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Adv. Pharm > Antifungal > Flashcards

Antifungal Flashcards

Exam 3

1
Q

What drugs are Azoles?

A

Antifungal:
Ketoconazole
Fluconazole

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2
Q

What drugs are non-Azoles?

A

Antifungal:
Terbinafine
Amphotericin B
Nystatin

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3
Q

Ketoconazole- MOA?

A

Mycotic cell membrane modifier -> decreases cell wall integrity -> cell death

Inhibits biosynthesis of ergosterol (key component of cell wall) -> decreased cell membrane -> cell death

(CYP inhibitor)

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4
Q

Fluconazole- MOA?

A

Mycotic cell membrane modifier -> decreases cell wall integrity -> cell death

Inhibits biosynthesis of ergosterol (key component of cell wall) -> decreased cell membrane -> cell death

(CYP inhibitor)

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5
Q

Azoles- side effects?

A

Increased LFTs
QT prolongation
CYP inhibitor -> accumulation
Increased effects of warfarin - monitor for bleeding

Hepatic- ketoconazole (hepatotoxicity w/ PO)
Renal dosing- Fluconazole

N/V/D

(Ketoconazole & Fluconazole)

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6
Q

Which azole required renal dose adjustment?

A

Fluconazole

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7
Q

Ketoconazole- formulation?

A

Topical- most common
Oral (hepatotoxicity- last line)

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8
Q

Fluconazole- formulation?

A

PO, IV

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9
Q

Amphotericin- MOA?

A

Binds to ergosterol -> forms pore -> altered cell membrane permeability -> cell death

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10
Q

Azoles- indication?

A

Systemic fungal infections
Fungal/bacterial/skin infections

(Ketoconazole & Fluconazole)

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11
Q

Amphotericin B- indications?

A

Broad spectrum
First line for Invasive infections;
yeast, molds, fungi

Bloodstream infection (alt. choice)
Invasive infection (alt. choice)

Meningitis (AmB w/ flucytosine)

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12
Q

Amphotericin B- formulation?

A

IV

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13
Q

Amphotericin B- side effects?

A

Nephrotoxic
Increased LFTs
Infusion reactions/histamine release

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14
Q

Nystatin- MOA?

A

Alters fungal cell wall permeability -> cell death

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15
Q

Nystatin- indication?

A

Oral thrush (alt. choice)
Cutaneous infection

(not for systemic)

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16
Q

Nystatin- formulation?

A

Swish/swallow
PO
Topical: cream, ointment powder

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17
Q

What drugs are antifungal?

A

Ketoconazole (PO
Fluconazole (PO

Terbinafine (PO
Amphotericin B
Nystatin

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18
Q

Terbinafine- MOA?

A

Inhibits sterol biosynthesis -> cell death

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19
Q

Terbinafine- indications?

A

Nail bed infections (onychomycosis)

Tinea pedis
Tinea cruris
Tinea corporis (ringworm)

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20
Q

Terbinafine- formulations?

A

Topical
PO- hepatotoxicity

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21
Q

Fluconazole- side effects?

A

Abdominal discomfort
Increased LFTs
Rash, photosensitivity
Prolonged QT
Cardiomyopathy

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22
Q

Fluconazole- indications?

A

Oral thrush- candida albicans
Esophageal infections- candida albicans

Alternative choice for Nail bed infections- dermatophytes

Yeasts
Fungi

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23
Q

How would you treat Tinea Pedis?
Tinea corporis?
Tinea Cruris?

A

Tinea pedis- athletes foot: topical antifungal creams- terbinafine, ketoconazole
PO (fluconazole, terbinafine) if immunocompromised or failed topical antifungal

Tinea corporis- ringworm: Tinea pedis- athletes foot: topical antifungal creams- terbinafine, ketoconazole
PO (fluconazole, terbinafine) if immunocompromised or failed topical antifungal

Tinea Cruris- jock itch: Tinea pedis- athletes foot: topical antifungal creams- terbinafine, ketoconazole
PO (fluconazole, terbinafine) if immunocompromised or failed topical antifungal

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24
Q

Uncomplicated vulvovaginal candidiasis- treatment?

A

Intravaginal clotrimazole cream
PO fluconazole

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25
Q

Complicated vulvovaginal candidiasis- treatment?

A

Topical azoles- ketoconazole
Fluconazole PO

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26
Q

Thrush- treatment?

A

Thrush- oropharyngeal candidiasis

Mild: Nystatin PO
Moderate/severe: Fluconazole PO

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27
Q

Esophageal candidiasis- treatement?

A

Fluconazole (PO or IV)

28
Q

What drugs are antivirals?

A

Acyclovir (herpes/ HSV)
Ganciclovir (herpes)

Oseltamivir (Influenza)

Paxolovid (COVID)

Emtricitabine (HIV)
Efavirenz (HIV)
Ritonavir (HIV)
Bictegravir (HIV)
Enfuvitride (HIV)

29
Q

What can herpes cause?

