Sketchy Pharm: Amphotericin, Flucytosine Flashcards

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1
Q

Recall that fungal membranes are composed of _______________ instead of cholesterol.

A

ergosterol

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2
Q

How does amphotericin work?

A

It binds ergosterol and forms pores in the fungal cell membrane.

(Think of the holes in the amphibian tank that are letting the water out.)

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3
Q

How can fungi develop resistance to amphotericin?

A

They can down-regulate ergosterol in the membrane. Without ergosterol, amphotericin is not able to penetrate the cell membrane.

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4
Q

How is amphotericin administered?

A

Intravenously (like the ivy on the frog’s cage)

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5
Q

Typically, amphotericin is only used for _______________.

A

systemic, life-threatening infections (represented by the anatomical body system model next to the frog’s cage)

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6
Q

How have drug developers packaged amphotericin so that it’s less toxic?

A

They make liposomal fat formulations that slow the delivery of the drug into the system and limit binding to human cholesterol.

(Think of the large frog chin representing a swollen liposome.)

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7
Q

What are the infusion-related toxicities?

A
  • Hypotension (teacher fainting)
  • Headache (teacher grabbing his head)
  • Fever (frog sweating next to bunsen burner)

Note: the teacher is doing this in response to the frog suddenly jumping on him, which represents the infusion reaction.

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8
Q

For CNS infections, amphotericin is administered ___________________.

A

intrathecally (like the frog’s tongue directly on the model’s brain)

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9
Q

________________ can occur at the injection site.

A

Thrombophlebitis (like the blue veins swollen on the frogs)

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10
Q

Intrathecal administration can cause ____________.

A

seizures (like the shaking seizure lines around the model)

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11
Q

_________________ occurs in almost all patients receiving amphotericin.

A

Irreversible renal damage (often type 1 acidosis)

Think of the chemist holding the yellow fluid in the tube shaped like a 1.

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12
Q

What electrolyte abnormalities are seen in amphotericin renal toxicity?

A

Hypokalemia from the renal tubular acidosis (think of the chemist slipping on the banana peel) and hypomagnesemia (like the magnets falling into the sink

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13
Q

To counteract the renal effects of amphotericin, ____________ is often administered during or before amphotericin.

A

saline (like the emergency saline shower)

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14
Q

How does amphotericin cause anemia?

A

From kidney damage leading to decreased EPO production (like the broken kidney-shaped jar that’s spilling blood)

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15
Q

Amphotericin is often used with ______________ to treat Cryptococcal meningitis.

A

flucytosine (like the flute player across the hall)

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16
Q

How does flucytosine work?

A

It gets converted to 5-fluorouracil in the cell. 5FU then inhibits fungal DNA and RNA synthesis.

(Think of the sheet music with F and C getting turned over so it looks like F and U. Next, the frog has smeared the helical chalk design just above the sheet music)

17
Q

Flucytosine and amphotericin are used to treat ________________.

A

Cryptococcal meningitis (like the crypt design on the chalkboard)

18
Q

_______________ has the same mechanism of action as amphotericin.

A

Nystatin

Think of the sign saying “Be NYce to lab animals” with the frog emblem.

19
Q

Nystatin is often used for ________________.

A

vaginal candidiasis and oropharyngeal candidiasis (like the Canadian flag above the girl getting hit in the crouch with the snowball and the water fountain – which represents the oral nystatin rinse done to treat oral candidiasis)