NR566 – Advanced Pharmacology for Care of the Family
Exam Study Guide – Midterm Exam
Key Concepts to Study
Week 1: Chapter 81
Pharmacokinetics of Amphotericin B: Amphotericin B is a drug of choice for most
systemic mycoses. Unfortunately, amphotericin B is highly toxic: Infusion reactions and
renal damage occur in many patients. Because of its potential for harm, amphotericin B
should be employed only against infections that are progressive and potentially fatal.
Amphotericin B binds to ergosterol, a component of the fungal cell membrane, increasing
permeability. The resultant leakage of intracellular cations (especially potassium) reduces
viability. Depending on the concentration of amphotericin B and the susceptibility of the
fungus, the drug may be fungistatic or fungicidal.
Amphotericin B: Minimizing Nephrotoxicity Kidney damage can be minimized by
infusing 1 L of saline on the days amphotericin is given.
The lipid-based formulations are as effective as the conventional formulation and cause
less toxicity but are more expensive. For treatment of systemic mycoses, all formulations
are administered by intravenous (IV) infusion. Infusions are given daily or every other day
for several months.
Itraconazole Drug Interactions
Are approved for treatment of aspergillosis, blastomycosis, and histoplasmosis. It is also
approved for treatment of oropharyngeal and esophageal candidiasis.
Itraconazole has been used off label to treat coccidioidomycosis, paracoccidioidomycosis,
sporotrichosis, and talaromycosis. It is sometimes used off label as antifungal prophylaxis
to prevent invasive fungal infections in severely immunocompromised patients and to treat
fungal infections such as vulvovaginal candidiasis and tinea capitis in these patients.
Drug Interaction with Itraconazole: Itraconazole has negative inotropic actions that can
cause a decrease in ventricular ejection fraction. Onset of complications such as heart
failure, QT interval prolongation, and torsades de pointes has occurred as long as 7 months
,after therapy has been initiated, associated with rare cases of liver failure, some of which
were fatal.
When administered with CYP3A4 inhibitors, serum levels of intraconazole can rise. At high
levels, itraconazole can cause potentially fatal ventricular dysrhythmias. In patients taking
cyclosporine or digoxin, levels of these drugs should be monitored; in patients taking
warfarin, prothrombin time should be monitored; and in patients taking sulfonylureas,
blood glucose levels should be monitored.
Therapeutic Uses of Caspofungin: Candidemia, candidal peritonitis, and abdominal
abscesses, esophageal candidiasis, neutropenic fever assumed due to fungal infections
(as empiric treatment)
Adverse Effects of Caspofungin: Infusion reactions, chills, HA, hypotension and
tachycardia, respiratory failure, peripheral edema, phlebitis, NVD, anemia, leukopenia,
elevated liver enzymes and serum creatinine, bacterial infections
Griseofulvin Indications. Mitotic inhibitor: Griseofulvin (generic) is the first oral antifungal
product for treatment of infections caused by dermatophytes.
Specifically, it is employed to treat tinea barbae, tinea capitis, tinea corporis, and tinea
cruris. It is also used to treat onychomycosis. It is effective against fungal infections
caused by Trichophyton spp., Epidermophyton floccosum, Microsporum audouini,
Microsporum canis, and Microsporum gypseum.
Administration is oral, and absorption can be enhanced by dosing with a fatty meal.
Dermatophytic infections of the skin typically respond in 3 to 8 weeks. However, infections
of the palms may require 2 to 3 months of treatment, and a year or more may be needed to
eliminate infections of the toenails.
Oral Terbinafine Indications
Azole Use in Older Adults
Tinea Pedis Treatment Tinea pedis, the most common fungal infection, generally responds
well to topical therapy. Patients should be advised to wear absorbent cotton socks, change
their shoes often, and dry their feet after bathing.
Treatment Choice for Systemic Mycoses The opportunistic mycoses—candidiasis,
aspergillosis, cryptococcosis, and mucormycosis—are caused by organisms that do not
,typically cause infection in healthy individuals but can readily infect people who are
debilitated or immunocompromised.
Amphotericin B is a drug of choice for most systemic mycoses. Unfortunately,
amphotericin B is highly toxic: Infusion reactions and renal damage occur in many patients.
