Sepsis- My Drug Chart

8/3/2019 Sepsis- My Drug Chart

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Echinocandin antifungals

Drug Indication/Dosage MOA CI Kinetics ADEs Misc

Anidulafungin (Eraxis) Candidemia, candidiasis of

esophagus, intra-abdominal and

peritonitis

Off-label: txt of Aspergillus

IV powder, IV only

Noncompetitive inhibitor of synthesis

of - (1,3)-D-glucagon of the cell wall;

decreased glucan content leads to

osmotic instability and cell lysis

Hypersensitivity Preg: C

PB: 84%

T1/2: 27hrs

Hypokalemia, diarrhea, DVT,

abnormal LFTs, hepatic necrosis,

seizure, histamine-mediated rxn

- do not a

-rate of i

1.1mg/m

-reconsti

then furt

Caspofungin (Cancidas) Txt of Aspergillus in refractory pts,candidemia, febrile neutropenia

IV powder, IV only

Inhibits synthesis of (1,3)-D-glucan, anessential component of the cell wall of

susceptible fungi. Highest activity in

regions of active cell growth.

Mammalian cells do not require (1,3)-

D-glucan, limiting potential toxicity.

hypersensitivity Preg: CPB: 97%

T1/2: 9-11hrs

Hypotension, rash, diarrhea,peripheral edema, tachycardia,

increased LFTs, complication of

infusion, fever, shivering, erythema

multiforme, SJS, pancreatitis,

hepatic necrosis, liver failure,

anaphylaxis, sepsis, septic shock,

Nephrotoxicity, renal impairment

pleural effusion, respiratory

distress, respiratory failure,

WBC, Hg, Hct, phlebitis, SCr

- dont m- admin s

admin as

- reconst

bacterios

- good ag

species

Micafungin (Mycamine) Esophageal candidiasis, Candida

prophylaxis is pts undergoing HSCT

Off-label: infxn due to Aspergillus

IV powder, IV only

semisynthetic lipopeptide

(echinocandin) synthesized by a

chemical modification of fermentation

product of Coleophoma empetri F-

11899, that inhibits the synthesis of 1,3

beta-D-glucan,a fundamental

constituent of fungal cell walls .


Substrate: 3A4 (minor)

Inhibits: 3A4 (weak)

PB: >99% to albumin

Metab: forms M-1

(catechol) and M-2

(methoxy)

T1/2: 11-21hrs

Febrile neutropenia, hemolytic

anemia, intravascular hemolysis,

neutropenia, thrombocytopenia,

hepatitis, renal impairment, drug-

induced anaphylaxis, D/N/V,

mucosal inflammation,

constipation, hypomagnesemia

- add NS

- infuse o

- flush ex

infusion


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Azole Antifungals

MOA: triazole antifungals that inhbit 14-alpha-demethylase ezyme needed to convert lanosterol to fecosterol in the biosynthesis of ergosterol. Depletes fungi of ergosterol. This means they cant construct their membranes prop

dividing and causing static activityDrug Indication/Dosage CI Kinetics ADEs Misc

Fluconazole (Diflucan) Candidiasis

Admin: IV, po

Dosage: IV sol, pow for susp, tablet


Inhibits: 2C9, 2C19, 3A4

PB: 11-12%

Bioavail: >90%

T1/2: 30hrs

N/V, LFTs, HA, torsades de

pointes, SJS, seizure, alopecia

(long term)

- shown resistance among C. albi

HIV pts

- C. glabrata less susceptibility

- max rate of infusion is 200mg/h

- high CNS penetration

Itraconazole (Sporanox)

BBW: Heart failure

BBW: high potential for

interactions

Candidiasis

Admin: IV, po

Dosage: capsule, solution

Concomitant use with 3A4 drugs,

hypersensitivity, pregnant women treating

onychomycosis,

Preg: C

Substrate: 3A4

Inhibits: 3A4, PGP

PB: 99.8%

Metab: 3A4 to hydroxy-

itraconazole

Rash, abnormal lipids, N, HA,

upper respiratory problems, CHF,

SJS, hepatoxicity, anaphylaxis

- Infuse over 1 hr

- after admin flush line with 15-20

over 30sec-15min

- Avoid pregnancy use contracept

post treatment

- low CNS penetration

Voriconazole (Vfend) Candidiasis

Admin: IV, po

Dosage: tablet, IV pow for sol, po

pow for sol

Concomitant use of carbamazepine, 3A4

substrates, ergot alkaloids, LA barbiturates,

St. Johns wort, rifampin, hypersensitivity

Preg: D

Substrate: 2C9, 2C19

Inhibits: 2C9, 3A4

PB: 58%

Metab: 2C19, 2C9, 3A4

Bioavial: 96%

Visual disturbances,

hallucinations, SJS/TEN,

pancreatitis, colored vision,

hepatoxicit, Creatinine increased

- High CNS penetration

- good against fluconazole resista

species


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Agent Contraindications Dosage/Admin Kinetics Adverse effects Pt. Counseling

Aztreonam

(Azactam, Cayston)

Rare cross-allergy to cephs and pens.

Use with caution in renal patients

Available as oral inhalation (Cayston), and IM/IV injection

Dosage: I.V.: 2 g every 6-8 hours; maximum: 8 g/day

Give in combo with levofloxacin or moxifloxacin, or

gatifloxacin, with or without aminoglycoside

Rash, N/V/D,

thrombophlebitis, pain at

injection site

Sepsis- My Drug Chart

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