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CMBM E3 CB > Anti-Fungals > Flashcards

Anti-Fungals Flashcards

1
Q

What cellular structure do Echinocandins target?

A

Cell wall: glucan synthesis

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2
Q

What cellular structure do Polyenes and Azoles target?

A

Cell membrane: ergosterol synthesis

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3
Q

What cellular structure do Flucytosines target?

A

DNA/RNA synthesis: pyrimidine analogues

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4
Q

What is the mechanism of action of polyenes?

A

Bind directly to ergosterol

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5
Q

What are the polyenes?

A

Amp-B

Nystatin

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6
Q

How would you treat cryptococcal meningitis?

A
  1. Amp-B w/ Flucytosine

2. Fluconazole

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7
Q

Which azole crosses the BBB?

A

Fluconazole

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8
Q

What is the mechanism of action of Allylamines?

A

Inhibit fungal squalene epoxidase –> cannot convert squalene to lanosterol
Interfere with ergosterol synthesis

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9
Q

What is ergosterol?

A

Sterol that is part of the fungal bilayered cell membrane

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10
Q

What are fungal cell walls comprised of?

A

90% chitin, GLUCAN, mannan

10% proteins, glycoproteins

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11
Q

What do anti-fungals target?

A

Proteins
Nucleus
Cell wall, especially glucan
Cell membrane, especially ergosterol

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12
Q

Effective anti-fungals typically have a _____, which leads to ______.

A

High therapeutic index / many adverse side effects

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13
Q

What was the first anti-fungal and when was it approved?

A

Nystatin – 1954

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14
Q

What class of anti-fungals is Terbinafine?

A

Allylamine (targets squalene epoxidase)

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15
Q

What is the mechanism of action of Azoles?

A

Bind to and inhibit cytochrome p450 and 14-alpha demethylase –> cannot convert lanosterol to ergosterol

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16
Q

What class of anti-fungals is Flucytosine?

A

Antimetabolite (pyrimidine analogue)

17
Q

What are side effects of Amp-B?

A

Chronic: Dose-dependent severe nephrotoxicity (decrease in GFR); may require dialysis
Acute: chills, fever, vomiting

18
Q

What OTC drug can you NOT take with azoles?

A

Antacids. Azoles are weak acids, therefore an antacid would inhibit them.

19
Q

What are the imidazoles?

A

Ketoconazole

Miconazole

20
Q

What are the triazoles?

A

Itraconazole
Fluconazole

**these drugs are newer and less toxic

21
Q

Broad spectrum
PO administration
Mostly replaced by Fluconazole

A

Ketoconazole

22
Q

Side effects of Ketoconazole

A

Gynecomastia

Hepatic failure

23
Q

Topical and vaginal suppositories

Dermatophytes

A

Miconazole

24
Q

Topical and vaginal suppositories

A

Clotrimazole

25
Q

Oral, esophageal, and vaginal candidiasis
Used for Cryptococcal meningitis (after initial treatment with Amp-B and Flucytosine)
Oral and IV

A

Fluconazole

**only azole to cross BBB

26
Q

Broad spectrum including tinea unguium
Indicated for systemic fungal infections
Also for oral and esophageal candidiasis

A

Itraconazole

27
Q

Oral and IV introduced in 2002
High bioavailability
Indicated for invasive Aspergillosis

A

Voriconazole

28
Q

How would you treat superficial fungal infections?

A

Terbinafine

29
Q

What is Flucytosine used for?

A

Systemic Candida and Cryptococcus neoformans infections

30
Q

What is Flucytosine not effective against?

A

Aspergillus

31
Q

What is the mechanism of action of the Echinocandins?

A

Inhibit 1,3-beta-glucan synthase

Cell wall synthesis inhibitor

32
Q

What class of anti-fungal is Caspofungin?

A

Echinocandin

33
Q

What is Caspofungin used for?

A

Invasive Amp-B resistant Aspergillosis
Esophageal Candidiasis
Pneumocystis pneumonia

34
Q

How would you treat Coccidioides immitis?

A
  1. Flucytosine
  2. Fluconazole, Ketoconazole, Itraconazole
  3. Amp-B
35
Q

How would you treat Pneumocystis jiroveci?

A

TMP/SMX

36
Q

How would you treat Mucor/Rhizopus?

A

Amphotericin B

**this infection has a 50% mortality rate even with early diagnosis

CMBM E3 CB (12 decks)

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