Antifungal agents

Question 1

Spectrum of amphotericin

Answer 1

broad - used for threatening systemic infections

Question 2

Spectrum of Nystatin

Answer 2

superficial candidal infections

Question 3

Which are topical only?

Answer 3

Nystatin, Terconazole, Clotrimazole/Miconazole

Question 4

Which are IV only?

Answer 4

Caspofungin (for aspergillosis refractory to ampho b)

Question 5

Amphotericin MOI

Answer 5

binds ergosterol and forms pores in membranes

Question 6

Amphotericin Adverse Reactions

Answer 6

fever/chills on infusion, nephrotoxicity (80%)- slow excretion by kidney, anemia

Question 7

Nystatin adverse reactions

Answer 7

well tolerated topically

Question 8

Caspofungin adverse reactions

Answer 8

rash, puritis

Question 9

Nystatin MOI

Answer 9

same as amphotericin

Question 10

Triazoles MOI

Answer 10

inhibits P450 ergosterol synthesis altering membrane permeability

Question 11

What is fluconazole used for?

Answer 11

orophoryngeal/esophageal/vulvovaginal candidiasis

Cryptococcal meningitis

Question 12

Which readily enters the CSF?

Answer 12

Fluconazole

Question 13

How is fuconazole administered and exreted?

Answer 13

IV/PO, renal excretion

Question 14

Whats the difference between triazoles and imidazoles?

Answer 14

imidazoles have less selective inhibition of fungal P450

Question 15

What is Ketoconazole used for?

Answer 15

systemic infections (candidiasis), used declining due to toxicity

Question 16

Adverse reactions of Ketoonazole?

Answer 16

anorexia, hepatotoxic, P450 inhibitor, inhibits andgrogen GC biosynthesis

Question 17

What forms of ketoconazole are available?

Answer 17

IV/PO/topical

Question 18

What are clotrimazole and miconazole used for

Answer 18

oral and vaginal candidiasis (topical only)

Question 19

What is terbinafine used for

Answer 19

onychomycosis (po) and athletes foot

Question 20

What are side affects of terbinafine?

Answer 20

headache, diarrhea, rash, some DDIs with CYP450 substrates

Question 21

How is terbinafine metabolized

Answer 21

hepatic P450

Question 22

What is Grisefulvin used for ?

Answer 22

severe dermatophytosis of skin, hair, nails

Question 23

Things to know about Grisefulvin

Answer 23

poor po absorption improved by fatty meals, hypersensitivity reactions, GI, headache & confusion

Question 24

Things to know about flucytosine

Answer 24

renally eliminated, nv, skin rashes, bone marrow depression if prolonged use