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MI Internal Medicine and Infectious Disease > Antifungal and Antiparasitic Therapy > Flashcards

Antifungal and Antiparasitic Therapy Flashcards

1
Q

What is the mechanism of action of Amphotericin and Nystatin?

A

Bind to ergosterol in cell membrane, disrupt cell wall permeability, resulting in cell death.

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2
Q

What is the nickname of Amphotericin, and why is this so?

A
  1. “Amphoterrible”

2. It’s toxicity (nephro)

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3
Q

Amphotericin and Nystatin are:
A) Fungistatic
B) Fungicidal

A

B

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4
Q

What is the spectrum of Amphotericin B IV?

A
  1. Candida
  2. Coccidioides
  3. Cryptococcus
  4. Blastomyces
  5. Histoplasma
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5
Q

What are the clinical indications for Amphotericin B IV?

A
  1. Aspergillus
  2. Cryptococcal meningitis
  3. Blastomycosis
  4. Coccidiomycosis
  5. Not 1st line for Candida
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6
Q

Nystatin is primarily used against what type of fungus? It is indicated for 2 conditions involving this pathogen.

A
  1. Candida

2. Oropharyngeal and vaginal candidiasis

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7
Q

The Azoles include: (4)

A
  1. Fluconazole
  2. Itraconazole
  3. Voriconazole
  4. Posaconazole
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8
Q

What is the MOA of the Azoles?

A

They inhibit lanosterol C14-demethylase to inhibit ergosterol synthesis

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9
Q

Azoles are “BLANK” against Candida, and “BLANK” against Aspergillus

A
  1. Fungistatic

2. Fungicidal

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10
Q

Which 2 Azoles have excellent bioavailability?

A
  1. Voriconazole

2. Fluconazole

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11
Q

What is one potential downside to the Azoles?

A

They are potent CYP 3A4 inhibitors

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12
Q

What is the spectrum of Fluconazole (IV/PO)

A
  1. Candida
  2. Coccidioides
  3. Blastomyces
  4. Histoplasma
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13
Q

What are the clinical indications for Fluconazole?

A
  1. Invasive C. albicans
  2. Esophageal candidiasis
  3. Severe mucocutaneous candidiasis
  4. Oral stepdown for cryptococcal meningitis
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14
Q

What is the spectrum of Itraconazole PO?

A
  1. Candida
  2. Aspergillus
  3. Coccidioides
  4. Cryptococcus
  5. Blastomyces
  6. Histoplasma
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15
Q

What are the clinical indications for Itraconazole PO?

A
  1. Oral stepdown for coccidiomycosis
  2. Blastomycosis
  3. Histoplasmosis
  4. Alternative for Candida and Aspergillus (but has poor oral absorption)
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16
Q

What is the spectrum of activity for Voriconazole (IV/PO)?

A
  1. Candida
  2. Aspergillus
  3. Coccidioides
  4. Cryptococcus
  5. Blastomyces
  6. Histoplasma
  7. Fusarium
  8. Scedosporium
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17
Q

What are the clinical indications for Voriconazole (IV/PO)?

A
  1. Aspergillus
  2. Fusarium
  3. Scedosporium
  4. Drug resistant fungal infections
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18
Q

What is the spectrum of Posaconazole PO?

A
  1. Candida
  2. Aspergillus
  3. Coccidioides
  4. Cryptococcus
  5. Blastomycosis
  6. Histoplasma
  7. Fusarium
  8. Scedosporium
  9. Zygomycetes
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19
Q

What are the clinical indications for Posaconazole PO?

A
  1. Zygomycetes
  2. Fusarium
  3. Scedosporium
  4. Drug resistant fungal infections (broad spectrum)
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20
Q

What 3 agents are considered Echinocandins?

A
  1. Anidulafungin
  2. Caspofungin
  3. Micafungin
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21
Q

What is the MOA of the Echinocandins?

A

They inhibit the production of B-(1,3)-D-glucan, needed for cell wall synthesis

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22
Q

Echinoderms are orally absorbed, T or F?

A

False. IV only.

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23
Q

All Echinocandins presented in class are given IV only? T or F

A

True.

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24
Q

What is the spectrum of the Echinocandins?

A
  1. Candida

2. Aspergillus

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25
Q

What are the clinical indications for the Echinocandins?

A
  1. Serious non-albicans Candida infections

2. Active against Aspergillus (studied in salvage therapy)

26
Q

What 4 agents are topical antifungals?

A
  1. Clotrimazole
  2. Ciclopirox
  3. Tolnaftate
  4. Terbinafine
27
Q

What is the spectrum of Clotrimazole cream?

A
  1. Trichophyton
  2. Microsporum
  3. Epidermophyton
  4. Candida
  5. Malassezia furfur
28
Q

What are the clinical indications for Clotrimazole cream?

