NR566 Midterm Study Guide Notes
Week 1
Chapter 79
Amphotericin B (Broad-spectrum antifungal)
o Pharmacokinetics
Absorption and distribution
Poorly absorbed in GI tract oral therapy can’t be used for
systemic infections
Does not readily penetrate to the CSF
Metabolism and excretion
Little is known about the elimination
Complete elimination takes a long time
o The drug has been detected in tissues more than a
year after cessation or treatment
o Minimizing Nephrotoxicity
By infusing 1L of saline on the days that the drug is given
Other nephrotoxic drugs should be avoided
Test kidneys function every 3-4 days
Monitor intake and output
Consider dose or frequency reduction in those with preexisting
renal impairment
If creatinine rises >3.5, the dosage should be reduced
Itraconazole (Broad-spectrum antifungal)
o Drug Interactions
Inhibition of hepatic drug metabolizing enzymes
Inhibits CYP3A4 can increase levels of many other drugs
o Most important drugs are: cisapride, pimozide,
dofetilide, and quinidine
Other drugs of concern: Cyclosporin, digoxin warfarin, and
sulfonylurea-type oral hypoglycemics
Drugs that raise gastric pH
Drugs that decrease gastric acidity (H2 antagonists, PPIs)
can reduce absorption of oral itraconazole
o Administer these drugs at least 1 hour before or 2
hours after intraconazole
Caspofungin Echinocandin (newest class of antifungal drugs)
o Therapeutic Uses
Treatment of aspergillus and candida species
o Adverse Effects
, Fever and phlebitis at the injection site
Less common: Headache, rash, N/V
Effects that can appear to be mediated by histamine release
rash, facial flushing, pruritic, sense of warmth
Griseofulvin Orally to treat superficial mycoses
o Indications
Dermatophytic infections of the skin, hair, and nails
Not active against Candida species or systemic mycoses
Oral Terbinafine Allylamine
o Indications:
Topical: ringworm infections (tinea corporis, tinea cruris, tinea
pedis)
Oral: Ringworm and onychomycosis (fungal infection of the nails)
Azole Use in Older Adults
o Older adults may not predictably absorb some antifungal agents
o Common drugs prescribed to older adults are increased by azoles
Warfarin, phenytoin, oral hypoglycemic agents
Tinea Pedis Ringworm of the foot
o Treatment
Generally responds well to topical treatment
Advise patients to: Wear absorbent cotton socks, changes their
shoes often, and dry their feet after bathing
Treatment Choice for Systemic Mycoses Opportunistic infections (seen
primarily in debilitated or immunocompromised hosts) and
nonopportunistic infections (any host)
o Treating systemic mycoses can be difficult
o These infections often resist treatment and hence may require prolonged
therapy with drugs that frequently prove toxic
Chapter 80
Acyclovir Agent of choice for most infections caused by HSV and VZV
o MOA: Inhibits viral replication by suppressing the synthesis of viral DNA
Critical step: Conversion of acyclovir to acyclo-guanosine
monophosphate (GMP) by thymidine kinase
o Indication
Mucocutaneous herpes simplex infections herpes infections of
the face and oropharynx (usually caused by HSV type 2)
Immunocompromised patients: Oral acyclovir can be used,
but IV is used for severe cases in these patients
Varicella Zoster infections shingles
High doses of oral acyclovir are effective in older adults
, Oral doses also effective for chickenpox in children,
adolescents, and adults, if dosing is begun early (within 24
hours of rash onset)
IV for immunocompromised patients
Herpes simplex genitalis
o Route of Administration Considerations
Oral
N/V/D, headache, vertigo
Safe during pregnancy
Topical
Local burning or stinging
IV
Can cause renal failure (unlike oral acyclovir)
Patients with preexisting renal disease and dehydration are
at increased risk
Oseltamivir (Tamiflu) Oral drug approved for the prevention and
treatment of the flu in patients 1 year and older
o MOA: Inhibits neuraminidase, a viral enzyme required for replication
o Administration
For prophylactic therapy:
Family members: Dosing should begin within 48 hours of
exposure and continue for 10 days
Nursing home residents or high-risk members of the
community: Dosing can be done continuously for up to 42
days
o Indications
Influenza A and B
Prophylactic therapy: family members of someone with the flu, and
residents of nursing homes
Both prophylaxis and treatment in pregnant women
Palivizumab
o Indications: Preventing RSV infection in premature infants and in young
children with chronic lung disease
Purpose of Annual Flu Vaccine
o Recommended for all people 6 months and older
o Especially important for persons at high risk for flu complications, and for
those who live with or care for persons at high risk
Flu Vaccine: Contraindications
o No LIVE vaccine: people at high risk for flu complications including
pregnant women
Should receive the inactivated vaccine
