228: Anti-Fungals

Question 1

topical treatment of candida, tinea pedis, tinea cruris…azole.

Answer 1

Imidazole (ketoconazole, miconazole, clotrimazole)

Question 2

Systemic azole active against aspergillus and candida.

Answer 2

Voriconazole.

Side effects include GI disturbance.

Question 3

systemic azole that doesn’t cover aspergillus

Answer 3

fluconazole

penetrates CSF - cryptococcal meningitis

Question 4

azole used for prophylaxis in immunocompromised patients.

Answer 4

itraconazole

Question 5

what do echinocandins do?

Answer 5

beta glucan inhibition (cell wall component)

Question 6

echinocandin active against aspergillus and candida

Answer 6

caspofungin
few side effects ( we dont have beta glucan in our cells)
fungostatic not killing - ineffective in immunocompromised

Question 7

what do allylamines do?

Answer 7

inhibit membrane synthesis ( as do azoles and echinocandins). via inhibitory action on squalene epoxidase.

Question 8

what is terbinafine?

Answer 8

allyamine used to treat nail infection and athletes foot.

Question 9

what do polyenes do?

Answer 9

inhibit membrane function - pore forming so content leak out.

Question 10

polyene firstline for neutropenic patient

Answer 10

amphotericin (e.g. AmBisome, encapsulated and opens when meets fungi)

toxicity warning - infusion reactions, renal impairment.

Question 11

polyene used to treat superficial candidiasis.

Answer 11

Nystatin

oral thrush mouthwash and nappy rash cream.

Question 12

how does flucytosine work?

Answer 12

inhibits nucleic acid synthesis

option for severe invasive infections)

Question 13

how do Azole Antifungals work?

Answer 13

inhibit cytochrome P450 so ergosterol isnt made (like cholesterol in cell membrane)