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Clinical Pharm Exam 3 > Antifungal > Flashcards

Antifungal Flashcards

1
Q

Allylamines Agents

A

Terbinafine
Amoroifine
Naftifine
Butenafine

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2
Q

Allylamines MOA

A

inhibits the enzyme squalene epoxidase, required for ergosterol synthesis (prevents formation of steroid –> leakage)

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3
Q

Polyenes Agents

A

Nystatin

Amphotericin B

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4
Q

Polyenes MOA

A

binds with sterol in the fungal cell membrane (ergosterol) and causes cell content to leak out and the cell dies

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5
Q

Allylamines Coverage

A 
Topical agents
Piedra
Tinea Nigra
Tinea Capitis
Favus
Pityriasis
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6
Q

Nystatin

A

Covers Candida Species Only
Minimal Side effects
Swish & Spit or Shampoo
Orally –> poorly absorbed from the GI tract; too toxic to be used systemically
Topically –> not absorbed from intact skin or mucous membrane

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7
Q

Amphotericin B Agents

A

Amphotericin B deoxycholate
Amphotericin B colloidal dispersion
Amphotericin B lipid complex
Liposomal Amphotericin B

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8
Q

Amphotericin B MOA

A

Binds to ergosterol within the fungal cell membrane
Results in depolarization of the membrane
Forms Pores: leakage of intracellular content
Exhibits concentration dependent killing

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9
Q

Amphotericin B Coverage

A

Broad Spectrum antifungal (Empiric therapy)
Active against most molds and yeast
Not active against C. lusitanae, Fusarium, Tricosporon, Scedosporium

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10
Q

Amphotericin B deoxycholate

A

Distributes quickly out of the blood and into liver and other organs and slowly re-enters circulation (linger effects
Poor penetration: CNS, saliva, bronchial secretions, pancreas, muscle and bone
ADE: Glomerular nephrotoxicity ( dose-dependent decrease in GFR), tubular nephrotoxicity (K, Mg+, and bicarbonate wasting), decreased erythropoietin production, and acute reactions (chills, fevers, tachypnea, hypotension)

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11
Q

Amphotericin B deoxycholate Support management

A

Fluids (for hydration or hypotension)
Add potassium replacement (if hypokalemia)
Avoid concurrent nephrotoxic agents
Premed with acetaminophen, diphenhydramine or hydrocortisone (for fever/chills)
add heparin to the infusion to manage thrombophlebitis

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12
Q

Amphotericin B colloidal dispersion

A

acute infusion related reactions

Reduced rates of nephrotocicity compared to Amphotericin B deoxycholate

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13
Q

Amphotericin B lipid complex

A

Distributed into tissues more rapidly
Highest levels achieved in spleen, liver, and lungs
Lowest levels in lymph nodes, kidneys, heart, and brain
reduced frequency and severity of infusion related reactions
Reduced nephrotoxicity

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14
Q

Liposomal Amphotericin B

A

Higher Cmax and larger AUC
Higher concentration in liver, lungs, and spleen
lower concentrations in kidney, brain, lymph nodes, and heart
May achieve higher brain concentrations
Reduced frequency and severity of infusion related reactions
Reduced rate of nephrotoxicity

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15
Q

Azoles MOA

A

inhibit 14-alpha-demethylase which converts lanosterol to ergosterol, and is required in fungal cell membrane synthesis; also block steroid synthesis in humans

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16
Q

Imidazoles Agents

A 
Miconazole
Ketoconazole
Butoconazole
Clotrimazole 
Econazole
Mebendazole
Oxiconazole
Sertaconazole
Sulconazole
Thiabendazole
17
Q

Triazoles Agents

A 
Fluconazole
Isavuconazole
Itraconazole
Posaconazole
Voriconazole
18
Q

Imidazoles Coverage

A 
Typically topical against:
     Tinea corporis
     Tinea cruris
     Tinia pedis
     Oropharyngeal candidiasis
     Vulvovaginal candidiasis
     Contact dermatitis
      Vulvular irritation
19
Q

Ketoconazole

A 
Candidia species
Blastomycosis
Histoplasmosis (not immunocompromised)
Coccidioidomycosis (not for meningitis or severely ill)
Paracoccidioidomycosis
INACTIVE against aspergillus
needs acidic gastric pH for absorption
Distributes into epidermis, synovial fluid, saliva, and lungs
Poor distribution into CSF and eye
Decrease dose for severe liver failure
Can inhibit sterol synthesis in humans
ADE
20
Q

