Anti-fungals

Question 1

Name 4 class effects of the Azoles.

Answer 1

CYP interactions, QTc prolongation, hepatotoxicity, bone marrow suppresion

Question 2

Flucanazole (Diflucan) is active against….(3)

Answer 2

candida (NOT krusei, glabrata),
cryptococcus
coccidio

Question 3

Flucanazole can interact with what 3 drugs?

Answer 3

warfarin - increase INR
phenytoin - increase drug levels
OCP - decrease effectiveness

Question 4

What is the oral bioavailability for flucanazole?

Answer 4

excellent - 90%

Question 5

How is flucanazole eliminated?

Answer 5

renally

Question 6

Itraconazole is more/less effective than Flucanazole against fungi, primarily ___________.

Answer 6

more

aspergillus

Question 7

Itraconazole maintains activity against….(5)

Answer 7

candida, cryptococcus
Histoplasmosis
Blastomyces
aspergillus

Question 8

Which azole requires gastric acidity for absorption and thus shouldn’t be taken with PPIs, antacids, H2RBs..

Answer 8

Itraconazole

Question 9

How does administration differ between a solution and capsule of itraconazole?

Answer 9

Solution - empty stomach

Capsule - with food, OJ, cola (Mushroom Caps)

Question 10

Voriconazole is active against …(6)

Answer 10

Candida, cryptococcus
histo
blasto
aspergillus….AND….MOLDS

Question 11

AEs of voriconazole (4)

Answer 11

Visual disturbances
hallucinations
rash
photosensitivity

Question 12

What is 1st line for aspergillus? Why?

Answer 12

Voriconazole

It covers it and it has good CNS penetration.

Question 13

T or F. Voriconazole should be taken with food.

Answer 13

False - empty stomach

Question 14

IV voriconazole has been known to cause damage to what organ?

Answer 14

kidneys – related to cyclodextrin accumulation

Question 15

Most anti-fungals are _________ eliminated.

Answer 15

hepatically — they cause hepatotoxicity.

Question 16

Posaconazole covers the same fungi as ______________.

Answer 16

Voriconazole

Question 17

Name a bad thing about having to take the suspension of posaconazole.

Answer 17

It requires a high fat meal for maximal absorption QID.

Question 18

A patient is diagnosed with a mucor infection. What are your two options?

Answer 18

Posaconazole

Amphotercin B

Question 19

Which azole is broad spectrum and low side effects, but is very expensive.

Answer 19

Posaconazole

Question 20

T or F. Polyenes have a wide spectrum of activity.

Answer 20

T

Question 21

T or F. Amphotericin B is available PO.

Answer 21

F - no oral formulation

Question 22

AEs of polyenes/Amphoterricin:

Answer 22

Lyte wasting (K, Mg)
Influsion rxns - fever, chills, rigors, hypotension
Acute renal failure
Anemia

Question 23

Does Amphotericin B cause renal or hepatotoxicity.

Answer 23

Renal toxicity

Question 24

Which anti-fungal requires pre-medications?

Answer 24

Amphotericin - APAP, diphenhydramine, prednisone, meperidine

Question 25

T or F. Amphotericin is good for CNS infections.

Answer 25

T

Question 26

Name the 4 types of Ampotericin.

Answer 26

Conventional cholesterol sulfate complex lipid complex liposomal

Question 27

Nystatin is another example of a ________ and is employed for _________ use.

Answer 27

``` Polyene Topical use (oral/vaginal candidiasis...) ```

Question 28

Echinocandids are active against what 2 fungi?

Answer 28

candida and aspergillus

Question 29

T or F. Echinocandids are administered orally and parentally.

Answer 29

F - only parenterally

Question 30

T or F. Echinocandids are known for having various side effects.

Answer 30

F - relatively benign SE profile and few drug interactions.

Question 31

T or F. Echinocandids are cheap.

Answer 31

F - expensive

Question 32

Name 3 echinocandids and put them in order of most drug interactions to least drug interactions.

Answer 32

Caspofungin > Mica > Anidula

Question 33

Fluocytosine has high/low CSF penetration, meaning it should/not be used for meningitis.

Answer 33

high | should

Question 34

T or F. You should dose adjust Fluocytosine in those with hepatic failure.

Answer 34

F - renal failure

Question 35

T or F. Fluocytosine should not be used with other anti-fungals.

Answer 35

F- rarely used as monotherapy because resistance develops quickly

Question 36

Fluocytosine has what AE that is related to its MOA?

Answer 36

bone marrow toxicity (it kills our cells)

Question 37

Which anti-fungal is a prodrug? What is the active form?

Answer 37

Fluocytosine | Flurouracil - 5FC

Question 38

What may happen when normal flora convert Fluocytosine to 5FC in the gut?

Answer 38

GI upset

Question 39

Fluocytosine is often combined with what other anti-fungal to treat what infection?

Answer 39

Ampho B | Cryptococcus meningitis

Question 40

A patient has athlete's foot (dermatophytoses). What is the best Tx? How is it available?

Answer 40

Terbinafine (Lamisil) | OTC - PO, gel, cream, lotion

Question 41

A patient with renal or hepatic dysfunction has ring worm. Is it okay to give them Lamasil?

Answer 41

No, avoid it if possible.

Question 42

Oral Terbinafine has been known to cause what AE?

Answer 42

taste disturbance

Question 43

What two antifungals are renally eliminated?

Answer 43

Fluocytozine | Fluconazole