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Pulmonology > 08.20 - Tx of Fungal Lung Infection (Sweatman) - Questions > Flashcards

08.20 - Tx of Fungal Lung Infection (Sweatman) - Questions Flashcards

1
Q

General MOA of Fluorocytosine

A

Nucleic Acid Synthesis inhibitor

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1
Q

Most common topical azoles

A

Clotrimazole, Miconazole

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2
Q

Griseofulvin is used to treat

A

Dermatophytosis

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3
Q

Summary of Ketoconazole

A

Discouraged - Hepatic, Renal, CYP

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3
Q

GI Toxicity

A

Itraconazole, Posaconazole, 5-FC

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4
Q

Photopsia Toxicity

A

Voriconazole

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4
Q

General MOA of Griseofulvin

A

Mitotic Spindle inhibitor

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5
Q

Important enzyme that azoles work through?

A

CYP450

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5
Q

Neither Amph B nor Flucytosine undergoes ___ metabolism

A

Hepatic

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6
Q

Most azoles are eliminated via the __ route, except ___

A

Hepatic, Fluconazole.

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7
Q

Clinical use of Caspofungin

A

IV - Aspergillus, Candida

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8
Q

General MOA of Amphotericin B

A

Punches hole through cell membrane (binds to ergosterol)

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8
Q

Other drug classes beside azoles with concerns over hepatic metabolism

A

None, maybe Griseofulvin

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8
Q

Which azoles have higest side effect incidence?

A

Itraconazole, Posaconazole

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8
Q

Pro-arrhythmogenic Azoles

A

Fluconazole, Posaconazole, Voriconazole

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9
Q

Adverse Effects of Amph B

A

Infusion-related rxns; Renal Toxicity (anemia)

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9
Q

With the excepton of Fluconazone, azoles are eliminated via what route

A

Hepatic

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10
Q

2 adverse toxicities of Ketaconazole

A

Hepatic, Adrenal

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10
Q

Fungal infection causing caseating granuloma

A

Histo

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11
Q

Summary of Posaconazole

A

Oral, CYP interactions, Mucormycoses

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12
Q

Infusion-related rxns; Renal Toxicity (anemia)

A

Amph B

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13
Q

Most significant aspect of Griseofulvin

A

Drug-drug interactions

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14
Q

How is Amph B administered

A

IV

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15
Q

Terbinafine Summary

A

No CYP, Well tolerated

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17
Q

80% of patients receiving oral Amph B experience

A

Renal Damage

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18
Q

Most common use for Nystatin

A

Topical only - Candidiasis

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19
Q

Infusion reactions

A

Amph B, Echinocandins

21
Q

First line therapy for most fungal species involves

A

Azole or Amphotericin B

23
Q

For which condition is Itraconazole the only first line suggested

A

Mild Blasto

24
Q

Tx for Mild Cocci? Severe?

A

Voriconazole; Amph B + Itra

25
Q

Fungal spheres containing endospores found in granulomas

26
Q

Adverse Effects of Caspofungin

A

Tolerated well (GI maybe)

27
Q

2 Azoles to avoid in pregnancy

A

Fluconazole, Voriconazole

28
Q

For which condition is Amphotericin B the only first line suggestion

A

Mucormycosis

30
Q

When should Ketoconazole be used

A

Only as necessary alternative for endemic mycoses

31
Q

General MOA of Caspofungin

A

Inhibitor of Beta-1-3-Glucan

33
Q

Inhibitor of Beta-1-3-Glucan

A

General MOA of Caspofungin

35
Q

Comparable drug to Amph B

36
Q

Mild vs Severe Blasto

A

Add Amphotericin B to Itraconazole for Severe

37
Q

Summary of Fluconazole

A

Good availability - oral and CSF; Best tolerance

38
Q

Azoles produce what type of adverse effects? Which members are worst?

A

GI - Itraconazole, Posaconazole

38
Q

Ketaconazole is the only azole that causes ___

A

Adrenal insufficiency

38
Q

Tx for Basto

A

Fluconazole or Amph B if severe

39
Q

Summary of Itraconazole

A

Poor penetration of CSF; New formulations overcome poor oral bioavailability

39
Q

Mech of Resistance for Caspofungin

A

Altered Glucan Synthetase

40
Q

Azole with highest CYP interaction

A

Voriconazole

41
Q

Neurologic, Cutaneous, and Visual Adverse Effects

A

Voriconazole

43
Q

Only azole with activity against mucormycosis

A

Posaconazole

45
Q

3 notable adverse effects of voriconazole

A

Photosensitivity Dermatitis, Visual Disturbances, Hallucinations

46
Q

IV - Aspergillus, Candida

A

Clinical use of Caspofungin

47
Q

Summary of Voriconazole

A

Good oral; CYP3A4 inhibitor

48
Q

Tx for Mild Histo? Severe?

A

Voriconazole; Amph B + Itra

49
Q

Tx for CNS Crypto

A

Amph B + Flucytosine

50
Q

Blocks conversion of squalene to squalene epoxide

A

Terbinafine

52
Q

Which azoles penetrate CSF well

A

Fluconazole, Voriconazole

54
Q

Azoles that poorly penetrate into CSF

A

Ketoconazole, Itraconazole

55
Q

Indication for Flucytosine

A

Cryptococcus

56
Q

Drugs classes with concern about drug-induced effects on hepatic metabolism

A

Azoles def, Griseolfulvin maybe

57
Q

General MOA for Echocandins

A

Fungins: Inhibit Beta-1-3-Glucan Synthesis (cell membrane)

59
Q

Rash Toxicity

A

All antifungals

61
Q

General MOA of Terbinafine

A

Ergosterol synthesis inhibitor (Squalene to Squalene Epoxide)

62
Q

Amph B Summary

A

Poor solubility, Nephrotoxic

63
Q

CNS Toxicity

A

Voriconazole

64
Q

Toxicity of Flucytosine

A

Obvious: Anemia, Leukopenia, Thrombocytopenia

65
Q

Administration of Nystatin

A

Topical only - Candidiasis

66
Q

1st line tx for Aspergillus

A

Voriconazole

67
Q

Renal Toxicity

Pulmonology (31 decks)

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