Antifungal (Lec 20)

Question 1

Mold vs Yeast

Answer 1

mold = multicell fungi
yeast = single cell fungi

Question 2

superficial mycoses are?

Answer 2

fungi of outer layer of skin/hair

Question 3

cutaneous mycoses are?

Answer 3

fungi deeper into keratinized layer of

dermis/hair/nails

Question 4

subcutaneous mycoses are?

Answer 4

fungi of dermis, subcut, mm and fascia

Question 5

systemic mycoses from primary pathogens?

Answer 5

originate in lungs,

spread thru system

Question 6

systemic mycoses from opportunistic pathogens?

Answer 6

candidiasis
aspergillosis
cryptococcosis

Question 7

Antifungals mechanism?

Answer 7

target memb or cell wall

Question 8

Amphotericin B mechanism?

Answer 8

interacts w/ ergosterol in memb making pores

Question 9

Amphotericin B spectrum?

Answer 9

broad

Question 10

Amphotericin B DOC for?

Answer 10

systemic infections

Question 11

Amphotericin B administered?

Answer 11

IV

Question 12

Amphotericin B side-effects?

Answer 12

nephrotoxicity due to:
infusion of drug
rxn occurring over time

Question 13

Amphotericin B toxicity from infusion sxs?

Answer 13

flu-like

Question 14

Amphotericin B toxicity over time?

Answer 14

cumulative azotemia (increased amounts of nitrogenous waste):
BUN and creatinine
= kidney damage

Question 15

Flucytosine mechanism?

Answer 15

becomes 5-fluorouracil ->

θ DNA,RNA synth

Question 16

Flucytosine active against?

Answer 16

cryptococcus neoformansº

Question 17

Flucytosine DOC?

Answer 17

(+ amphotericin B)

cryptococcus infections

Question 18

Flucytosine side-effects?

Answer 18

↓ bone marrow

↑ liver enzymes

Question 19

Azole antifungals?

Answer 19

Ketoconazole (Nizoral)
Fluconazole (Diflucan)
Voriconazole (Vfend)
Itraconazole (Sporonox)

Question 20

Azole mechanism?

Answer 20

inhibit synth of ergosterol (in memb)

Question 21

Ketoconazole spectrum?

Answer 21

broad

Question 22

Ketoconazole side-effects?

Answer 22

gynecomastia

drug interactions from P450 inhibition

Question 23

Fluconazole penetration?

Answer 23

good into body fluids, esp CSF (tx meningitis)

Question 24

Fluconazole side-effects?

Answer 24

better tolerated than other azoles

Question 25

Fluconazole administered?

Answer 25

oral

IV

Question 26

Voriconazole active against?

Answer 26

fungus

molds

Question 27

Voriconazole DOC for?

Answer 27

aspergillus w/ ampho B

* ºtreatment of invasive aspergillosis

Question 28

Voriconazole side-effects?

Answer 28

drug interactions
visual impairments (reversible)

Question 29

Itraconazole active against?

Answer 29

same as others

Question 30

Itraconazole elimination?

Answer 30

hepatic metabolism

Question 31

Echinocandin drugs?

Answer 31

Caspofungin
Micafungin
Anidulafungin

Question 32

Echinocandins mechanism?

Answer 32

inhibits β(1,3)-D-glucan in cell wall

Question 33

Caspofungin active against?

Answer 33

aspergillosis in refractory pts

Question 34

Caspofungin side-effects?

Answer 34

mild

(P) ↑ liver enzymes

Question 35

Caspofungin administration?

Answer 35

IV

Question 36

Onychomycosis is?

Answer 36

Candida dermatophytes (ringworm) of the nails

Question 37

Griseofluvin mechanism?

Answer 37

binds to keratin where:
binds microtubules of fungi ->
destroys spindle structure

Question 38

Griseofluvin active against?

Answer 38

ringworm of skin, hair, nails

Question 39

Griseofluvin DOC for?

Answer 39

onychomycosis

Question 40

Griseofluvin length of tx?

Answer 40

6 mo - 1 yr

Question 41

Griseofluvin side-effects?

Answer 41

GI
CNS
hematological

Question 42

Griseofluvin contraindicated?

Answer 42

acute intermittent porphyria

hepatocellular failure

Question 43

Terbinafine active against?

Answer 43

dermatophytes

Question 44

Terbinafine mechanism?

Answer 44

interferes w/ sterol synth

Question 45

Nystatin used to tx?

Answer 45

orally - GI candida

topically - other candida