A
  1. Tinea pedis
  2. Tinea cruris
  3. Tinea corporis
  4. Tinea versicolor
  5. Cutaneous candidiasis
29
Q

What is the spectrum of Ciclopirox?

A
  1. Trichophyton
  2. Microsporum
  3. Epidermophyton
  4. Candida
  5. Malassezia furfur
30
Q

What are the clinical indications for Ciclopirox?

A
  1. Mild onychomycosis
  2. Tinea pedis
  3. Tinea cruris
  4. Tinea corporis
  5. Cutaneous candidiasis
  6. Tinea versicolor
31
Q

What is the spectrum of Tolnaftate?

A
  1. Trichophyton
  2. Microsporum
  3. Epidermophyton
  4. Malassezia furfur
32
Q

Tolnaftate is not effective against which fungus?

33
Q

What are the clinical indications for Tolnaftate?

A
  1. Tinea pedis
  2. Tinea cruris
  3. Tinea corporis
  4. Tinea versicolor
34
Q

What is the spectrum of Terbinafine?

A
  1. Dermatophytes (Trichophyton, Microsporum, Epidermophyton)
35
Q

What are the clinical indications for Terbinafine?

A

PO for Tinea capitis and onychomycosis

Topical: Tinea pedis, Tinea cruris, Tinea corporis, Tinea versicolor

36
Q

These 6 agents are considered Antimalarial

A
  1. Chloroquine
  2. Mefloquine
  3. Atovaquone/proguanil
  4. Artesunate
  5. Quinine
  6. Primaquine
37
Q

What are the clinical indications for Chloroquine?

A
  1. Malarial prophylaxis

2. Tx for chloroquine susceptible regions

38
Q

What are the clinical indications for Mefloquine?

A
  1. Malaria prophylaxis for Chloroquine resistant regions or chloroquine intolerance.
39
Q

What are the clinical indications for Atovaquone/proguanil?

A
  1. Malarial prophylaxis for chloroquine/mefloquine resistant regions or intolerance of these drugs
  2. 1st line for uncomplicated P. falciparum Tx
40
Q

What antibiotic can be used as alternative malaria prophylaxis or adjunctive Tx?

A

Doxycycline

41
Q

What are the clinical indications for Artesunate IV?

A
  1. Preferred Tx for severe malaria, followed by PO therapy.
42
Q

What are the clinical indications for Quinine IV/PO?

A
  1. IV for 2nd line Tx of severe malaria (+ PO therapy)

2. PO 2nd line for uncomplicated malaria

43
Q

What are the clinical indications for Primaquine?

A
  1. Terminal prophylaxis for P. ovale, P. vivax; primary prophylaxis
44
Q

If you cannot use a 1st line PO med for malaria, what antibiotic can be used for combination malaria Tx?

A

Clindamycin

45
Q

Why is Mefloquine not used for malarial Tx?

A
  1. At the high doses required for Tx it can cause neuropsychiatric effects
46
Q

What are 2 contraindications for Primaquine?

A
  1. Pregnancy

2. G6PD deficiency

47
Q

What 5 drugs are Antihelminthics?

A
  1. Albendazole
  2. Mebendazole
  3. Ivermectin
  4. Pyrantel pamoate
  5. Praziquantel
48
Q

What are the clinical indications for Albendazole PO?

A
  1. Alternative for Strongyloidiasis, roundworm, pinworm, whipworm, hookworm
49
Q

What are the clinical indications for Mebendazole PO?

A
  1. Roundworm, pinworm, whipworm, hookworm
50
Q

What are the clinical indications for Ivermectin PO?

A
  1. Strongyloidiasis

2. Alternative for roundworm or whipworm

51
Q

What are the clinical indications for Pyrantel pamoate PO?

A
  1. Pinworm

2. Hookworm

52
Q

What are the clinical indications for Praziquantel PO?

A

Intestinal tapeworms

53
Q

Which Antihelminthic agent can cause Mazzoti reaction?

A

Ivermectin

54
Q

What is the Mazzoti reaction?

A

Host inflammatory reaction to death of parasites - fever, hives, asthma, GI upset

55
Q

Ivermectin is not effective for?

56
Q

Iodoquinol and Paromomycin are effective against what type of pathogens?

57
Q

What are the clinical indications for Iodoquinol PO?

A
  1. Dientamoeba fragilis
  2. Amebiasis
  3. Alternative for Blastocystis
58
Q

What are the clinical indications for Paromomycin PO?

A
  1. Alternative agent for Dientamoeba fragilis, amebiasis, giardiasis
59
Q

Which antibiotic has activity against intestinal protozoa?

A

Metronidazole

60
Q

What are the clinical indications for Permethrin (cream, lotion)?

A
  1. Scabies

2. Lice

61
Q

Which 2 agents are considered Polyenes?

A
  1. Amphotericin

2. Nystatin

MI Internal Medicine and Infectious Disease (35 decks)

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