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PR3124 > Anti-fungals > Flashcards

Anti-fungals Flashcards

1
Q

Amp B - Class

A

Polyene

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2
Q

Amp B - MOA

A

Ergosterol -> pores -> electrolytes leak -> cell membrane

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3
Q

Amp B - Spectra

A

Cryptococcus
Candidiasis
Histoplasmosis
Asperigillus

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4
Q

Amp B - Formulation

A 
Formulation:
Na deoxycholate (conventional)
Aritifical lipids (liposomes)
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5
Q

Amp B - Liposomes

A

Reduced renal toxicity
Increased CSF penetration
Costly

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6
Q

Amp B - PK

A

Poor CSF penetration

Renal dysfx - dose adjustment

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7
Q

Amp B - SE

A

Fevers, chills, thrombophlebitis - slow infusion
Nephrotoxicity - CI in renal impairment
Ototoxicity
HypoTN - may require K supplement

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8
Q

5-FC - Class

A

Fluorinated pyrimidine analogue

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9
Q

5-FC - MOA

A

Cytosine permease -> Cytosine deaminase -> 5-FU ->

1) FUTP -> Uridylic acid -> Protein synthesis
2) FdUMP -> Thymidylate synthase -> DNA synthesis

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10
Q

5-FC - Fungistatic/cidal?

A

Fungistatic

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11
Q

5-FC - Clinical

A

ONLY Combi w AmpB for Candidiasis & Cryptococcus ( cannot be used alone)

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12
Q

5-FC - PK

A

Good oral
Penetrate CSF
Renal dysfx - dose adj

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13
Q

5-FC - SE

A

GI
BM suppression
Hepatotoxicity

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14
Q

Echinocandins - MOA

A

Inhibit B-1,3-glucan synthase complex -> Cell wall

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15
Q

Echinocandins - PK

A

Poor oral
No CSF
Renal dysfx - No dose adj needed
Liver dysfx - Dose adj

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16
Q

Echinocandins - Clinical

A

1st line - Invasive candidiasis

2nd line - Invasive aspergilliosis

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17
Q

Triazoles - MOA

A

Inhibit C-14 a-demethylase -> Block conversion from Lanosterol to Ergosterol -> Cell membrane

18
Q

Name the 3 Triazoles

A

Fluconazole
Itraconazole
Voriconazole

19
Q

Fluconazole (Triazole) - Spectra

A 
Candidiasis
Cryptococcous
Histoplasmosis
Blastomycosis
Vulvovaginal candidiasis - single oral dose
Fungal meningitis
20
Q

Fluconazole (Triazole) - PK

A

Good oral
Good CSF
Renal dysfx - dose adj
Excreted unchanged in urine = Good for UTI

21
Q

Itraconazole (Triazole) - PK

A

Good oral
Poor CSF
Low pH better for absorption (Take w/ food & coke)

22
Q

Voriconazole (Triazole) - PK

A

Good oral

Good CSF

23
Q

Itraconazole (Triazole) - Spectra

A 
Broader than Fluconazole
Blastomycosis
Asperigillosis
Onychomycosis
Oral candidiasis (oral solution)
24
Q

Voriconazole (Triazole) - Spectra

A

Broad spec
1st line - Invasive asperigillosis
Candida

25
Q

Triazoles - SE/CI

A 
N/V
Hepatotoxicity
QT prolongation
Cardiotoxicity (Itraconazole)
Neurotoxicity - Visual disturbance (Voriconazole)
CI: Pregnancy
26
Q

Triazoles - DDI

A

Inhibit CYP3A4

  • Warfarin
  • Cyclosporine
  • Oral hypoglycemic agents
27
Q

Clotrimazole (Imidazoles) - Spectra

A

Dermatophytes
Oropharyngeal candidiasis
Vulvovaginal candidiasis (Cream)

28
Q

Name the 2 Imidazoles

A

Clotrimazole

Miconazole

29
Q

Imidazoles - Formulation in vulvovaginal candidiasis

A

Clotrimazole - cream

Miconazole - Pessary

30
Q

Miconazole (Imidazoles) - Spectra

A 
Tinea
Vulvovaginal candidiasis (Pessary)
31
Q

Nystatin - Class

A

Polyene

32
Q

Nystatin - MOA

A

Similar to AmpB

33
Q

Nystatin - Spectra

A 
Oropharyngeal candidiasis (mouthwash)
Vulvovaginal candidiasis (intravaginal)
Cutaneous candidiasis (Topical)
GI fungal infections
34
Q

Imidazoles - SE

A

Skin irritation

Edema

35
Q

Nystatin - SE

A

Skin irritation

36
Q

Terbinafine - MOA

A

Inhibit squalene epoxidase -> Block conversion of squalene to lanosterol -> Cell membrane

37
Q

Terbinafine - Spectra

A

Trichophyton
Onychomycosis
Tinea captitis (Oral)

38
Q

Oral formulations of what 2 antifungals for Tinea captitis?

A

Itraconazole

Terbinafine

39
Q

Terbinafine - PK

A

Poor oral
Extensive metabolism by CYP
Excreted mainly in urine
Hence avoid in hepatic & renal dysfx

40
Q

Terbinafine - SE/CI

A

GI
Hepatic failure
Exacerbate SLE
Avoid in breastfeeding

41
Q

Terbinafine - Pregnancy?

A

Vaginal > Oral

42
Q

Terbinafine - DDI

A

with Azoles = Increase serum [Terbinafine]

Incr halflife of SSRI/MAOIs

PR3124 (3 decks)

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