Anti-Fungal

Question 1

MOA Amphotericin B

Answer 1

Polyene

binds ergosterol forming pore in fungal membrane

Question 2

RES Amphotericin B

Answer 2

decreased membrane ergosterol or reduced affinity

Question 3

PKX Amphotericin B

Answer 3

insoluble (IV administration)

Question 4

AE Amphotericin B

Answer 4

Very toxic

fever, chills, spasms, HTN, nephrotoxicity**

Question 5

Liposomal Amphotericin B

Answer 5

less toxicity due to less interaction with mammalian cell membrane cholesterol

Question 6

Azoles

Answer 6

“AZOLE”
Imidazole - 2 N - KETO, MICO, CLOT + AZOLE
Triazole - 3 N

Question 7

MOA Azole

Answer 7

inhibit ergosterol synthesis

Question 8

RES Azole

Answer 8

efflux pumps
mutation in target enzymes
low ergosterol in membrane

Question 9

AE Azoles

Answer 9

minor interaction with p450

Question 10

Azole with highest therapeutic index

Answer 10

Fluconazole

Question 11

Interactions with Itraconazole

Answer 11

Low pH for absorption
Absorption blocked by antacids, PPI, H2 blockers
Interacts with hepatic enzymes

Question 12

AE Voriconazole

Answer 12

visual disturbances, hallucinations, rash

Question 13

Broadest spectrum Azole

Answer 13

Posaconazole

Question 14

Topical Azole

Answer 14

Efinaconazole

Question 15

MOA Flucytosine

Answer 15

transported into fungal cell

Incorporated into DNA/RNA to inhibit synthesis

Question 16

RES Flucytosine

Answer 16

altered metabolism

Question 17

AE Flutocytosine

Answer 17

bone marrow toxicity - anemia, leukopenia, thrombocytopenia

Question 18

MOA Echinocandins

Answer 18

“FUNGIN”
inhibit fungal cell wall synthesis
Inhibit B-glucan
High selective toxicity - $$

Question 19

MOA Allylamines

Answer 19

Inhibit ergosterol synthesis
Terbinafine (topical/oral)
Naftifine (topical)

Question 20

MOA Nystatin

Answer 20

similar MOA of Amphotericin B

Binds to cell wall and creates pores

Question 21

Drug of choice for Aspergillosis

Answer 21

Voriconazole

Question 22

Drug of choice for mild/moderate Blastomycosis

Answer 22

Itraconazole

Question 23

Drug of choice for severe Blastomycosis

Answer 23

Amphotericin followed by Itraconazole

Question 24

Drug of choice for vaginal Candidiasis

Answer 24

Azole (topical) or
Nystatin or
Fluconazole (oral)

Question 25

Drug of choice for oropharyngeal Candidiasis

Answer 25

Clotrimazole or Miconazole Nystatin (oral) Fluconazole

Question 26

Drug of choice for esophageal Candidiasis

Answer 26

Fluconazole

Question 27

Drug of choice for invasive Candidiasis

Answer 27

Fluconazole or | Echinocandin

Question 28

Drug of choice for Coccidioidomycosis

Answer 28

Fluconazole or | Itraconazole

Question 29

Drug of choice for Cryptococcosis

Answer 29

Amphotericin B + flucytosine followed by fluconazole

Question 30

Drug of choice for HIV pts with Cryptococcosis

Answer 30

Fluconazole

Question 31

Drug of choice for Histoplasmosis

Answer 31

Amphotericin + Itraconazole

Question 32

Drug of choice for HIV pts with Histoplasmosis

Answer 32

Itraconazole

Question 33

Drug of choice for Mucormycosis

Answer 33

Amphotericin B

Question 34

Drug of choice for cutaneous Sporotrichosis

Answer 34

Itraconazole

Question 35

Drug of choice for extracutaneous Sporotrichoisis

Answer 35

Amphotericin followed by Itraconazole

Question 36

Drug of choice for Dermatomycosis

Answer 36

Topical azole or | Topical terbinafine

Question 37

Drug of choice for onychomycosis

Answer 37

Oral terbinafine or Oral itraconazole or Topical efinaconazole