Antifungal

Question 1

Where are fungal infections most common

Answer 1

superficial on the skin

Question 2

What are superficial fungal infections

Answer 2

Pityriasis versicolor
Tinea nigra

Question 3

What are some cutaneous fungal infections

Answer 3

dermatophytosis (Tineas)
Candidiasis

Question 4

What are some subcutaneous fungal infections

Answer 4

sporotrichosis (Rose-gardners)
Chromomycosis

Question 5

What are some systemic fungal infections

Answer 5

coccidiomycosis
histoplasmosis
blastomycosis
cryptococcosis
systemic candidiasis
aspergillosis
Zygomycetes

Question 6

What are the groups of antifungals

Answer 6

Polyenes
Azoles
Echinocandins
Allylmines
Other

Question 7

What drugs are polyenes

Answer 7

Amphotericin B
Nystatin

Question 8

What drugs are azoles

Answer 8

Clotrimazole
Ketoconazole
Fluconazole
Itraconazole
Posaconazole
Voriconazole

Question 9

What drugs are echinocandins

Answer 9

Caspofungin

Question 10

What drugs are allylamines

Answer 10

Terbinafine

Question 11

What drugs are considered “other” antifungals

Answer 11

flucytosine
Griseofulvin

Question 12

What is the MOA of amphotericin B

Answer 12

Lipophilic rod-like molecule that disrupts fungal cell wall by binding to sterols (ergosterol) = pores form in the membrane and K+ leaks out causing cellular death

Question 13

What produces amphotericin B

Answer 13

Streptomycin Nodosus

Question 14

what amphotericin B used for

Answer 14

Severe invasive fungal infections

Question 15

How is amphotericin B administered

Answer 15

IV- there is poor PO absorption

Question 16

what kind of nephrotoxicity can amphotericin B cause

Answer 16

Azotemia from dose dependent decrease in GFR

Question 17

What can exacerbate amphotericin B nephrotoxicity

Answer 17

cyclosporin
tacrolimus
aminoglycosides
pre-existing renal insufficiency
hypotension

Question 18

What can reduce nephrotoxicity with amphotericin B

Answer 18

Saline loading
increased infusion time

Question 19

Why does K+, MG2+ need to be monitored with amphotericin B

Answer 19

Because renal tubular acidosis can occur from significant K+ and mag wasting

Question 20

What are adverse drug reactions of Amphotericin

Answer 20

Infusion related reaction (Incidence may decrease with future doses)

N/V
Anemia
phlebitis

Question 21

What drug is 5-FC

Answer 21

flucytosine

Question 22

What kind of drug is flucytosine

Answer 22

synthetic pyrimidine analog

Question 23

What is the MOA of 5-FC

Answer 23

inhibits thymidylate synthase and incorporates into fungal RNA disrupting nucleic acid and protein synthesis

Question 24

Why can 5-FC NOT be a monotherapy

Answer 24

Resistance is too high

Question 25

What is 5-FC given with

Answer 25

Synergistic with amphotericin for systemic mycosis / meningitis (caused by cryptococcus and candida) Used with itraconazole for tx of chromoblastomycosis infections

Question 26

What is the PK of 5-FC

Answer 26

Good PO absorption Penetrates CSF

Question 27

What are the adverse reactions for flucytosine

Answer 27

reversible neutropenia/thrombocytopenia Dose related BM suppression Reversible hepatic dysfunction GI upset, N/V, Diarrhea (Common)

Question 28

What are the two groups of azoles

Answer 28

imadazoles triazoles

Question 29

Which drugs are imidazole

Answer 29

ketoconazole miconazole Clotrimazole

Question 30

Which drugs are triazoles

Answer 30

Fluconazole itraconaxole voriconazole posaconazole

Question 31

What is the MOA of imidazole

Answer 31

inhibits C-14 alpha-demethylase which blocks the demylenaton of Ianosterol to ergosterol = disruption of membrane structure

Question 32

Which imidazoles can only be used topically

Answer 32

Miconazole and clotrimazole (too toxic for systemic use)

Question 33

Which drug should ketoconazole NOT be used with

Answer 33

amphotericin B

Question 34

Which fungi can ketoconazole be used against

Answer 34

candida histoplasmosis blastomyces coccidioides *NOT aspergillus

Question 35

What impairs absorbtion of ketoconazole

Answer 35

Drugs that decrease gastric secretions

Question 36

What is the MOA of triazoles

Answer 36

Inhibits synthesis of cell membrane via fungal CYP450 inhibition similar to ketoconazole *does not interfere with mammalian CYP450 enzymes

Question 37

What can fluconazole be used

Answer 37

Candida Cryptococcus neoformans coccidiomycosis

Question 38

What are adverse reactions for fluconazole

Answer 38

N/V Rash Alopecia

Question 39

What are contraindications for fluconazole

Answer 39

teratogenic

Question 40

What is itraconazole the drug of choice to use against

Answer 40

histoplasmosis blastomycosis sporotrichosis

Question 41

What are drug interactions with itraconazole

Answer 41

warfarin statins phenytoin

Question 42

What is the BBW for itraconazole

Answer 42

if a patient with ventricular dysfunction and has onychomycosis, do not administer.. can make worse