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Antifungals - Coggle Diagram
Antifungals
Azoles (Conversion 1:1)
Fluconazole
PO/IV: 50-800 mg qd
Renally cleared/dosed, adequately penetrates the CNS (fungal meningitis)
Voriconazole- take on empty stomach
LD:
6 mg/kg IV q12h x2 doses
MD:
4 mg/kg IV q12h or 200 mg PO q12h
Renally (CrCl <50) and hepatically dosed
Goal Tr= < 5 mcg/mL
CIs:
barbiturates, carbamazepine, efavirenz, quinidine, rifabutin, rifampin, ritonavir, sirolimus
Side Effects:
hepatoxicity, phototoxicity, QT prolongation, CNS toxicity- hallucinations
Monitoring:
LFTs, renal fctn, K, Ca, Mg
1st line for Aspergillus
Cresemba (Isavuconazonium)- requires a filter for administration
IV/PO: 372 mg q8h x6 doses then 372 mg qd
CI:
Strong CYP3A4 inhibitors/inducers, QT shortening
Side Effects:
hepatotoxicity, infusion rxn, SJS/TENS, teratogenic, particulates
Monitoring:
LFTs, electrolytes
Activity:
C. albicans, C. parapsilosis, C. tropicalis. Limited against C. glabrata d/t resistance. C. Krusi is fluconazole resistant.
Side Effects:
Hepatoxicity (inc LFTs)
Monitoring:
LFTs, QT prolongation
Amphotericin B
Conventional Formulation
0.1-1.5 mg/kg/day
Requires premedication with tylenol, hydrocortisone/benadryl, and NS bolus
Lipid Formulation (fewer toxicities)
Amphotericin B Lipid
5 mg/kg/day
Liposomal Amphotericin B
3-6 mg/kg/day
Activity:
Candida, Cryptococcus neoformans, Aspergillus, Zygomycetes, Histoplasma capsulatum, Blastomyces dermatitidis, Coccidioides immitis
Side Effects:
Infusion-related chills/fever/headache/malaise/rigors, BP changes, thrombophelebitis, hypokalemia (watch with dig), hypomagnesia, anemia.
Monitoring:
renal fctn (nephrotoxic), LFTs, electrolytes
Echinocandins- No renal adj.
Micafungin
Candidemia: 100 mg IV qd
Esophageal Candidiasis: 150 mg Iv qd
Caspofungin
70 mg IV on day 1, then 50 mg Iv qd
Activity:
Candida +strains resistant to azoles (galbrata & krusei)
Side Effects:
Histamine rxns, SJS/TENS, liver toxicity, hyper/hypokalemia, hypomagnesia
Monitoring:
K, Mg, LFts, Scr