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Pharm > AntiFungal > Flashcards

AntiFungal Flashcards

1
Q

Who is most suspeptible to fungal infections?

A
  • immunocompromised patients
    • transplant
    • HIV/AIDS
    • autominnue condition
    • corticosteriod use and antibiotic use
  • can happen in immunocompent patients as well
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2
Q

Terbinafine

A

MOA- inhibition of squalene epoxidase- reducing fungal cell membrance ergosterol synthesis

Indication- Tinea cosporis (ring worm), tinea pedis (athletes foot), tinea cruris (jock itch), onchomycosis (nail fungus)

Renal elimination but hepatic impairment

Oral formuation

Monitor- SCr, LFT, CBC if >6 weeks to treat immunodifficient patients

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3
Q

Butenafine

A

MOA- inhibition of squalene epoxidase- reducing fungal cell membrance ergosterol synthesis

Indication- Tinea cosporis (ring worm), tinea pedis (athletes foot), tinea cruris (jock itch), onchomycosis (nail fungus)

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4
Q

Naftifine

A

MOA- inhibition of squalene epoxidase- reducing fungal cell membrance ergosterol synthesis

Indication- Tinea cosporis (ring worm), tinea pedis (athletes foot), tinea cruris (jock itch), onchomycosis (nail fungus)

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5
Q

Amorolfine

A

MOA- inhibition of squalene epoxidase- reducing fungal cell membrance ergosterol synthesis

Indication- Tinea cosporis (ring worm), tinea pedis (athletes foot), tinea cruris (jock itch), onchomycosis (nail fungus)

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6
Q

Ketoconazole

A

Azoles- imizaoles

MOA- inhibition of 14 alpha-demethylase whihc converts lonosterol to erogosterol= disruption in cell membrane synthesis; block steriod synthesis in humans

Indication- candida spp, blastomycosis, histoplasmosis NOT aspergillius

Topical formulation

Need gastic pH for absoprtion- DDI H2RA, PPI, antacids

Contraindicated with patients with hepatic impairment

BBB warning- QTc prolongation (do not use in cardiac patients)

INTERACTION WITH CYP INHIBITORS

Alopecia, mentral irregularities

Inhibits the synthesis of aldosterone, cortisol and testosterone (can be used for advanced prostate cancer)

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7
Q

Clotrimazole

A

Azoles- imizaoles

MOA- inhibition of 14 alpha-demethylase whihc converts lonosterol to erogosterol= disruption in cell membrane synthesis; block steriod synthesis in humans

Indication- Tinea cosporis, tinea pedis, tinea cruris, oropharyngeal candidiasis, vovluvaginal candidiasis

Topical Forumulation

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8
Q

Miconazole

A

Azoles- imizaoles

MOA- inhibition of 14 alpha-demethylase whihc converts lonosterol to erogosterol= disruption in cell membrane synthesis; block steriod synthesis in humans

Indication- Tinea cosporis, tinea pedis, tinea cruris, oropharyngeal candidiasis, vovluvaginal candidiasis

Topical Forumulation

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9
Q

Econazole

A

Azoles- imizaoles

MOA- inhibition of 14 alpha-demethylase whihc converts lonosterol to erogosterol= disruption in cell membrane synthesis; block steriod synthesis in humans

Indication- Tinea cosporis, tinea pedis, tinea cruris, oropharyngeal candidiasis, vovluvaginal candidiasis

Topical Forumulation

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10
Q

Mebendazole

A

Azoles- imizaoles

MOA- inhibition of 14 alpha-demethylase whihc converts lonosterol to erogosterol= disruption in cell membrane synthesis; block steriod synthesis in humans

Indication- Tinea cosporis, tinea pedis, tinea cruris, oropharyngeal candidiasis, vovluvaginal candidiasis

Topical Forumulation

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11
Q

Oxiconazole

A

Azoles- imizaoles

MOA- inhibition of 14 alpha-demethylase whihc converts lonosterol to erogosterol= disruption in cell membrane synthesis; block steriod synthesis in humans

Indication- Tinea cosporis, tinea pedis, tinea cruris, oropharyngeal candidiasis, vovluvaginal candidiasis