Week 1
Chapter 79
Amphotericin B (Broad-spectrum antifungal)
o Pharmacokinetics
Absorption and distribution
Poorly absorbed in GI tract oral therapy can’t be used for
systemic infections
Does not readily penetrate to the CSF
Metabolism and excretion
Little is known about the elimination
Complete elimination takes a long time
o The drug has been detected in tissues more than a
year after cessation or treatment
o Minimizing Nephrotoxicity
By infusing 1L of saline on the days that the drug is given
Other nephrotoxic drugs should be avoided
Test kidneys function every 3-4 days
Monitor intake and output
Consider dose or frequency reduction in those with preexisting
renal impairment
If creatinine rises >3.5, the dosage should be reduced
Itraconazole (Broad-spectrum antifungal)
o Drug Interactions
Inhibition of hepatic drug metabolizing enzymes
Inhibits CYP3A4 can increase levels of many other drugs
o Most important drugs are: cisapride, pimozide,
dofetilide, and quinidine
Other drugs of concern: Cyclosporin, digoxin warfarin, and
sulfonylurea-type oral hypoglycemics
Drugs that raise gastric pH
Drugs that decrease gastric acidity (H2 antagonists, PPIs)
can reduce absorption of oral itraconazole
o Administer these drugs at least 1 hour before or 2
hours after intraconazole
Caspofungin Echinocandin (newest class of antifungal drugs)
o Therapeutic Uses
Treatment of aspergillus and candida species
o Adverse Effects
, Fever and phlebitis at the injection site
Less common: Headache, rash, N/V
Effects that can appear to be mediated by histamine release
rash, facial flushing, pruritic, sense of warmth
Griseofulvin Orally to treat superficial mycoses
o Indications
Dermatophytic infections of the skin, hair, and nails
Not active against Candida species or systemic mycoses
Oral Terbinafine Allylamine
o Indications:
Topical: ringworm infections (tinea corporis, tinea cruris, tinea
pedis)
Oral: Ringworm and onychomycosis (fungal infection of the nails)
Azole Use in Older Adults
o Older adults may not predictably absorb some antifungal agents
o Common drugs prescribed to older adults are increased by azoles
Warfarin, phenytoin, oral hypoglycemic agents
Tinea Pedis Ringworm of the foot
o Treatment
Generally responds well to topical treatment
Advise patients to: Wear absorbent cotton socks, changes their
shoes often, and dry their feet after bathing
Treatment Choice for Systemic Mycoses Opportunistic infections (seen
primarily in debilitated or immunocompromised hosts) and
nonopportunistic infections (any host)
o Treating systemic mycoses can be difficult
o These infections often resist treatment and hence may require prolonged
therapy with drugs that frequently prove toxic
Chapter 80
Acyclovir Agent of choice for most infections caused by HSV and VZV
o MOA: Inhibits viral replication by suppressing the synthesis of viral DNA
Critical step: Conversion of acyclovir to acyclo-guanosine
monophosphate (GMP) by thymidine kinase
o Indication
Mucocutaneous herpes simplex infections herpes infections of
the face and oropharynx (usually caused by HSV type 2)
Immunocompromised patients: Oral acyclovir can be used,
but IV is used for severe cases in these patients
Varicella Zoster infections shingles
High doses of oral acyclovir are effective in older adults
, Oral doses also effective for chickenpox in children,
adolescents, and adults, if dosing is begun early (within 24
hours of rash onset)
IV for immunocompromised patients
Herpes simplex genitalis
o Route of Administration Considerations
Oral
N/V/D, headache, vertigo
Safe during pregnancy
Topical
Local burning or stinging
IV
Can cause renal failure (unlike oral acyclovir)
Patients with preexisting renal disease and dehydration are
at increased risk
Oseltamivir (Tamiflu) Oral drug approved for the prevention and
treatment of the flu in patients 1 year and older
o MOA: Inhibits neuraminidase, a viral enzyme required for replication
o Administration
For prophylactic therapy:
Family members: Dosing should begin within 48 hours of
exposure and continue for 10 days
Nursing home residents or high-risk members of the
community: Dosing can be done continuously for up to 42
days
o Indications
Influenza A and B
Prophylactic therapy: family members of someone with the flu, and
residents of nursing homes
Both prophylaxis and treatment in pregnant women
Palivizumab
o Indications: Preventing RSV infection in premature infants and in young
children with chronic lung disease
Purpose of Annual Flu Vaccine
o Recommended for all people 6 months and older
o Especially important for persons at high risk for flu complications, and for
those who live with or care for persons at high risk
Flu Vaccine: Contraindications
o No LIVE vaccine: people at high risk for flu complications including
pregnant women
Should receive the inactivated vaccine
