[2] Anti-Fungals

Question 1

[Mechanism of Action]

Polyene Antifungal Drugs

Answer 1

Cell membrane destruction via disruption of osmotic gradient

Question 2

[Mechanism of Action]

Azoles

Answer 2

Cell membrane destruction via interruption of ergosterol synthesis

Question 3

Polyenes are products of?

Answer 3

Streptomyces

Question 4

Gold standard and has the broadest spectrum for yeasts

Answer 4

Amphotericin B

Question 5

Effect of hepatic or renal impairment on Amphotericin B metabolism

Answer 5

Little to no impact, no dose adjustment is required

Question 6

[Route of Administration]

Amphotericin B

Answer 6

IV

Intrathecally

Question 7

Most significant adverse reaction to Amphotericin B

Answer 7

Renal damage, specifically K+ bicarbonate wasting that can lead to hypokalemia

Question 8

First successful antifungal antibiotic to be developed

Answer 8

Nystatin

Question 9

Nystatin is an effective broad-spectrum antifungal drug but because of its toxicity it is limited to this kind of use

Answer 9

Topical

Question 10

Are Azoles fungistatic or fungicidal?

Answer 10

Fungistatic

Question 11

Classification of Azoles

Answer 11

Imidazoles (2)

Triazoles (3)

Question 12

Examples of Imidazoles

Answer 12

Ketoconazole
Miconazole
Clotrimazole

Question 13

Examples of Triazoles

Answer 13

Itraconazole
Fluconazole
Voriconazole

Question 14

What specifically do Azoles inhibit during ergosterol synthesis

Answer 14

Inhibits 14-a-demythylase from lanosterol

Question 15

This classification of azoles has a lower specificity as compared to the other class which results to greater numbers of drug interactions and side effects

Answer 15

Imidazoles

Question 16

What class of drug does Ketoconazole fall under?

Answer 16

Imidazole

Azoles

Question 17

What class of drug does Fluconazole fall under

Answer 17

Triazole

Azoles

Question 18

This drug is the standard for azoles, replacing Amphotericin B for managing certain forms of systemic mycoses

Answer 18

Fluconazole

Question 19

[Route of Administration]

Fluconazole

Answer 19

Oral

Question 20

Fluconazole is a 2nd line drug for? Why?

Answer 20

Cryptococcal meningitis

This is because it is able to attain a high level of CSF concentration

Question 21

This specific azole has the least adverse effects or number of drug interactions

Answer 21

Fluconazole

Question 22

These fungi are resistant to Fluconazole

Answer 22

Candida glabrata

Candida krusei

Question 23

Fluconazole is most commonly used to treat

Answer 23

Mucocutaneous candidiasis

Question 24

What class of drug does Itraconazole fall under

Answer 24

Triazole

Azoles

Question 25

Itraconazole is the azole of choice for treatment of?

Answer 25

Dimorphic fungi: Histoplasma Blastomyces Sporothrix

Question 26

Azole of choice for aspergillosis

Answer 26

Voriconazole

Question 27

Adverse effect associated with intake of Voriconazole

Answer 27

Visual Disturbances

Question 28

[Mechanism of Action] Flucytosine

Answer 28

Converted to 5-fluorouracil -> 5 -fluorodeoxyuridine monophosphate FdUMP and fluorouridine triphosphate FUTP which inhibits DNA and RNA synthesis respectively FdUMP -> DNA FUTP -> RNA

Question 29

What is the interaction of Flucytosine with Amphotericin B

Answer 29

Synergy, may be related to enhanced penetration through damaged fungal cell membranes

Question 30

Most common adverse effect of Flucytosine

Answer 30

Bone marrow toxicity with anemia, leukopenia, and thrombocytopenia

Question 31

[Mechanism of Action] Echinocandins

Answer 31

Inhibit beta (1-3) glucan synthase, disrupting fungal cell wall and causing cell death

Question 32

Drug used for empirical therapy of presumed fungal infections in febrile and neutropenic adult patients

Answer 32

Echinocandins

Question 33

Griseofulvin is used only for?

Answer 33

Systemic treatment of dermatophytosis

Question 34

Drug of choice for Onychomycosis

Answer 34

Terbinafine

Question 35

What class of drug does Terbinafine fall under

Answer 35

Allylamine

Question 36

Clinical use for Terbinafine

Answer 36

Taken orally for dermatophytes

Question 37

Griseofulvin and Terbinafine are both used as keratophilic medication, what makes them different?

Answer 37

Terbinafine is a fungicide

Question 38

Nystatin is commonly used to treat this

Answer 38

Vaginal Candidiasis

Question 39

What classes of antifungals are Fungicidal?

Answer 39

Polyene | Terbinafine

Question 40

What classes of antifungals are Fungistatic?

Answer 40

Azoles Flucytosine Griseofulvin

Question 41

What antifungals can penetrate the CNS?

Answer 41

Fluconazole | Flucytosine