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POD Exam 2 > antifungal drugs > Flashcards

antifungal drugs Flashcards

1
Q

list 3 situations where there is an increase risk of fungal infection

A
  • chemotherapy
  • leukemia, AIDS
  • placement of indwelling catheters
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2
Q

why aren’t there many antibacterial agents against fungi

A

fungi infection is eukaryotic invading eukaryotic, small differences

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3
Q

what is a difference between fungi and mammals

A

cell wall of fungi have chitin and ergosterol

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4
Q

what is the mechanism of action for amphotericin B

A
  • binds to ergosterol of fungal plasma membrane
  • alters membrane permeability
  • leakage of ions
  • death
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5
Q

when does amphotericin B work as a fungistatic and fungicidal

A

depends on concentration

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6
Q

what is the distribution for amphotericin B

A

poor CSF penetration

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7
Q

what is the major and minor adverse effect of amphotericin B

A

Main: nephrotoxicity
minor: hematologic, electrolyte imbalance

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8
Q

what causes hematologic effects in amphotericin

A
  • erythropoietin production decrease

- anemia

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9
Q

what causes electrolyte imbalance effects in amphotericin

A
  • K, bicarbonate, Mg wasting
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10
Q

is the nephrotoxicity adverse effect in amphotericin B reversible

A

yes

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11
Q

what are some infusion related adverse effects of amphotericin B

A

shaking, chills, fever

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12
Q

how is infusion related adverse effects avoided

A

premedicate with NSAIDs, acetaminophen, antihistamines or meperidine

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13
Q

what is the spectrum of activity for amphotericin B

A

broad

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14
Q

when is amphotericin B used for topical use for what disease

A

Candida

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15
Q

when is amphotericin B given as a medication

A

for severe cases

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16
Q

amphotericin B is mixed with what other component for drug use

A

lipids

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17
Q

what makes the lipid formulations of amphotericin B better than amph B by it self

A
  • less nephrotoxicity

- equivalent efficacy

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18
Q

where does Flucytosine (5-fluorocytosine) work

A

penetrates fungal cell wall

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19
Q

what does Flucytosine do in the cell wall of fungus

A

deaminated to 5-fluorouracil by cytosine deaminase

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20
Q

what does 5-fluorouracil do

A
  • competes with uracil

- decreases production of DNA, RNA, and protein synthesis

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21
Q

how is Flucytosine distributed

A

CSF penetration

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22
Q

what are 2 adverse effects for Flucytosine

A
  • bone marrow hypoplasia

- increase hepatic enzymes in serum

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23
Q

what is the domino effect of Flucytosine because of bone marrow hypoplasia

A

anemia
leukopenia
thrombocytopenia

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24
Q

who is more likely to get bone marrow hypoplasia from Flucytosine

A
  • prolonged therapy

- combination with amphotericin B

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25
Q

dosing by itself what can flucytosine treat

A

candida

cryptococcus

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26
Q

combined with amphotericin B, flucytosine can treat

A

cryptococcus meningitis in AIDS patients

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27
Q

is it better to use flucytosine in combination or by itself and why

A

combination, resistance can develop if used alone

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28
Q

what is the mechanism of action for Azole Antifungal

A

interfere with fungal cytochrome P-450 dependent enzyme

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29
Q

what is P450 responsible for

A

demethylation of lanosterol and conversion to ergosterol

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30
Q

is Azole antifungal static or cidal

A

both

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31
Q

what are 4 main adverse effects of Azole antifungal

A
  • nausea/vomiting
  • decrease testosterone and ACTH
  • hepatits (rare)
  • increase aminotransferase (not rare)
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32
Q

Antacids, PPI, H2 antagonists have what interaction in the body

A

decrease absorption due to decreased acidic environment

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33
Q

what happens when azoles are taken with warfarin

A

increase anticoagulation effect

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34
Q

Ketoconazole is absorbed how well

A

rapidly from GI

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35
Q

Ketoconzaole largely replaced what drug

A

Itraconazole

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36
Q

how well is fluconazole absorbed

A

rapidly from GI

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37
Q

how well is fluconazole distributed

A

widely distributed even into CSF

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38
Q

how is Fluconazole eliminated

A

renal excreted unchanged in urine

39
Q

Fluconazole treats what

A

cyrptococcal infections- meningitis

  • coccidiomycosis
  • candidiasis
40
Q

how well is Itraconazole distributed

A

widely distributed, poorly into CSF

41
Q

what does Itraconazole covers what diseases

A

wide spectrum

42
Q

Itraconazole can be administered and how and what does it treat

A

orally for histoplasmosis/blastomycosis

43
Q

amphotericin B should be used if severe life-threatening cases, once there is clinical improvement the patient can be switched to what drug

