Antifungal

Question 1

First line treatment for onychomycosis

Answer 1

Terbinafine

Question 2

First line treatment for tinea capitis and ringworm

Answer 2

Terbinafine

Question 3

First line treatment for blastomyces

Answer 3

Itraconazole

Question 4

First line treatment for cryptococcal meningitis in AIDS

Answer 4

FLUconazole
FLU easily penetrates BBB

Also prophylactic

Question 5

First line treatment for inVasive aspergillosis

Answer 5

Voriconazole

Question 6

First line treatment for invasive mucormycosis

Answer 6

Isavuconazole

Question 7

First line treatment for ringworm and Trichophyton (athlete’s foot)

Answer 7

Miconazole

Question 8

First line treatment for oral/vaginal thrush

Answer 8

Miconazole

Question 9

Amphotericin B

Answer 9

Amphoteric polyene macrolide
Binds ergosterol and SEQUESTERS it —> death

Systemic

Question 10

Amphotericin B indications

Answer 10

Broadest spectrum
Candida
Cryptococcus
Blastomyces
Histoplasma

Leishmania

Question 11

Amphotericin B side effect

Answer 11

Nephrotoxic
Fever and chills

Azotemia if C-AMB

Question 12

C-AMB and ABCD

Answer 12

Colloidal amphotericin B
More nephrotoxic

Question 13

L-AMB and ABLC

Answer 13

Liposomal amphotericin B
More expensive

Question 14

Notably hepatotoxic triazole

Answer 14

Itraconazole

Question 15

Notably teratogenic triazole

Answer 15

Voriconazole

Question 16

First line treatment for candida in oropharynx

Answer 16

Posaconazole (suspension)

Question 17

First line treatment for Leishmaniasis

Answer 17

Amphotericin B

Question 18

Terbinafine

Answer 18

Inhibits squalene epoxidase —> less ergosterol synthesis
Alters cell membrane permeability

Question 19

Terbinafine indications

Answer 19

Onychomycosis
Tinea capitis
Ringworm

Question 20

Triazole MOA

Answer 20

Inhibit 14-a-sterol demethylase
—> impair biosynthesis of ergosterol = more permeable
AND
—> accumulate toxic 14a-methyl-3,6-diol (ERGII gene)

Resistance from ERGII genes

Question 21

Itraconazole

Answer 21

Triazole

Blastomyces
Invasive aspergillosis
More
HEPATOTOXIC and GI

Question 22

Why amphotericin B before triazoles?

Answer 22

Triazoles are very hepatotoxic

Question 23

Voriconazole

Answer 23

Triazole

Invasive ASPERGILLOSIS***1
Candida
May cause visual/auditory hallucinations

Question 24

Fluconazole

Answer 24

Triazole

CYRPTOCOCCAL MENINGITIS**1
Candida
Coccidioides

Question 25

Posaconazole

Answer 25

Triazole

Candida

Question 26

Isavuconazole

Answer 26

Triazole

Invasive MUCORMYCOSIS**1
Invasive aspergillosis

Question 27

Ketoconazole

Answer 27

Imidazole, topical

Largely replaced by itraconazole

Question 28

Miconazole

Answer 28

Imidazole, topical

Ringworm
Tricophyton (athlete’s foot)
Oral/vaginal thrush

Question 29

What medication is an echinocandin?

Answer 29

Caspofungin

Question 30

Caspofungin

Answer 30

Echinocandin
Inhibit 1,3-b-d-glucan synthesis —> cell wall rupture
IV
Invasive candida & aspergillus

Question 31

Caspofungin side effects

Answer 31

Bloating or swelling face, arms, hands, feet
Blue lips, fingernails, skin
Less urine
Difficulty breathing

Question 32

Nystatin

Answer 32

Binds ergosterol —> sequester —> death
TOPICAL
CANDIDA: skin, vagina, mouth, esophagus

Question 33

Why isn’t nystatin given IV?

Answer 33

Too toxic

Question 34

Nystatin is used as prophylaxis for:

Answer 34

AIDS patients with fungal infection risk