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Clinical Pharmacology Exam 3 > Anti-Fungal > Flashcards

Anti-Fungal Flashcards

1
Q

What are the common primary care fungi?

Which two are resistant to fluconazole?

A

C. albicans

resistant:
- C. krusei
- C. glabrata

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2
Q

Who gets griseofulvin and why?

A

Peds - tinea capitis

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3
Q

What is the main echinocandin? What’s the MOA?

A

Micafungin

MOA: cell wall
- inhibit synthesis of b-D-glucan

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4
Q

Echinocandins are not excreted in urine. What should you not use these meds for?

A

UTI

  • active drug is broken down before getting to kidneys
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5
Q

What are echinocandins indicated for?

A

“deep seeded systemic blood stream infections and abscesses”

  • invasive candida infection (including most non-albicans Candida)
  • Aspergillus infections
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6
Q

What are the three classes that work on the cell membrane?

A
  1. Polyenes
  2. Azoles
  3. Allylamines
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7
Q

What is the go-to Polyene to be aware of?

A

Liposomal amphotericin B (IV)

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8
Q

Nystatin is a topical polyene used for these two things?

A
  1. OP candidiasis

2. “Intertrigo”

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9
Q

What is the MOA of amphotericin B?

A

Binds ergosterol –> alters CELL MEMBRANE permeability –> leakage of cell components and death

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10
Q

How is amphotericin B excreted from the body?

A

Preceptor trick Q!!

No one knows!!

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11
Q

What are the drug interactions of amphotericin B?

A

Drug interaction: nephrotoxic drugs**

Monocytes/macrophages are stimulated and release proinflammatory cytokines = F/C/rigors during infusion

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12
Q

There are plenty of jibberish clinical indications for amphotericin B. What’s the bolded one?

A

Aspergillosis

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13
Q

Ampho B common ADRs?

A
  • F/C/rigors (common)
  • HA, NV, dec BP, tachypnea

Occur 1-3hr into infusion and last 1hr

Pre hydrate + slow infusion to minimize these ADRs

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14
Q

Ampho B dose-limiting ADRs?

A

Most concerned about electrolyte abnormalities (DEC K & Mg)

Monitor SCr - nephrotoxicity

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15
Q

Azoles can be used topically for what 3 “areas”? Name the bolded drug for each as well.

A

Oral - clotrimazole

Skin - clotrimazole

Vaginal - clotrimazole, miconazole

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16
Q

What are the 3 “old” systemic azoles?

A
  1. Ketoconazole
  2. Fluconazole
  3. Itraconazole

“New” systemic azoles - essentially supercharged fluconazole and will be “distractors” on the exam

17
Q

Ketoconazole is rarely used systemically, except for what condition?

A

Metastatic prostate cancer

18
Q

Itraconazole has minimal use except for which two fungi?

A

Histoplasmosis

Blastomycosis

19
Q

What is the azole MOA?

A

CELL MEMBRANE

Inhibits fungal CYP450 which converts lanosterol –> ergosterol

No ergosterol = damaged cell wall, increased permeability, cell lysis

20
Q

Tell me about fluconazole CYP?

A

Strong inhibitor of 2C9, 2C19, 3A4

21
Q

What are 3 other pearls about the pharmacology of azoles (fluconazole)?

A
  1. Renal excretion (80% as unchanged drug)
    - only antifungal that develops appropriate active urinary concentration**
  2. > 90% bioavailability
  3. 30hr half life - single dose will be in your system for a week
22
Q

Due to CYP interactions, what is one medication Paxton specified to have careful monitoring of if the patient is on fluconazole? (2C9)

A

Warfarin

23
Q

What are fluconazole clinical indications?

A

Candida infections: thrush, vaginitis, cutaneous, “invasive”

24
Q

Fluconazole ADRs?

A

Fairly well-tolerated

Teratogen

High dose - start getting concerned about QT prolongation

25
Q

What should you use in a pregnant patient for vaginal candidiasis? What should you avoid?

A

Use: vaginal azoles (e.g. clotrimazole) - 1st line**

Avoid: Fluconazole (teratogen)

  • do not use for vaginitis
  • do not use in women TRYING to become pregnant, either**
26
Q

What is the allylamine to know? What’s the MOA?

A

Terbinafine

MOA: CELL MEMBRANE
- inhibits ergosterol synthesis earlier in the pathway (similar concept as ACL inhibitor)

(inhibits squalene epoxidate which prevents ergosterol synthesis)

27
Q

What two things should you be aware of regarding terbinafine and pharmacology?

A
  1. Strong 2D6 inhibitor

2. Concentrates in skin and nail beds and has relatively low bloodstream concentration

28
Q

What are the two common clinical indications for allylamines (terbinafine)?

A
  1. Cutaneous dermatophyte infections (topical)

2. Onychomycosis (PO)

29
Q

What are the main ADRs for allylamines (terbinafine)?

A
  1. Dysgeusia (like metformin, etc, etc)
  2. HTX - get baseline LFTs. If normal, you don’t really need to monitor
    - more concern for older person with liver disease

Clinical Pharmacology Exam 3 (19 decks)

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