A

itraconazole

44
Q

what effects the absorption of Voriconazole

A

high fat meals

45
Q

Voriconazole interacts with what

A

cytochrome P450

46
Q

Rifampin treats what

A

tuberculosis

47
Q

what does Rifampin do to Voriconazole

A

increases metabolism of V, so don’t give V to patients on Rifampin

48
Q

what happens with Voriconazole is given with Sirolimus

A

sirolimus concentration increases

49
Q

what is sirolimus used for

A

prevent organ rejection

immuno-suppresent

50
Q

Voriconazle has what adverse effects

A

visual disturbances

51
Q

Voriconazole is used for what disease

A
  • invasive aspergillosis

- candidiasis

52
Q

what does posaconazole treatt

A

Candida and aspergillus infections in severely compromised patients

53
Q

what is the mechanism of action for caspofungin

A

blocks fungal cell wall synthesis

- glycogen synthesis inhibitor

54
Q

is caspofungin acetate the first line of drug

A

no

55
Q

what are adverse effects of caspofungin acetate

A

phlebitis, headache, fever, increased LFT, SrCr needs to be monitered

56
Q

phlebitis

A

inflammation of walls of vein

57
Q

what is the mechanism of action for Griseofulvin

A

disrupts cell mitotic spindle structure

- arrested in metaphase

58
Q

how is Griseofulvin administered

A

orally

59
Q

how is Griseofulvin absorbed

A

microsize: variable- fat food increase

- ultramicrosize: completely absorbed

60
Q

Griseofulvin targets what in the body

A

dermatophytosis: fungal infection of skin

61
Q

how is Griseofulvin administered

A

orally, not topically

62
Q

what is the major side effect of Griseofulvin

A

headache/dizziness

63
Q

what is the mechanism of action for Terbinafine

A

inhibits squalene epoxidase

64
Q

what is squalene epoxidase

A

key enzyme in sterol biosynthesis in fungi

65
Q

what are 5 adverse effects of Terbinafine

A
  1. nausea/diarrhea
  2. hypersensitivity/rash
  3. liver enzyme abnormalities
  4. hematologic effects
  5. headache ( most common)
66
Q

Terbinafine treats what disease

A

onychomycosis

67
Q

Terbinafine is not recommended for what patients

A

liver or renal dysfunction

-pregnant women

68
Q

Terbinafine is just as effective as what other drug

A

itraconazole

69
Q

name treatments for Oral Candidiasis (thrush)

A

Nystatin

clotrimazole troches

70
Q

how is Nystatin administered

A

swished in mouth then swallowed

- no absorbed from GI

71
Q

severe Histoplasmosis

A

AmB

72
Q

moderate Histoplasmosis

A

Itr > Flu

73
Q

mild Histoplasmosis

A

Itr> Flu

74
Q

severe blastomycosis

A

AmB

75
Q

moderate blastomycosis

A

Itr > Flu

76
Q

mild blastomycosis

A

Itr> flu

77
Q

severe Candidiasis

A

AmB

78
Q

moderate Candidiasis

A

AmB or Flu or Cas

79
Q

mild Candidiasis

A

Flu or Cas

80
Q

Severe coccidioidomycosis ( meningeal, disseminated, pulmonary)

A

AmB/Flu
AmB> Flu
AmB >Flu

81
Q

moderate coccidioidomycosis ( meningeal, disseminated, pulmonary)

A

Flu
Azole
Azole

82
Q

Mild coccidioidomycosis ( meningeal, disseminated, pulmonary)

A

Flu
Azole
Azole

83
Q

Severe Aspergillosis

A

AmB

84
Q

moderate Aspergillosis

A

AmB > Itr

85
Q

mild Aspergillosis

A

Itr > AmB

86
Q

severe cryptococcal meningitis

A

AmB/5-FC

87
Q

moderate cryptococcal meningitis

A

Flu or AmB

88
Q

Mild cryptococcal meningitis

A

Flu

89
Q

following amphotericin B therapy for deep-seated candidisasis?

A

Fluconazole

flucytosine

90
Q

following amphotericin B therapy for cryptococcal meningitis

A

fluconazole

91
Q

following amphotericin B therapy for disseminated coccidioidomycosis

A

Fluc,

Itr

92
Q

following amphotericin B therapy for paracoccidioidomycosis

A

sufonamide

93
Q

following amphotericin B therapy for blastomycosis

A

Itr

94
Q

following amphotericin B therapy for Histoplasmosis

A

Itr

POD Exam 2 (28 decks)

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