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Maddy - CPR I - some pharm > Anti-Fungal Pharm > Flashcards

Anti-Fungal Pharm Flashcards

1
Q

MOA amphotericin B

A

forms complex with ergosterol and disrupts plasma membrane permeability (forms pores)

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2
Q

what organisms does amphotericin B fight against

A 
CC(yeasts), HBC(endemic mycoses), AA(pathogenic molds)
- Candida albicans
• Cryptococcus neoformans
• Histoplasma capsulatum 
• Blastomyces dermatitidis 
• Coccidioides immitis
• Aspergillus fumigatus
• Agents of mucormycosis
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3
Q

resistance to amphotericin B

A
  • decreased ergosterol

- modified ergosterol (less affinity for amphotericin B)

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4
Q

when to give IV amphotericin B

A

systemic infections for wide distributions

- fungal meningitis

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5
Q

when to give oral amphotericin B

A

fungi in GI lumen

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6
Q

adverse effects amphotericin B

A
  • fever, chills, muscle spasms, vom, HA, hypotension
  • renal damage
  • anemia
  • seizures
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7
Q

how to prevent adverse effects amphotericin B

A

premedication with corticosteroids, antipyretics, antihistamines, or meperidine

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8
Q

MOA flucytosine

A

flucytosine –> cytosine permease –> FdUMP and FUTP –> FdUMP inhibits DNA synthesis, FUTP inhibits RNA synthesis

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9
Q

what organisms does flucytosine fight against

A
  • C. neoformans
  • some candida
  • dematiaceous molds that cause chromoblastomycosis
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10
Q

resistance to flucytosine

A

altered metabolism of flucytosine

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11
Q

how is flucytosine administered

A 
oral only (in US)
- widely distributes in body including CNS
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12
Q

adverse effects flucytosine

A
  • bone marrow toxicity (anemia, leukopenia, thombocytopenia)

- derangement of liver enzymes

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13
Q

MOA of azoles

A

reduction of ergosterol synthesis by inhibiting fungal CYP450

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14
Q

what organisms do azoles fight against

A

broad spectrum

  • many candida
  • c. neoformans
  • endemic mycoses
  • dermatophytes
  • aspergillus
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15
Q

resistance to azoles

A

upregulation of fungal CYP350

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16
Q

adverse effects azoles

A
  • minor GI symptoms
  • can cause abnormalities in liver enzymes
  • some drug-drug interactions
17
Q

adverse effects ketoconazole

A

greater propensity to inhibit mammalian cytochrome P450 and less selective for fungal P450 enzymes
- rarely used

18
Q

adverse effects of sukassazole

A

somi’s dumb

19
Q

what fungi does itraconazole specifically treat

A
  • dimorphic fungi (histoplasma, blastomyces, sporothrix)
  • aspergillus sp
  • dermatophytes and onchomycosis
20
Q

what is the azole choice for invasive aspergillosis

A

voriconazole

21
Q

benefits of fluconazole

A
  • high oral availability
  • good CSF penetration
  • drug interactions less common
  • lease effect of all azoles on hepatic enzymes
22
Q

azole choice of treatment for secondary prophylaxis of cryptococcal meningitis

A

fluconazole

23
Q

most commonly used tx for mucocutaneous candidiasis

A

fluconazole

24
Q

can fluconazole be used against aspergillosis

A

nope, no activity against it or other filamentous fungi

25
Q

toxicities from voriconazole

A
  • rash
  • elevated hepatic enzymes
  • visual disturbances
  • photosensitivity dermatitis
26
Q

what changes in dose of other drugs need to occur when prescribing voriconazole or posaconazole

A

there needs to be a dose reduction in meds metabolized by CYP3A4 because voriconazole and posaconazole inhibit mammalian CYP3A4
(cyclosporine, tacrolimus, statins)

27
Q

broadest spectrum of all azoles

A

posaconazole

28
Q

only azole with significant activity against mucormycosis

A

posaconazole

29
Q

when is posaconazole used as prophylaxis

A
  • during induction chemotherapy for leukemia

- in allogenic bone marrow transplant pts

30
Q

MOA of echinocandins

A

inhibit synthesis of beta (1-3)-glucan at fungal cell wall by inhibiting glucan synthase

31
Q

spectrum of activity for echinocandins

A
  • candida
  • aspergillus
  • NO coverage C. neoformans or agents of zygomycosis/mucormycosis
32
Q

what fungi does caspofungin (an echinocandin) specifically treat

A
  • disseminated and mucocutaneous candidal infections
  • empiric anti-fungal therapy during febrile neutropenia
  • invasive aspergillosus
33
Q

what fungi does micafungin (an echinocandin) specifically treat

A
  • mucocutaneous candidiasis
  • candidemia
  • prophylaxis of candidal infections in bone marrow transplant pts
34
Q

what fungi does anidulafungin (an echinocandin) specifically treat

A
  • esophageal candidiasis and invasive candidiasis
35
Q

how are each echinocandin administered and what is their half life

A

only parenteral administration (IV)

  • caspofungin: 9-11 hours
  • micafungin: 11-15 hours
  • anidulafungin: 24-48 hours
36
Q

adverse effects echinocandins

A
  • well tolerated

- minor GI stuff

Maddy - CPR I - some pharm (25 decks)

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