Antifungal agents

Question 1

Bind to fungal cell membrane ergosterol and increase membrane permeability

Answer 1

Amphotericin B (AMB), Nystatin

Question 2

Inhibition of ergosterol synthesis

Answer 2

Clotrimazole, econazole, miconazole, ketoconazole, fluconazole, itraconazole, voriconazole

Question 3

Inhibition of ergosterol + lanosterol synthesis

Answer 3

Terbinafine

Question 4

Inhibition of fungal cell wall synthesis

Answer 4

Echinocandins – Caspofungin,
micafungin

Question 5

Inhibition of nucleic acid synthesis

Answer 5

5-flucytosine

Question 6

Inhibition of fungal mitosis

Answer 6

Griseofulvin

Question 7

MOA AMB

Answer 7

N

Question 8

Adverse effects of amphotericin-B

Answer 8

Nephrotoxicity
* Haemolytic anaemia (hypochromic normocytic
anemia)
* Hepatic impairment
* Infusion related toxicity – hypotension, fever,
chills, tachypnea
* Intrathecal administration – seizures

Question 9

AMB Therapeutic uses

Answer 9

Invasive aspergillosis
* Mucormycosis
* Disseminated histoplasmosis
Slow i.v. infusion
* Topical AMB: Oropharyngeal and cutaneous candidiasis
* Cryptococcal meningitis – intrathecal injection
* Reserve drug – resistant cases of Kala azar, mucocutaneous leishmaniasis (slow i.v. infusion)

Question 10

Mechanism of flucytosine and amphotericin-B

Answer 10

AMB increases the entry of flucytosine into the cell by creating pores in the cell membrane
* Flucytosine acts inside the fungal cell by inhibiting thymidylate synthetase thereby inhibiting fungal DNA synthesis.
* Enhances the activity of flucytosine,
* of development of resistance
* decreases the dose requirement of AMB
Used in cryptococcosis and candidiasis

Question 11

Therapeutic uses of Nystatin

Answer 11

Topical:
Oropharyngeal, corneal, conjunctival, cutaneous candidiasis
Oral:
Intestinal candidiasis and superinfection due to candida
Vaginal :vaginal candidiasis

Question 12

Systemic (oral/IV) AZOLE

Answer 12

Fluconazole, Itraconazole, Voriconazole ,Ketoconazole

Question 13

Topical AZOLE

Answer 13

Clotrimazole, Miconazole, Econazole, Ketoconazole

Question 14

Mechanism of action AZOLE

Answer 14

N

Question 15

Ketoconazole USES

Answer 15

Oropharyngeal candidiasis
Seborrheic dermatitis Dermatophytosis Candidiasis
Kala-azar
Dermal leishmaniasis Cushing’s syndrome Prostatic carcinoma

Question 16

Itraconazole

Answer 16

• Disseminated or chronic pulmonary histoplasmosis
• Non-meningeal blastomycosis
• Oropharyngeal and cutaneous candidiasis
• Ringworm infections (T. capitis & T. corporis)
• Fungal nail infections (Onychomycosis)
• Invasive aspergillosis
• Sporotrichosis

Question 17

Voriconazole

Answer 17

• Invasive aspergillosis
• Candidiasis

Question 18

Fluconazole

Answer 18

-Candidiasis (vulvovaginal, oropharyngeal, mucocutaneous and systemic candidiasis) -Meningeal cryptococcosis

Question 19

Mechanism of action of terbinafine

Answer 19

N

Question 20

Terbinafine
Therapeutic uses

Answer 20

• Onychomycosis (oral)
• Tinea infections (topical)
• Candidiasis

Question 21

Terbinafine adr

Answer 21

Headache
Hepatic enzyme elevation
GI upset

Question 22

ketoconazole, miconazole, clotrimazole

Answer 22

• Tinea infections (tinea corporis, tinea cruris, tinea versicolor)
• Candidiasis
• Seborrheic dermatitis – ketoconazole

Question 23

Terbinafine

Answer 23

Tinea infections

Question 24

Nystatin

Answer 24

Candidiasis

Question 25

Tolnaftate

Answer 25

Tinea infections, Dermatomycosis

Question 26

Ciclopirox

Answer 26

Tinea infections, Dermatomycosis, Candidiasis, Onychomycosis

Question 27

Clioquinol

Answer 27

Dermatophyte infections, seborrheic dermatitis, monilial and trichomonas vaginitis, pityriasis versicolor

Question 28

Therapeutic uses of echinocandins

Answer 28

Invasive aspergillosis
* Disseminated and mucocutaneous candidiasis