A

Oropharyngeal disease
Genital disease
Chicken pox -> shingles
CMV
EBV
Mono

30
Q

Anti-HSV drugs- MOA?

A

Suppresses synthesis of viral DNA -> inhibits viral replication

(Acyclovir & Ganciclovir)

31
Q

Anti-HSV drugs- indication?

A

Treating symptoms/outbreaks of:
HSV
VZV
HZV

Most effective within 72hr of rash

(Acyclovir & Ganciclovir)

32
Q

Anti-HSV drugs- side effects?

A

Nephrotoxicity - AKI
Crystal nephropathy w/ IV Acyclovir
Neurotoxicity
Thrombotic microangiopathy- TTP/HUS

(Acyclovir & Ganciclovir)

33
Q

Acyclovir- formulations?

A

PO
IV- risk of crystal nephropathy

34
Q

Acyclovir- indications?

A

Genital herpes
Invasive HSV infections
Herpes simplex labialis (cold sores)
Varicella zoster (chicken pox)
Recurrent herpes zoster (shingles)

35
Q

Genital herpes- treatment?

A

Acyclovir, PO

36
Q

Herpes simplex labialis- treatment?

A

Acyclovir, cream/buccal tablet

37
Q

Invasive HSV infection- teatment?

A

Acyclovir, IV

38
Q

Varicella zoster- treatment?

A

Acyclovir, PO

39
Q

Herpes zoster- treatment?

A

(shingles)

Acyclovir

40
Q

What drug is anti-influenza?

A

Oseltamivir

41
Q

Oseltamivir- MOA?

A

Inhibits release of new viral particles from infected cells -> decreased amount of virus in the body

42
Q

Oseltamivir- indications?

A

Influenza, treatment/prophylaxis

43
Q

Oseltamivir- fromulation?

A

PO
Capsules, suspensionO

44
Q

Oseltamivir- side effects?

A

Neuropsychiatric:
Confusion, delirium, hallucinations,
N/V

45
Q

What drug is anti-COVID?

46
Q

Paxlovid- indications?

A

Mild-moderate COVID
Symptomatic pts w/ risk of progression to severe disease

Initiate within 5 days of COVID symptoms onset

47
Q

Paxlovid- MOA?

A

Inhibits viral replications
“Booster”- Increased plasma concentration of med 1(above action)

48
Q

Paxlovid- side effects?

A

Renal dose adjustments
DDI
Increased LFTs / Hepatic adverse effects
Dysgeusia- altered taste

49
Q

What is PrEP?

A

HIV Pre-exposure prophylaxis, for high risk people

50
Q

What drug is used as HIV PrEP?

A

Emtricitabine

51
Q

Emtricitabine- indications?

A

At-risk pts:
Sex w/ men and women
Anal sex w/o condoms
Sexual relationship w/ HIV-positive partner
Bacterial STI diagnosed
Injected non-prescribed drug user

52
Q

What is PEP?

A

HIV Postexposure prophylaxis
After possible HIV exposure, within 72hours
Daily for 28days

53
Q

Emtricitabine- side effects?

A

Renal toxicity
Decreased bone density
Increased TG
Weight gain

54
Q

Emtricitabine- MOA?

A

Reverse transcriptase inhibition -> inhibits replication of HIV

55
Q

Emtricitabine- side effects?

A

Lactic acidosis
Hepatomegaly

56
Q

Bictegravir- indications?

A

Treatment of HIV-1

57
Q

Bictegravir- MOA?

A

Strand transfer inhibitor -> interferes with HIV replication -> decreases viral load

58
Q

Bictegravir- side effects?

A

Headache
Insomnia
Diarrhea
Weight gain

Separate Al/Mg

59
Q

Efavirenz- indications?

A

Treatment for HIV

60
Q

Efavirenz- MOA?

A

Reverse transcriptase inhibitor

Decreased amount of HIV in blood

61
Q

Efavirenz- side effects?

A

Severe rash
Hepatotoxicity
CYP-substrate

62
Q

Ritonavir- indication?

A

Treatment of HIV-1

63
Q

Ritonavir- MOA?

A

Protease inhibitor -> inhibits HIV replication

64
Q

Ritonavir- side effects?

A

Metabolic complications- hyperglycemia, DM exacerbation
Hepatotoxicity
CYP inhibitor

65
Q

Enfuvirtide- indications?

A

HIV treatment

66
Q

Enfuvirtide- MOA?

A

Entry inhibitor -> Inhibits HIV fusion with host cells

67
Q

Enfuvirtide- side effects?

A

Injection site reactions
Pain, erythema, nodules

Adv. Pharm (9 decks)

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