Topical Forumulation

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12
Q

Sertaconazole

A

Azoles- imizaoles

MOA- inhibition of 14 alpha-demethylase whihc converts lonosterol to erogosterol= disruption in cell membrane synthesis; block steriod synthesis in humans

Indication- Tinea cosporis, tinea pedis, tinea cruris, oropharyngeal candidiasis, vovluvaginal candidiasis

Topical Forumulation

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13
Q

Sulconazole

A

Azoles- imizaoles

MOA- inhibition of 14 alpha-demethylase whihc converts lonosterol to erogosterol= disruption in cell membrane synthesis; block steriod synthesis in humans

Indication- Tinea cosporis, tinea pedis, tinea cruris, oropharyngeal candidiasis, vovluvaginal candidiasis

Topical Forumulation

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14
Q

Thiabendazole

A

Azoles- imizaoles

MOA- inhibition of 14 alpha-demethylase whihc converts lonosterol to erogosterol= disruption in cell membrane synthesis; block steriod synthesis in humans

Indication- Tinea cosporis, tinea pedis, tinea cruris, oropharyngeal candidiasis, vovluvaginal candidiasis

Topical Forumulation

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15
Q

Fluconazole

A

Azoles- triazole

MOA- inhibition of 14 alpha-demethylase whihc converts lonosterol to erogosterol= disruption in cell membrane synthesis; block steriod synthesis in humans

systemic invasive fungal infections

CYP INTERACTIONS 3A4 (Itra & Posa> Fluc, Vori & Isovuconazole)

Indication Candidasis (oroesophageal/ urogenital/ vulvovigial), prohylaxis in BMT or solid organ translany Cryptococcus NO aspergillius,

Newer- less hormonal inhibitoon, broader spectrum, less toxic, better tissue distribution

CNS Penetration

Renal adjustments for renal failure

ADR- alopecia

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16
Q

Itraconazole

A

Azoles- triazole

MOA- inhibition of 14 alpha-demethylase whihc converts lonosterol to erogosterol= disruption in cell membrane synthesis; block steriod synthesis in humans

systemic invasive fungal infections

CYP INTERACTIONS 3A4 (Itra & Posa> Fluc, Vori & Isovuconazole)

Indication Candidasis (oropharengeal and esophageal), step down therapy for Aspergillius

Newer- less hormonal inhibitoon, broader spectrum, less toxic, better tissue distribution

Capsule given with meal

Solution should be given on empty stomach (preferred)

ADR- Hypertension, Hypokalemia, Edema

Contraindiated in cardiac patients (QTc prolongation)

17
Q

Voriconazole

A

Azoles- triazole

MOA- inhibition of 14 alpha-demethylase whihc converts lonosterol to erogosterol= disruption in cell membrane synthesis; block steriod synthesis in humans

systemic invasive fungal infections

CYP INTERACTIONS 3A4, CYP2C9, CYP2C19 (Itra & Posa> Fluc, Vori & Isovuconazole)

Indication- resistant candida, aspergillius

Newer- less hormonal inhibitoon, broader spectrum, less toxic, better tissue distribution

Larg Vd and good CNS penetration

Take with no food

Monitor- level >5mg/L = CNS toxicity, SCr, electrolytes, LFT, ophthalmic exam

ADR- N/V/D, liver dysfunction, visual abnormalities, hepatotoxicity, SJS, and auditiory disturbance

18
Q

Posaconazole

A

zoles- triazole

MOA- inhibition of 14 alpha-demethylase whihc converts lonosterol to erogosterol= disruption in cell membrane synthesis; block steriod synthesis in humans

systemic invasive fungal infections

Oral administration- slow onset

CYP INTERACTIONS 3A4, (Itra & Posa> Fluc, Vori & Isovuconazole)

Indication- resistant candida, aspergillius

Newer- less hormonal inhibitoon, broader spectrum, less toxic, better tissue distribution