Because of its potential for harm, amphotericin B should be employed only against
infections that are progressive and potentially fatal.
Chapter 82
Herpes simplex virus (HSV) and varicella zoster virus (VZV) are members of the herpesvirus
group. HSV causes infection of the genitalia, mouth, face, and other sites. VZV is the cause
of varicella (chickenpox) and herpes zoster (shingles), a painful condition resulting from
reactivation of VZV that has been dormant within sensory nerve roots.
Acyclovir Acyclovir (Zovirax) is the agent of first choice for most infections caused by HSV
and VZV. The drug can be administered topically, orally, and intravenously.
****Inform patients that acyclovir only decreases symptoms; it does not eliminate the
virus and does not produce a cure. Advise patients to apply topical acyclovir with a
finger cot or rubber glove to avoid viral transfer to other body sites or other people.
Explain that some transient local burning or stinging may occur and that this does not
indicate a reaction.
MOA Acyclovir inhibits viral replication by suppressing the synthesis of viral DNA
Indication Herpes infections of the face and oropharynx are usually caused by HSV type 2
(HSV-2). For immunocompetent patients, oral acyclovir can be used to treat primary
infections of the gums and mouth. Oral acyclovir can also be taken prophylactically to
prevent episodes of recurrent herpes labialis (cold sores).
Varicella zoster infections. High doses of oral acyclovir are effective for herpes zoster
(shingles) in older adults. Oral therapy is also effective for varicella (chickenpox) in
children, adolescents, and adults provided that dosing is begun early (within 24 hours of
rash onset). Intravenous acyclovir is the treatment of choice for VZV infection in the
immunocompromised host.
Route of Administration Considerations Oral bioavailability is low, ranging from 15% to
30%. No significant absorption occurs with topical use. Topical acyclovir frequently causes
transient local burning or stinging; systemic reactions do not occur. Oral acyclovir is safe
during pregnancy, so it can be used to suppress recurrent genital herpes near term.
, IV acyclovir is generally well tolerated. The most common reactions are phlebitis and
inflammation at the infusion site. Reversible nephrotoxicity, indicated by elevations in
serum creatinine and blood urea nitrogen, occurs in some patients. The cause is
deposition of acyclovir in renal tubules. The risk for renal injury is increased by
dehydration and use of other nephrotoxic drugs. Kidney damage can be minimized by
infusing acyclovir slowly (over 1 hour) and ensuring adequate hydration during the
infusion and for 2 hours after.
Oseltamivir (Tamiflu) Treatment: Should be taken within 48 h of symptom onset.
MOA Antiviral effects derive from inhibiting neuraminidase, a viral enzyme required for
replication. As a result of neuraminidase inhibition, newly formed viral particles are unable
to bud off from the cytoplasmic membrane of infected host cells.
Administration IIV and RIV are administered by intramuscular (IM) injection. The LAIV is
administered by intranasal spray.
Indications Oseltamivir (Tamiflu) is an oral drug approved for the prevention of influenza in
patients 1 year of age and older and for treatment of influenza in patients 2 weeks and
older. In addition to reducing symptom duration, oseltamivir can reduce symptom severity
and the incidence of complications (sinusitis, bronchitis). Because of the harmful effects
of influenza on the developing embryo and fetus, the American College of Obstetricians
and Gynecologists (ACOG) recommends oseltamivir for both prophylaxis and treatment in
pregnant patient
Palivizumab Indications
indicated for preventing RSV infection in premature infants and at-risk young children up to
24 months. Both bind to a surface protein on RSV and thereby prevent replication. Both are
given IM. Nirsevimab has a much longer half-life, allowing for single-dose therapy.
Palivizumab requires administration monthly throughout RSV season.
