Antifungal chemotherapy

Question 1

what are the opportunistic fungal infections?

Answer 1

candida
aspergillus
cryptococcus

Question 2

onychomycosis causes what type of fungal infection?

Answer 2

cutaneous / subcutaneous

Question 3

dimorphic fungi usually cause what type of infection?

Answer 3

systemic

Question 4

what are the unique targets for fungi?

Answer 4

fungal cell membrane (ergosterol, ergosterol synthesis)

fungal cell wall (glucans)

Question 5

what is the MOA of amphotericin B?

Answer 5

weaken membrane function (bind ergosterol)

forms amp B containing pores to alter membrane permeability

Question 6

caspofungin targets what fungal component / process?

Answer 6

cell wall synthesis

Question 7

5-flurocytosine targets what fungal component / process?

Answer 7

nucleic acid synthesis

Question 8

what are the systemically active drugs used for systemic infections?

Answer 8

polyenes
azoles
flucytosine
echinocandins

Question 9

what is the most widely used drug in treating systemic mycoses?

Answer 9

amphotericin B

Question 10

what drug has the broadest spectrum of action and is useful against systemic fungal infections?

Answer 10

amphotericin B

Question 11

when does amphotericin B resistance occur?

Answer 11

decrease in membrane ergosterol concentration

modification of target - reduced affinity

Question 12

what is the tissue penetration profile of amphotericin B?

Answer 12

widely distributed into most tissues but poor CNS penetration

Question 13

what is the most common and most serious long term toxicity associated with amphotericin B?

Answer 13

nephrotoxicity

Question 14

what is done to make amphotericin B less toxic? why?

Answer 14

liposomal packaged formulations

less interaction of drug with mammalian cell membrane

Question 15

what is the MOA of the azoles?

Answer 15

inhibit ergosterol synthesis - bind to enzyme responsible for converting lanosterol to ergosterol

causes leaky membranes

Question 16

what are the clinical uses for the azoles?

Answer 16

pathogenic yeast
systemic mycoses
dermatophytes

Question 17

what are the adverse reactions of the azoles?

Answer 17

minor GI disturbances

interaction with hepatic cyp450s

Question 18

what are the MORs of the azole drugs?

Answer 18

efflux pumps
mutations in target enzyme
decreased ergosterol content in cell membrane

Question 19

which azole has the highest therapeutic index of all the azoles?

Answer 19

fluconazole

Question 20

fluconazole is the agent of choice for what conditions?

Answer 20

candidiasis
cryptococcosis
coccidiomycosis

Question 21

what is the drug of choice for candidiasis, cryptococcosis, and coccidiomycosis?

Answer 21

fluconazole

Question 22

what is the drug of choice for blastomycosis, coccidiomycosis, histoplasmosis, sporotrichosis, and dermatophyte?

Answer 22

itraconazole

Question 23

itraconozole is the drug of choice for what conditions?

Answer 23

blastomycosis 
coccidiomycosis 
histoplasmosis 
sporotrichosis 
dermatophyte

Question 24

what drug has replaced amphotericin B as treatment of choice for aspergillosis?

Answer 24

voriconazole

Question 25

what is the drug of choice for aspergillosis?

Answer 25

voriconazole

Question 26

what azole has the highest spectrum of activity?

Answer 26

posaconazole

Question 27

what are the main indications for posaconazole?

Answer 27

aspergillus | agents of mucormycoses

Question 28

flucytosine is used as part of combination therapy for what organisms?

Answer 28

cryptococcus | candida

Question 29

what is the MOA of flucytosine?

Answer 29

interferes with both protein and nucleic acid synthesis

Question 30

flucytosine is effective against which organisms?

Answer 30

cryptococcal infections

Question 31

what test is used to identify cryptococcus neoformans?

Answer 31

india ink stain

Question 32

the india ink stain is used to identify which organism?

Answer 32

cryptococcus neoformans

Question 33

which drug is effective against cryptococcus neoformans and meningitis?

Answer 33

flucytosine

Question 34

what is the main toxicity of flucytosine?

Answer 34

bone marrow suppression

Question 35

what is the general MOA of the echinocandins? what dictates their selectivity?

Answer 35

inhibit fungal cell wall synthesis attack beta glucans (not present in mammalian cells)

Question 36

what are the main indications for the echinocandins?

Answer 36

candida and aspergillus

Question 37

what are the oral systemic drugs for cutaneous and mucocutaneous infections?

Answer 37

griseofulvin | allylamines (terbinafine)

Question 38

griseofulvin and allylamines (terbinafine) are used for what purposes, generally?

Answer 38

cutaneous and mucocutaneous infections

Question 39

what drug is used orally for dermatophyte infections?

Answer 39

griseofulvin

Question 40

what specific infection is griseofulvin used for?

Answer 40

dermatophyte

Question 41

what is the MOA of the allylamines?

Answer 41

ergosterol synthesis inhibitors

Question 42

what is the first line treatment for onychomycosis?

Answer 42

terbinafine (allylamine)

Question 43

terbinafine is the first line treatment for what condition?

Answer 43

onychomycosis

Question 44

what are the topical antifungal classes?

Answer 44

polyenes azoles allylamines

Question 45

nystatin is useful against what type of infection?

Answer 45

candida