhibit the synthesis of ergosterol by blocking the enzyme C-14 alpha-demethylase
What is the primary route of excretion for posaconazole?
Feces
Which fungal infections is itraconazole the preferred agent for?
Histoplasmosis and Blastomycosis
What is the loading dose of Isavuconazole?
200 mg q8h for 2 days
What is the main advantage of azoles over amphotericin B?
They are less toxic
What is the percentage of peak serum concentration of fluconazole that can penetrate the cerebrospinal fluid?
70%–90%
What is the duration of therapy for amphotericin B?
14 days
Which antifungal has the best global availability?
Itraconazole
What is the most frequent adverse event associated with voriconazole?
Visual disturbances
Which organisms are sensitive to flucytosine?
Cryptococcus neoformans and Candida albicans
Which echinocandin is metabolized by slow peptide hydrolysis?
Caspofungin
Which of the following is not a sensitive organism to Amphotericin B?
Pseudallescheria boydii
Which of the following is true about Isavuconazole?
It is non-inferior to voriconazole in invasive aspergillosis with fewer side effects
What is the daily price range for amphotericin B deoxycholate in surveyed countries?
<$1 to $171
What is the recommended treatment for cryptococcal meningitis?
A combination of Amphotericin B and flucytosine
What is the percentage of patients who can develop alteration of renal function with AMBD?
80%
What is the standard dosage of flucytosine?
100 mg/kg/day divided into four doses
What is the recommended approach to treating azole-resistant infections?
Switching to combination therapy with an echinocandin and an azole
What is the target trough serum level for prophylaxis and treatment with itraconazole?
<0.5 ug/ml for prophylaxis and 1.0–2.0 ug/ml for treatment
What is the recommended dose adjustment of fluconazole for patients with a CrCl of less than 50 mL/min?
25%
What is the recommended oral dose of voriconazole for a patient weighing less than 40 kg?
100 mg every 12 hours
Which of the following is a potential adverse effect of posaconazole?
Mucositis
Which echinocandin is excreted in an inactive form in the bile and urine?
Micafungin
Which echinocandin is recommended for the treatment of esophageal candidiasis with a loading dose of 100mg followed by 50mg daily?
Anidulafungin
What are the infusion-related toxicities of amphotericin B?
Fever, rigors, headaches, anorexia, nausea, vomiting, dyspnea, and hypotension
What is the most common hematologic adverse event associated with flucytosine use?
Neutropenia
What is the dose of ABLC for empiric therapy?
3 mg/kg/day
What is the therapeutic indication for the combination of amphotericin B and flucytosine?
Treatment of cryptococcal meningitis and disseminated disease
Which echinocandin is fungicidal against Candida spp. but only fungistatic against Aspergillus?
Caspofungin
What is the reduction of hematocrit units that one-third of patients may experience with amphotericin B?
15 units
What is the biphasic excretion of amphotericin B?
A rapid elimination half-life of 24 hours, followed by a prolonged terminal half-life of 15 days
Is amphotericin B safe to use during pregnancy?
Yes, it is safe with no evidence of teratogenesis or toxicity in infants
Study Notes
"Test Your Knowledge on Antifungal Therapy for Systemic Mycoses" - Take this quiz to assess your understanding of the properties and usage of major antifungal drugs such as amphotericin B, flucytosine, triazoles, and echinocandins. Learn about the clinical challenges posed by systemic mycoses and the relative non-toxicity of azole antifungals. Sharpen your knowledge and stay up-to-date with the latest treatments for
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