Purpose of Annual Flu Vaccine:
Influenza is a highly contagious infection spread by aerosolized droplets produced by
coughing or sneezing. The virus enters the body through mucous membranes of the nose,
mouth, or eyes. Viral replication takes place in the respiratory tract. Symptoms begin 2 to 4
days after exposure and last 5 to 6 days. Influenza is characterized by fever, cough, chills,
sore throat, headache, and myalgia (muscle pain). For typical patients, infection results in
Exam Study Guide – Midterm Exam
Key Concepts to Study
Week 1: Chapter 81
Pharmacokinetics of Amphotericin B: Amphotericin B is a drug of choice for most
systemic mycoses. Unfortunately, amphotericin B is highly toxic: Infusion reactions and
renal damage occur in many patients. Because of its potential for harm, amphotericin B
should be employed only against infections that are progressive and potentially fatal.
Amphotericin B binds to ergosterol, a component of the fungal cell membrane, increasing
permeability. The resultant leakage of intracellular cations (especially potassium) reduces
viability. Depending on the concentration of amphotericin B and the susceptibility of the
fungus, the drug may be fungistatic or fungicidal.
Amphotericin B: Minimizing Nephrotoxicity Kidney damage can be minimized by
infusing 1 L of saline on the days amphotericin is given.
The lipid-based formulations are as effective as the conventional formulation and cause
less toxicity but are more expensive. For treatment of systemic mycoses, all formulations
are administered by intravenous (IV) infusion. Infusions are given daily or every other day
for several months.
Itraconazole Drug Interactions
Are approved for treatment of aspergillosis, blastomycosis, and histoplasmosis. It is also
approved for treatment of oropharyngeal and esophageal candidiasis.
Itraconazole has been used off label to treat coccidioidomycosis, paracoccidioidomycosis,
sporotrichosis, and talaromycosis. It is sometimes used off label as antifungal prophylaxis
to prevent invasive fungal infections in severely immunocompromised patients and to treat
fungal infections such as vulvovaginal candidiasis and tinea capitis in these patients.
Drug Interaction with Itraconazole: Itraconazole has negative inotropic actions that can
cause a decrease in ventricular ejection fraction. Onset of complications such as heart
failure, QT interval prolongation, and torsades de pointes has occurred as long as 7 months
,after therapy has been initiated, associated with rare cases of liver failure, some of which
were fatal.
When administered with CYP3A4 inhibitors, serum levels of intraconazole can rise. At high
levels, itraconazole can cause potentially fatal ventricular dysrhythmias. In patients taking
cyclosporine or digoxin, levels of these drugs should be monitored; in patients taking
warfarin, prothrombin time should be monitored; and in patients taking sulfonylureas,
blood glucose levels should be monitored.
Therapeutic Uses of Caspofungin: Candidemia, candidal peritonitis, and abdominal
abscesses, esophageal candidiasis, neutropenic fever assumed due to fungal infections
(as empiric treatment)
Adverse Effects of Caspofungin: Infusion reactions, chills, HA, hypotension and
tachycardia, respiratory failure, peripheral edema, phlebitis, NVD, anemia, leukopenia,
elevated liver enzymes and serum creatinine, bacterial infections
Griseofulvin Indications. Mitotic inhibitor: Griseofulvin (generic) is the first oral antifungal
product for treatment of infections caused by dermatophytes.
Specifically, it is employed to treat tinea barbae, tinea capitis, tinea corporis, and tinea
cruris. It is also used to treat onychomycosis. It is effective against fungal infections
caused by Trichophyton spp., Epidermophyton floccosum, Microsporum audouini,
Microsporum canis, and Microsporum gypseum.
Administration is oral, and absorption can be enhanced by dosing with a fatty meal.
Dermatophytic infections of the skin typically respond in 3 to 8 weeks. However, infections
of the palms may require 2 to 3 months of treatment, and a year or more may be needed to
eliminate infections of the toenails.
Oral Terbinafine Indications
Azole Use in Older Adults
Tinea Pedis Treatment Tinea pedis, the most common fungal infection, generally responds
well to topical therapy. Patients should be advised to wear absorbent cotton socks, change
their shoes often, and dry their feet after bathing.
Treatment Choice for Systemic Mycoses The opportunistic mycoses—candidiasis,
aspergillosis, cryptococcosis, and mucormycosis—are caused by organisms that do not
,typically cause infection in healthy individuals but can readily infect people who are
debilitated or immunocompromised.
Amphotericin B is a drug of choice for most systemic mycoses. Unfortunately,
amphotericin B is highly toxic: Infusion reactions and renal damage occur in many patients.
