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pharm exam 3 > Antifungal > Flashcards

Antifungal Flashcards

1
Q

superficial mycoses

A

limited to outermost layers of skin and hair

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2
Q

cutaneous mycoses

A

extend deeper into dermis and include invasive hair and nail diseases. Restricted to keratinized layers of skin, hair, and nails

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3
Q

subcutaneous mycoses

A

involve dermis, subcutaneous tissue, muscle, and fascia

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4
Q

systemic mycoses

A

originate primarily in lungs and may spread to other organ systems

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5
Q

give two important examples of opportunistic mycoses

A
  • aspergillosis - cryptococcosis
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6
Q

all available antifungals target the cell membrane or cell wall except

A
  • Griseofulvin
  • Flucytosine
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7
Q

MOA of Amphotericin B. static or cidal?

A
  • interaction with sterol of fungal membrane, Ergosterol, that results in pore formation
  • fungicidal
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8
Q

spectrum of Amphotericin B

A

broad antifungal spectrum

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9
Q

DOC: treatment of most systemic antifungal infections

A

Amphotericin B

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10
Q

toxicities of Amphotericin B

A
  • nephrotoxic
    • ​dose dependent - can lead to irreversible kidney damage
    • azotemia: BUN and serum creatinine levels are elevated
  • binding to human membrane sterols does occur
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11
Q

MOA of Flucytosine

A
  • metabolic antagonism of fungal DNA and RNA
    • Flucytosine is converted to 5-fluorouracil which interferes with fungal DNA and RNA synthesis
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12
Q

DOC: Cryptococcus infections

A

Flucytosine + amphotericin B

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13
Q

spectrum of Flucytosine

A
  • broad antifungal spectrum; less than amphotericin B
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14
Q

important distribution of Flucytosine

A

enters CSF

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15
Q

toxicities of Flucytosine

A
  • depression of bone marrow
  • may elevate ALT or AST
  • renal impairment can lead to toxicity
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16
Q

List the “Azoles.” Which is the prototype?

A
  • Ketoconazole
  • Fluconazole
  • Voriconazole
  • Itraconazole
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17
Q

MOA of “Azoles.” Static or cidal

A
  • inhibits the synthesis of ergosterol
  • fungistatic
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18
Q

spectrum of Ketoconazole

A

broad antifungal spectrum

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19
Q

route of administration of Amphotericin B

A

IV

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20
Q

route of administration of flucytosine

A

well absorbed orally

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21
Q

route of administration of Ketoconazole

A

oral

22
Q

distribution of Ketoconazole

A
  • widely distributed in the body, largely bound to plasma
  • CNS penetration is low
23
Q

toxicity of Ketoconazole

A
  • gyneocomastia
  • inhibits P450 system, drug interactions
24
Q

route of administration of Fluconazole

A

oral and IV

25
Q

distribution of Fluconazole

A

penetrates CSF - use for fungal meningitis

26
Q

toxicity of Fluconazole

A
  • less toxic than amphotericin B or flucytosine and better tolerated than ketoconazole
  • less drug interactions
27
Q

route of administration of Voriconazole

A

Oral and IV

28
Q

distribution of Voriconazole

A

Modest CSF penetration

29
Q

DOC: Aspergillus

A

Voriconazole + Amphotericin B

30
Q

toxicities of Voriconazole

A
  • drug interactions
  • visual impairment: reversible
31
Q

toxicities of Itraconazole

A

potent inhibitor of CTP3A4 - drug interactions

32
Q

route of administration of Itraconazole

A

oral

33
Q

name the 3 Echinocandins. What is the prototype

A
  • Caspofungin
  • Micafungin
  • Anidulafungin
34
Q

MOA of Echinocandins. static or cidal

A

inhibits synthesis of major fungal cell wall component B(1,3)-D-glucan

  • fungicidal
35
Q

route of administration of Caspofungin

A

IV

36
Q

toxicity of Caspofungin

A

lack of nephrotoxicity and few drug interactions = attractive treatment option

37
Q

uses of Caspofungin

A
  • alternate treatement option: invasive Asperigillosis in refractory patients
  • esophageal candidiasis
38
Q

Name the three antifungals that are used for local/topical treatment

A
  • Griseofulvin
  • Terbinafine
  • Nystatin
39
Q

dermatophytes

A

fungal infection that affects different parts of the body

ex: tinea corporis

40
Q

MOA of Griseofulvin: static or cidal

A
  • binds to microtubules and destroys mitotic spindle structure
  • binds to keratin and prevents infection in new skin
  • fungistatic
41
Q

DOC: Onychomycosis

A

Griseofulvin

42
Q

route of administration of Griseofulvin

A

only oral, not topical

43
Q

uses of Griseofulvin

A

treats dermatophytosis infections of skin, hair, and nails

44
Q

contraindications of Griseofulvin

A
  • acute intermittent porphyria
  • hepatocellular failure
45
Q

route of administration of Terbinafine

A

oral or topical

46
Q

MOA of Terbinafine. static or cidal?

A
  • interferes with sterol biosynthesis
  • fungicidal
47
Q

route of administration of Nystatin

A
  • oral: GI candida infections
  • topical: other candida infections
48
Q

use of Nystatin

A
  • polyene Abx
  • used for candidal infections
49
Q

What do Tioconazole, Clotrimazole, and Miconazole have in common

A

topical azoles used for skin and vaginal candidiasis

50
Q

Name the two polyene antifungal antibiotics

A
  • amphotericin B
  • nystatin

pharm exam 3 (7 decks)

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