Ketoconazole ADE

A

GI distress
Rash
Increased LFTs
hepatitis –> can be fatal if not d/c
Dose-dependent inhibition of syntheis of testosterone –> impotence or gynecomastia
menstrual irregularities
alopecia
Dose-related decrease in cortisol synthesis
hypermineralocorticoid state –> HTN in long term use
Teratogenic in animals

21
Q

Ketoconazole DDI

A

Antacids, H2 blockers, proton pump inhibitors, sucralfate decrease absorption of ketoconazole
Rifampin decreases ketoconazole
CYP inhibition: cyclosporine, warfarin, phenytoin

22
Q

Fluconazole

A

Covers everything except: C.krusei, Aspergillus, Fusarium, Scedosporium, and zygomycetes

ADE: well tolerated, GI intolerance, Elevated LFTs, Rash

23
Q

Isavuconazole

A

Covers Aspergillus and mucomycosis

ADE: GI, QTc shortening, Fatigue, Chest pain, hypokalemia, hypomagnesemia, nephrotoxicity, hypotension

DDI: VIa CYP 3A4

24
Q

Itraconazole

A

Covers everything except: Fusarium, Scedosporium, and zygomycetes
Low coverage C. glabrata and C. krusei

ADE: C/I patients with CHF due to negative inotropic effects, QTc prolongation (other arrhythmias, hepatoxicity, rash, hypokalemia, GI tolerance

DDI: Strong inhibtor of CYP 3A4

25
Q

Posaconazole

A

Covers everything except Scedosporium

ADE: hepatotoxicity, QTc prolongation, GI intolerance

metabolized via Glucuronidation

26
Q

Voriconazole

A

Covers eveything except Scedosporium and zygomycetes

ADE: Visual/auditory disturbances, peripheral edema, rash, n/v/d, hepatotoxicity, headache, fever
Severe: SJS, liver failure, anaphalaxis, renal failure, QTc prolongation

Dose for
Cirrhosis
Renal impairment (CrCl<50ml/min use oral formulation to avoid accumulation)

DDI: many DDI

27
Q

Echinocandin MOA

A

inhibit the synthesis of glucan in cell wall, probably via the enzyme 1,3- glucan synthase

28
Q

Echinocandin Agents

A

Anidulafungin
Caspofungin
Micafungin

29
Q

Echinocandin Coverage

A

Covers ALL candida and Aspergillus

Blastomyces & Coccidioides

30
Q

Caspofungin DDI

A

NO CYP metabolism
CYP inducers reduce caspofungin levels
Cyclosporine –> increases AUC of caspofungin (monitor LFTs)
Tacrolimus –> reduces tacrolimus levels (monitor)

31
Q

Micafungin DDI

A

Nifedipine increases AUC and Cmax of Nifedipine –> monitor BP
Sirolimus Increases concentration of Sirolimus (monitor)

32
Q

Anidulafungin DDI

A

No DDI

33
Q

Echinocandin ADE

A

well tolerated
infusion related reaction (fever, phlebitis)
GI intolerance
Hypokalemia
Hypomagnesium
Elevated LFTs
Caspofungin has higher frequency of liver related lab abnormalities and higher frequency of infusion related pain and phlebitis

34
Q

Other Antifungal Agents

A 
Flucytosine
Griseofulvin
Salicycic Acid
Tinactin or Tolnaftate
Potassium Iodide
35
Q

Flucytosine MOA

A

converted by ctosine deaminase into 5-fluorouracil –> 5-fluorouridine triphosphate and incorporated into fungal RNA leading to miscoding. Also converted into 5-fluorodeoxyuridine monophosphate which interfers with DNA synthesis

36
Q

Griseofulvin MOA

A

binds to polymerized microtubules and inhibits fungal mitosis

37
Q

Flucytosine Coverage

A 
Destributes into tissues, CSF, and bodily fluids
Candida species except C. krusei
Cryptococcus neoformans
Aspergillus species
Synergy with amphotericin B
38
Q

Flucytosine Resistance

A

Loss of cytosine permease that permits flucytosine to cross the fungal cell membrane
Loss of any of the enzymes required to produce the active forms that interfere with DNA synthesis
RESISTANCE occurs frewuently and rapidly with flucytosine as MONOTHERAPY

39
Q

Flucytosine ADE

A 
Bone marrow suppression (dose-dependent)
Hepatotoxicity (dose dependent)
Enterocolitis
Toxicities occur more commonly in patients with renal impairments
Contraindicated in Pregnancy

Clinical Pharm Exam 3 (5 decks)

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