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Pharmacology > Antifungal > Flashcards

Antifungal Flashcards

1
Q

Unique targets for anti fungal therapy

A

Fungal cell membrane

Fungal cell wall

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2
Q

What drugs can be used for systemic fungal infections?

A

Amphotericin B, most azoles, fucystosine, and echinocandins

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3
Q

Amphotericin B MOA

A

Binds to egosterol in fungal cell membrane, and forms amp B containing pores=>alter membrane permeability=>fungicidal

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4
Q

Amphotericin B recommended use

A

Systemic Candidiasis
Cryptococcal Meningitis
Systemic disease caused by molds, including dimorphics

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5
Q

Amp B resistance

A

Reduced concentration of erogsterol in the membrane

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6
Q

Amp B Pharm properties

A

Nearly insoluble in water, widely distributed except for CNS

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7
Q

Amp B Adverse

A

Infusion reaction in almost all patients=> fever, chills, muscle spasms, vomiting, headache, HTN
Nephortoxicity=>decreased renal perfusion

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8
Q

Azoles MOA

A

Inhibit enzyme responsible for ergosterol synthesis=>make membrane leaky and damaged

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9
Q

Azole spectrum of activity

A

Pathogenic yeast=>candida and cryptococcus
Systemic mycoses
Dermatophytes

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10
Q

Azole resistance

A

Efflux pumps, mutation in target genes, and decreased ergosterol content in membrane

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11
Q

Azoles Adverse

A

Relatively non-toxic
Some GI problems
Interaction with P450=>varies from drug to drug

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12
Q

Fluconazole distinguishing characteristics, first line treatment for?

A

First line drug for many fungal infections=>highest therapeutic index
Widely distributed including CNS
Lowest interaction w/ P450 enzymes
Agent of choice for: candida, cryptococcis, coccidiomycosis

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13
Q

Itraconazole compared to fluconazole

A

Lipophilic
Broader spectrum of activity
Lower therapeutic index
More drug-drug interactions

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14
Q

Voriconazole Spectrum of activity. What is voriconazole the tx of choice for?

A

Very broad=> candida, endemic dimorphics

**due to low toxicity, has replaced amp B as tx of choice for aspergillosis

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15
Q

Voriconazole adverse rxns

A

Transient visual disturbances and hallucinations

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16
Q

Posaconazole spectrum of activity

A

Broadest spectrum of all azoles

Effective in treating Candida, Aspergillus, and agents of mucormycoses in diabetic patients

17
Q

Flucytosine MOA

A

Interferes w/ both protein and nucleic acid synthesis

18
Q

Flucytosine use

A

Combo therapy to treat severe cryptococcal infections (India ink stain!)

19
Q

Flucytosine adverse reactions

A

Bone marrow toxicity=>anemia, leukopenia, thrombocytopenia

20
Q

Echinocandins MOA

A

Inhibit synthesis of B-glucans=>weaken the cell walls of fungal cells.

21
Q

3 Echinocandin drugs

A

End in fungin
Capsofungin
Micafungin
Anidulafungin

22
Q

Echinocandins use

A

Treat invasive disease caused by Candida and Aspergillus=>used when fungal disease does not respond to toher drugs

23
Q

Echinocandins pharmacology

A

Need to be IV, poor penetration to CNS

24
Q

Echinocandins Adverse

A

Extremely well tolerated=>only attack compounds that exist in fungal cell walls

25
Q

Oral drugs used for cutaneous/mucocutaneous infectiosn

A

Griseofulvin

Terbinafineq

26
Q

Griseofulvin Use/Target cells

A

Dermatophyte infections

Targets kerating precursor cells

27
Q

Terbinafine MOA

A

Inhibits enzye squalene epoxidase

28
Q

Terbinafine Use

A

First line tx for onychomycosis

Keratophilic=>concentrates in skin, hair, and nails.

29
Q

Terbinafine adverse

A

Rare=> GI distress, headache, elevated liver enzymes (does NOT interact w/ p450 system)

30
Q

Topical antifungal agents

A

Nystatin
Clotrimazole, miconazole
Terbinafine, Naftifine

31
Q

Nystatin MOA

A

polyene, binds to ergosterol in fungal cell membrane

32
Q

Nystatin Use

A

Only topically, used to treat local infections

Also used to treat thrush (candida in the mouth)

33
Q

Clotrimazole and miconazole Use

A

Vulvovaginal candidiasis and dermatophytes=> athlete’s foot, jock itch, ringworm, etc.
Oral lozenges available for tx of thrush

34
Q

Terbinafine and Naftifine use

A

jock itch and ringworm

Pharmacology (11 decks)

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