Monitor- SCr, electrolytes, LFT

ADR- GI, HA, rare hepatoxicity , QTc prolongation, hemolytic uremic syndrome

19
Q

Isavuconazole

A

zoles- triazole

MOA- inhibition of 14 alpha-demethylase whihc converts lonosterol to erogosterol= disruption in cell membrane synthesis; block steriod synthesis in humans

systemic invasive fungal infections

Prodrug- isavuconazonium (372 mg= 200 of isavuconazole)

CYP INTERACTIONS 3A4 CONTRAINDICATED in inhibition and inducer

Indication- invasive aspergillius, mucormycosis NO Candidis

Newer- less hormonal inhibitoon, broader spectrum, less toxic, better tissue distribution

HALF LIFE- 130 hours

ADR- GI, Hypokalemia, elevated LFTs, HA

Monitor- LFT

20
Q

Nystatin

A

Polyenes

MOA- Bind with sterols in the fungal cell memebrane (prinically ergosterol. leads to cell contents to leak out and ultimately cell death

Indication- Candidia

Minimal systemic absorption- almost entirely excreted in feces unchanged

Too toxic for systemic administration

Oropharyngeal candidiasis- retaini mouth for as long as possible

Intestinal candidiasis

also administed topically

21
Q

Amphotericin deoxycholate- AmB-d

A

Polyenes

MOA- Bind with sterols in the fungal cell memebrane (prinically ergosterol. leads to cell contents to leak out and ultimately cell death

Indication- most candida spp and aspergiluss, most fungus except fusarium spp. and A. terreus LIFE THREATENING INFECTIONS

Amphoteric- soluable both basic and acid environment and insoluable in water

more then 90% protein bound

ADR- neprotoxic, infusion-replated reactions (premedicated with APAP or IBU, diphenhydramine w/wo steroid. Rigors- meperidine

Side effects- thromphlebitis (add Heparin), cadiac arrhythmia rash, decrease erthropoietin production and electrolyte derangement

Monitor- SCr, BUN, electrolyte, CBC, LFT

22
Q

Amphotericin B lipid compex

A

Polyenes

MOA- Bind with sterols in the fungal cell memebrane (prinically ergosterol. leads to cell contents to leak out and ultimately cell death

Indication- most candida spp and aspergiluss, most fungus except fusarium spp. and A. terreus LIFE THREATENING INFECTIONS

Less nephrotoxic, less infusion related reactions

High Cmax and larger AUC

Higher tissue concentration

Hepatoxicity- increased alk phos and conjugated bili

23
Q

Liposomal ampotericin

A
24
Q

Caspofugins

A

Echinocandins

MOA- inhibit beta 1,3 synthase so beta 1,3 glucan in cell wall cannot be made

Indication- Invasive candidiasis, Empiric coverage for neutropenic fever, (fungicidal against most Candida spp, fungistatic against aspergillus

IV formulation only

Minumum CSF penetration

No renal adjustments

Well tolerated-low adverse eventd rates

CYP inducers reduce dose (increase dose)

Cycoporine may incrase AUC by 35%

Reduce tacrolimus levels by 20%

25
Q

Micafungin

A

Echinocandins

MOA- inhibit beta 1,3 synthase so beta 1,3 glucan in cell wall cannot be made

Indication- Invasive candidiasis, Empiric coverage for neutropenic fever, (fungicidal against most Candida spp, fungistatic against aspergillus

IV formulation only

Increases concentration of sirolimus

Increases AUC and Cmas of nifedipine

26
Q

Anidulafungin

A

Echinocandins

MOA- inhibit beta 1,3 synthase so beta 1,3 glucan in cell wall cannot be made

Indication- Invasive candidiasis, Empiric coverage for neutropenic fever, (fungicidal against most Candida spp, fungistatic against aspergillus

IV formulation only

27
Q

Flucytosine

A

MOA- converted to 5- florouracil by suspectible fungi

Indication- candida spp (except krusei), cryptococcus neoformans, aspergillus

NOT USED AS MONOTHERAPY

Synergistic effecr AmB

administer with food to limit n/v

toxicity- n/v/d, bone marrow supression, enterocolitis, hepatotoxicity

monitor- CBC, SCr, LFT

DDI- avoid with other nephortoxic and bone marrow supressive drugs

Pharm (9 decks)

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