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Pulmonology > Anti-Fungals > Flashcards

Anti-Fungals Flashcards

1
Q

What is the MOA of Polyenes? (Amphotericin B)

A

Insert into yeast membrane, bind to ergosterol and create pores-> disruption of membrane integrity

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2
Q

What are the side effects of Amphotericin B at infusion?

A

Fever, chills, anemia, and hypotension

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3
Q

What is the late onset side effect associated with Amphotericin B?

A

Nephrotoxicity, and aggravates nephrotoxicity of other meds (i.e. ahminoglycosides, HIV drugs)
Damage to distal tubule leads to Na/K/Mg wanting, hypokalemia, and compensatory GFR decrease

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4
Q

What is the drug of choice for Mucormycosis?

A

Amphotericin B

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5
Q

What is the drug of choice for Cryptococcal meningitis?

A

Amphotericin B WITH 5-Fluorocytosine

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6
Q

What is the MOA of Imidazoles/Trizoles?

A

Inhibit 14a-demethylase (yeast CYP450) and prevent conversion of lanosterol-> ergosterol. Ergosterol deficit disrupts cell membrane integrity.

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7
Q

What is the clinical use of Fluconazole?

A 
Narrow spectrum- active against Candida and Cryptococcus
Renal clearance (75%)- good for Candida kidney infections
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8
Q

What is the mechanism of resistance to Azoles?

A

Overexpression or mutation of lanosterol-14a-demethylase

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9
Q

What is the MOA of Echinocandins?

A

Inhibit B-(1,3)-glucan biosynthesis-> osmotic fragility

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10
Q

What are the therapeutic indications for Echinocandins?

A

Serious opportunistic infections, especially if refractory to other therapies: Candida and Aspergillus only

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11
Q

What are the Echinocandins?

A

Caspifungin, Micafungin, Anidulafungin (all IV)

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12
Q

What is the drug of choice for Histoplasmosis?

A

Itraconazole

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13
Q

What is the drug of choice for Blastomycosis?

A

Itraconizole

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14
Q

What clinical use does Itraconazole have?

A

DOC for Histo and Blasto, also treats Coccidiodes and Candida (Broad spectrum)

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15
Q

What is the drug of choice for Aspergillosis?

A

Voriconazole

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16
Q

What does Itraconazole need to be absorbed?

A

Needs gastric acidity to dissolve

Antacids, PPI’s, H2 antagonists impair absorption

17
Q

What Azoles are CYP450 inhibitors that enhance renal toxicity?

A

Voriconazole and Itraconazole

18
Q

What drug class should be avoided in pregnancy?

A

All trizoles

Pulmonology (4 decks)

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