Antifungals

Question 1

What antifungals are used to treat aspergillosis (first line)

Answer 1

Voriconazole, amphotericin

Question 2

What antifungals are used to treat aspergillosis (intolerant to first-line)?

Answer 2

Caspofungin, itraconazole, posaconazole

Question 3

First line and alternatives to treat vaginal candidiasis treatment?

Answer 3

Fluconazole (first line) or itraconazole or voriconazole (if resistant)

Question 4

What is used to treat invasive or disseminated candidiasis?

Answer 4

Echinocandin

Question 5

What is used to treat CNS candidiasis?

Answer 5

Amphotericin

Question 6

What is the treatment for cryptococcosis mengingitis?

Answer 6

Amphotericin and flucytosine for 2 weeks then oral fluconazole for 8 weeks

Question 7

What is the treatment for histoplasmosis (non-meningeal and severe)?

Answer 7

Itraconazole (non-meningeal) or amphotericin (severe) followed by itraconazole

Question 8

Can oral terbinafine be used for pityriasis versicolor?

Answer 8

No

Question 9

What is used to treat for tinea capitis and onychomycosis?

Answer 9

Griseofulvin, triazole antifungals, oral imidazole and terbinafine

Question 10

What is used to treat prophylaxis in immunocompromised patients (fungal)?

Answer 10

Fluconazole (not against Aspergillus spp.), itraconazole (effective against Aspergillus)

Question 11

What is caspofungin not effective against?

Answer 11

Fungal infections of the CNS

Question 12

What can fluconazole be used to treat?

Answer 12

Fungal meningitis and candiduria (excreted largely unchanged in the urine)

Question 13

When should itraconazole be avoided?

Answer 13

In patients with liver damage

Question 14

What is posaconazole used to treat?

Answer 14

Invasive fungal infections unresponsive to conventional treatments

Question 15

What is voriconazole used to treat?

Answer 15

Life-threatening fungal infections

Question 16

What medications belong to the class of amidazole antifungals?

Answer 16

Clotrimazole, econazole, ketoconazole, ticonazole and miconazole

Question 17

What are amidazole antifungals used to treat?

Answer 17

Vaginal candidiasis and dermatophyte infections

Question 18

List polyene antifungals.

Answer 18

Amphotericin and nystatin

Question 19

What cautions should be taken with amphotericin’s formulation?

Answer 19

There are lipid formulations of amphotericin as well as a conventional formulation. Lipid formulations are less toxic. The conventional formulation is associated with nephrotoxicity. These formulations are NOT interchangeable.

Question 20

List echinocandin antifungals.

Answer 20

Caspfungin and micafungin

Question 21

What are echinocandin antifungals used against?

Answer 21

Asperigillus spp. and Candida spp. They are not effective against fungal infections of the CNS.

Question 22

Caspofungins are recommended to be used with what type of drugs?

Answer 22

Enzyme inducers such as carbamazepine, dexamethasone, phenytoin and rifampicin

Question 23

What dose adjustments are recommended with caspofungin?

Answer 23

Half the dose in moderate (renal) impairment

Question 24

What are the indications of amphotericin?

Answer 24

Aspergillosis, severe invasive candidiasis, cryptococcal meningitis and disseminated cryptoccocis in HIV patients

Question 25

What are the monitoring requirements for amphotericin?

Answer 25

Hepatic and renal function tests, blood counts, and plasma electrolyte (including plasma-potassium and magnesium concentration)

Question 26

When should amphotericin be discontinued?

Answer 26

Abnormal hepatic function

Question 27

What is the licensing for fluconazole capsules OTC?

Answer 27

Age: 16-60 Indication: Vaginal candidiasis and candidal balanitis Dose/container: 150mg, max dose of 150mg.

Question 28

What are the indications of fluconazole?

Answer 28

Vaginal candidiasis, candidal balanitis, mucosal candidiasis, dermal candidiasis Invasive candidal infections Cryptococcocal infections (including meningitis) Tinea pedis, corporis, cruris

Question 29

What are the indications of isavuconazole?

Answer 29

Invasive aspergillosis

Question 30

What are the indications of itraconazole?

Answer 30

``` Aspergillosis Histoplasmosis Cryptococcosis (inc. meningitis) Onychomycosis Pityriasis versicolor Systemic candidiasis Oral or oesophageal candidiasis in HIV+ Tinea pedis and manuum (30 days/7 days) Tinea corporis and cruris (15 days/7 days) ```

Question 31

What should patients be advised when taking itraconazole?

Answer 31

Seek prompt medication attention if symptoms such as anorexia, nausea, vomiting, fatigue, abdominal pain or dark urine develop (indicative of liver disorder)