Anti-fungal 🪱

Question 1

Risk Factors for fungal infections

Answer 1

1. Acute leukaemia
2. Neutropenia
3. Immunosuppression
4. Glucocorticoids
5. Mucositis
6. Broad spectrum antibiotic use

Question 2

Symptoms of fungal infections

Answer 2

• fever and chills
• bloody cough
• Shortness of breath
• chest or joint pain
• headaches, eye symptoms
• skin lesions

Question 3

3 classes of anti fungal

Answer 3

1. Azole
2. Echinocandin
3. 5 FU

Question 4

Why loading doses?

Answer 4

Don’t delay treatment increases mortality

Question 5

Which antifungals don’t need loading doses?

Answer 5

All need EXCEPT

micafungin
Amphotericin B
Flucytosine

Question 6

Which antifungals metabolise HEPATICALLY

Answer 6

ITRACONAZOLE
VORICONAZOLE
CASPOFUNGIN

Question 7

Table of antifungal drugs

Question 8

Voriconazole

DRUG DRUG INTERACTIONS

Answer 8

CYP2A4, 2C19, 2C9

> 2C19*17 = ULTRA RAPID

> Inflammation affects performance of CYP450

Question 9

Voriconazole

SIDE EFFECTS

Answer 9

Hepatotoxicity > metabolised in liver

= any mild liver dysfunction = reduced metabolism, long t 1/2 and toxic concentrations.

Question 10

Echinocandins

Name 3

Answer 10

Caspofungin
Anidulafungin
Micafungin

Question 11

Echinocandins

Use

Answer 11

For
Invasive candida infections

Only iv admin

Or use combo if suspect resistance
Azole + echinocandins

Question 12

Moa of

AMPHOTERCIN B

Answer 12

Binds to ergosterol in the cell membrane of fungi, disrupting thr integrity of the membrane.

Question 13

AMPHOTERCIN B
Selectivity of ergosterol over cholesterol

Answer 13

Selectivity for binding to ergosterol over cholesterol is low so also toxic to mammalian cells

Question 14

AZOLE

MOA

Answer 14

Interferes with steroid synthesis

Question 15

AZOLE

RESISTANCE

Answer 15

Active effluxion of adolescents

Over expression of the ERG11 gene = Decreases affinity for azoles

Question 16

Interactions with AZOLES

Answer 16

Azoles inhibit CYP450 activity and are both substrate and Inhibitors of CYP3A4