Antifungal Pharm

Question 1

Topical Azole Antifungal Drugs

Answer 1

Clotrimazole (Lotrimin) ointment; (Desenex) powder
Miconazole (Micatin, Monostat Derm)
Ketoconazole (Nizoral)

Question 2

Topical azole antifungals

Answer 2

Fungicidal

Impairs the formation of fungal cell membranes therefore increasing permeability
Intracellular contents leak out leading to cell death

Indications: Tinea corporis, tinea cruris, tinea pedis, cutaneous candidiasis

Question 3

Topical azole antifungals Contraindications

Answer 3

Pregnancy, lactation
Use with caution in liver failure
Ketoconazole not for use in asthma patients or history of sulfa allergy

Question 4

Clotrimazole

Answer 4

Cutaneous candidiasis (topical)
Vulvovaginal candidiasis (topical)
Oropharyngeal candidiasis (oral)

Contraindications:
Hypersensitivity to clotrimazole or any component of the formulation

Question 5

Mycostatin (Nystatin)

Answer 5

Indications: Cutaneous and mucocutaneous infections caused by Candidia
Oral and intestinal Candidia infections

MOA: Binds to sterols in fungal cell membrane and changes the cell wall permeability leading to leakage of intracellular contents

Question 6

Mycostatin adverse effects

Answer 6

Contact dermatitis
Stevens-Johnson syndrome

Oral
Nausea, vomiting, diarrhea

Question 7

Systemic Azole Antifungals

Answer 7

Ketoconazole (Nizoral)
Itraconazole (Sporanox)
Fluconazole (Diflucan)

Inhibit CYP450

Mechanism of action
Inhibit synthesis of ergosterol (cell membrane)

Question 8

Ketoconazole (Nizoral)

Answer 8

Rare cases of serious hepatotoxicity, including hepatic failure and death
Drug is used for nail fungus

Question 9

Itraconazole (Sporanox)

Answer 9

Aspergillosis
Blastomycosis
Esophageal and oropharyngeal candidiasis (oral soln)
Coccidioidomycosis
Histoplasmosis
Onychomycosis

Question 10

Itraconazole contraindications

Answer 10

Hypersensitivity
Concurrent administration with other CYP450 drugs
Ventricular dysfunction (negative inotrope)
CHF
Pregnancy or intend to become pregnant

Question 11

Fluconazole (Diflucan)

Answer 11

Blastomycosis (CNS disease)
Candidiasis
Coccidioidomycosis (Meningitis, pneumonia, prophylaxis)
Crypococcosis (Meningitis, pneumonia)

Question 12

Fluconazole contraindications

Answer 12

Hypersensitivity to fluconazole or other azoles

Coadministration of CYP3A4 substrates which may lead to QT prolongation (cisapride, primozide or quinidine)

Question 13

Systemic Allylamine Antifungals Terbinafine (Lamisil)

Answer 13

Oral/systemic formulation:
Oncychomycosis of the toenails, fingernails
Tinea capitis

Topical:
Tinea pedis
Tinea cruris
Tinea corporis

Question 14

Griseofulvin(Fungistatic)

Answer 14

Indications:
Used to treat tinea infections of the skin, hair and nails
Most commonly used for the treatment of tinea capitis

Question 15

Griseofulvin(Fungistatic) MOA

Answer 15

Inhibits fungal cell division

Binds to human keratin making it resistant to fungal invasion

Question 16

Griseofulvin(Fungistatic) Administration

Answer 16

Fatty meals (peanut butter or icecream) can increase GI absorption
With food or milk to decrease GI upset

Question 17

Contraindications and precautions with the administration of Griseofulvin.

Answer 17

Liver failure
Porphyria
Pregnancy (category X)
Use with caution if history of penicillin allergy as potential for cross reactivity
Breast feeding not recommended

Question 18

Amphotericin B(Fungicidal)

Answer 18

IV only

Indications: severe systemic and CNS infections that are progressive and potentially life threatening

SE: Anaphylaxis