Because of its potential for harm, amphotericin B should be employed only against
infections that are progressive and potentially fatal.
Chapter 82
Herpes simplex virus (HSV) and varicella zoster virus (VZV) are members of the herpesvirus
group. HSV causes infection of the genitalia, mouth, face, and other sites. VZV is the cause
of varicella (chickenpox) and herpes zoster (shingles), a painful condition resulting from
reactivation of VZV that has been dormant within sensory nerve roots.
Acyclovir Acyclovir (Zovirax) is the agent of first choice for most infections caused by HSV
and VZV. The drug can be administered topically, orally, and intravenously.
****Inform patients that acyclovir only decreases symptoms; it does not eliminate the
virus and does not produce a cure. Advise patients to apply topical acyclovir with a
finger cot or rubber glove to avoid viral transfer to other body sites or other people.
Explain that some transient local burning or stinging may occur and that this does not
indicate a reaction.
MOA Acyclovir inhibits viral replication by suppressing the synthesis of viral DNA
Indication Herpes infections of the face and oropharynx are usually caused by HSV type 2
(HSV-2). For immunocompetent patients, oral acyclovir can be used to treat primary
infections of the gums and mouth. Oral acyclovir can also be taken prophylactically to
prevent episodes of recurrent herpes labialis (cold sores).
Varicella zoster infections. High doses of oral acyclovir are effective for herpes zoster
(shingles) in older adults. Oral therapy is also effective for varicella (chickenpox) in
children, adolescents, and adults provided that dosing is begun early (within 24 hours of
rash onset). Intravenous acyclovir is the treatment of choice for VZV infection in the
immunocompromised host.
Route of Administration Considerations Oral bioavailability is low, ranging from 15% to
30%. No significant absorption occurs with topical use. Topical acyclovir frequently causes
transient local burning or stinging; systemic reactions do not occur. Oral acyclovir is safe
during pregnancy, so it can be used to suppress recurrent genital herpes near term.
, IV acyclovir is generally well tolerated. The most common reactions are phlebitis and
inflammation at the infusion site. Reversible nephrotoxicity, indicated by elevations in
serum creatinine and blood urea nitrogen, occurs in some patients. The cause is
deposition of acyclovir in renal tubules. The risk for renal injury is increased by
dehydration and use of other nephrotoxic drugs. Kidney damage can be minimized by
infusing acyclovir slowly (over 1 hour) and ensuring adequate hydration during the
infusion and for 2 hours after.
Oseltamivir (Tamiflu) Treatment: Should be taken within 48 h of symptom onset.
MOA Antiviral effects derive from inhibiting neuraminidase, a viral enzyme required for
replication. As a result of neuraminidase inhibition, newly formed viral particles are unable
to bud off from the cytoplasmic membrane of infected host cells.
Administration IIV and RIV are administered by intramuscular (IM) injection. The LAIV is
administered by intranasal spray.
Indications Oseltamivir (Tamiflu) is an oral drug approved for the prevention of influenza in
patients 1 year of age and older and for treatment of influenza in patients 2 weeks and
older. In addition to reducing symptom duration, oseltamivir can reduce symptom severity
and the incidence of complications (sinusitis, bronchitis). Because of the harmful effects
of influenza on the developing embryo and fetus, the American College of Obstetricians
and Gynecologists (ACOG) recommends oseltamivir for both prophylaxis and treatment in
pregnant patient
Palivizumab Indications
indicated for preventing RSV infection in premature infants and at-risk young children up to
24 months. Both bind to a surface protein on RSV and thereby prevent replication. Both are
given IM. Nirsevimab has a much longer half-life, allowing for single-dose therapy.
Palivizumab requires administration monthly throughout RSV season.
Purpose of Annual Flu Vaccine:
Influenza is a highly contagious infection spread by aerosolized droplets produced by
coughing or sneezing. The virus enters the body through mucous membranes of the nose,
mouth, or eyes. Viral replication takes place in the respiratory tract. Symptoms begin 2 to 4
days after exposure and last 5 to 6 days. Influenza is characterized by fever, cough, chills,
sore throat, headache, and myalgia (muscle pain). For typical patients, infection results in
