42-Antifungals

Question 1

Candidiasis, Aspergillosis, cryptococcus and mucormycosis are all examples of what?

Answer 1

opportunistic systemic mycoses therefore they are typically present in immunocompromised patients

Question 2

Sporotrichosis, blastomycosis, histoplasmosis, coccidoidomycosis are all examples of what?

Answer 2

Non-opportunistic systemic mycoses

Question 3

What are the four classes of systemic fungal treatment?

Answer 3

polyene antibiotics, azoles, echinocandins, and pyrinidine analogues

Question 4

A polyene abx, amphotericin B is typically the drug of choice for what?

Answer 4

most systemic mycoses

Question 5

What is the benefit of amphotericin B lipid formulation over the regular amphotericin B?

Answer 5

limits renal toxicity

Question 6

T/F bladder irrigation using amphotericin B is not associated with renal toxicity.

Answer 6

True, it is basically topical

Question 7

ADRs of amphotericin B?

Answer 7

NEPHROTOXICITY (depends on the dose), infusion reaction, hypokalemia, bone marrow suppression

Question 8

How do you pretreat for infusion reaction of amphotericin B?

Answer 8

Benadryl and APAP

Question 9

To decrease the nephrotoxicity of the poleyene drug - amphotericin B, we give another drug in combination to increase the power of amphoB. In doing so, we can give lower doses of amphoterrible, what drug is this?

Answer 9

Flucytosine

Question 10

This polyene is the DOC for intestinal disease and is used topically for rashes, oral thrush and vaginal candidiasis. It has no systemic absorption

Answer 10

nystatin

Question 11

What polyene can be used in an opthalmic suspension for blepharitis?

Answer 11

natamycin

Question 12

Azoles drugs __________ (induce/inhibit) CYTP450

Answer 12

inhibit

Question 13

Name the ADRs of azoles

Answer 13

Cardiosuppression – negative inotrope
Liver damage
Inhibits CYTP450
N/V/D
Rashes
Needs gastric acid to work-watch H2 blockers

Question 14

This azole is commonly used for fungal infections of the nail and is TID pulse dosing.

Answer 14

itraconazole

Question 15

Is amphotericin B absorbed well in the gut? does it go through the BBB?

Answer 15

nope neither through the gut or the BBB, thats why we give it IV or intrathecally

Question 16

Is fluconazole absorbed well in the gut? does it go through the BBB?

Answer 16

Yes to both and it is eliminated unchanged in the urine. This is why it can be used to treat cryptococcal meningitis

Question 17

What drug can be used to treat cryptococcal meningitis but can cause liver disease and SJS?

Answer 17

fluconazole

Question 18

T/F depending on the dose, fluconazole can be fungistatic or fungicidal.

Answer 18

True! It is also renal adjusted

Question 19

What is the drug of choice for invasive aspergillosis?

Answer 19

voriconazole

Question 20

What azoles most common side effect is visual disturbances?

Answer 20

voriconazole

Question 21

In renal impaired pts, is it okay to give IV voriconazole?

Answer 21

no give PO. The IV solvent can accumulate to toxic levels in renal pts

Question 22

Which drug is used to treat seborrheic dermatitis but can also lower sex hormone levels?

Answer 22

ketoconazole

Question 23

What drug is only approved to treat oral thrush and prevent aspergillus and candida in immunocompromised?

Answer 23

posaconazole

Question 24

How long is the treatment for fingernails/toenails with the drug terbinafine?

Answer 24

fingernails = 6 weeks
toenails = 12 weeks
terbinafine = lamisil, watch the LFTs

Question 25

naftifine is used for what?

Answer 25

tinea pedis, cruris and corporis

Question 26

This drug is used to treat aspergillosis and candida and is better tolerated than AmphoB. It is altered by anything that increases or decreases hepatic metabolism.

Answer 26

Caspofungin

Question 27

This drug is used to treat severe fungal infections (endocarditis, Meningoencephalitis, cryptococcal) and is always used in combination with another drug.

Answer 27

flucytosine

Question 28

ADRs of flucytosine

Answer 28

mild cardiotoxicity, myelotoxicity, and renal damage

Question 29

This drug is used to treat topical fungal infections. It is deposited in the hair, nails and skin and given orally with high fat meal to increase absorption

Answer 29

Griseofulvin

Question 30

Is griseofulvin an inducer or inhibitor?

Answer 30

inducer

Question 31

This anti-fungal can be added to nail polish for topical application

Answer 31

ciclopirox

Question 32

tinea _______________ - body ringworm responds to topical treatment for at least 1 week after rash has cleared

Answer 32

corporis

Question 33

Tinea _________ -athletes foot responds to topical therapy , cotton socks and dry feet

Answer 33

pedis

Question 34

Tinea ___________ - jock itch responds to topical therapy for at least 1 week after symptoms subside

Answer 34

cruris

Question 35

Tinea _________ - scalp is difficult to treat. You need oral therapy. Name 2 drugs you can give.

Answer 35

capitus. 2 drugs = griseofulvin or terbinafine

Question 36

How treat vaginal candidiasis?

Answer 36

fluconazole (diflucan) 150mg

Question 37

How can you treat oral thrush?

Answer 37

clotrimazole troche = oropharyngeal candida

nystatin = non-esophageal candida

Question 38

This drug is used to treat seborrheic dermatitis topically and is rarely used orally due to toxicity

Answer 38

ketoconazole

Question 39

This azole drug when taken orally will elevate warfarin levels so it typically is used topically

Answer 39

miconazole

Question 40

This drug interferes with microtubule function and blocks mitosis, therefore it only affects cells that are actively growing. Hint: standard treatment for tine capitis

Answer 40

griseofulvin

Question 41

Trade name for butenafine

Answer 41

lotrimin ultra

Question 42

Trade name for tolnaftate

Answer 42

Tough acting tinactin