Antifungals

Question 1

Aspergillosis first and second line

Answer 1

Voriconazole

2nd Liposomal ampotericin b

Question 2

Treatment of invasive aspergillosis who are refractory to or intolerant of itraconazole or amphotericin b

Answer 2

Posiconazole

Question 3

Aspergillosis treatment when intolerant to voriconazole or liposomal amptoericin b

Answer 3

Caspofungin or itraconazole

Question 4

Types of antifungals

Answer 4

Imidazoles - clotrimazole, econazole nitrate, ketoconazole, miconazole and tioconazole

Echinocandin - caspofungin Micafungin, anidulafungin

Polyenes -amphotericin b and nystatin

Question 5

MHRA safety warning for amphotericin

Answer 5

specify between liposomal, pegylated liposomal, lipid complex and conventional formulation
not interchangable
serious harm and fatal overdose can occur
verify before administration

Question 6

triazole antifungals

Answer 6

fluconazole, isavuconazole, itraconazole, posaconazole, voriconazole

Question 7

risk of heart failure and hepatoxicity in

Answer 7

itraconazole and should be avoided in patients with ventricular dysfunction

discontinue with signs of hepatitis jaundice , abdomen pain ,anaorexia, N+V, fatigue

Question 8

voriconazole risks of

Answer 8

hepatoxicity and phototoxicity
hepatitis, cholestatic jaundice and acute hepatic failure reported
discontinue with severe abnormalities in LFTs

LFTS measured before treatments 1 weeks and monthly

photoxoicity - consider discontinue
monitor for premalignant skin lesions and squamous cell carcinomas - discontinue if these occur

avoid direct sunlight and sunbeams
cover unexposed skin and use high factor SPF
sunburn or skin reaction -medical attention

Question 9

Vaginal candidiasis may be treated with

Answer 9

ocally acting antifungals or with fluconazole given by mouth; for resistant organisms in adults, itraconazole can be given by mouth.

Question 10

Oropharyngeal candidiasis generally responds to

Answer 10

topical therapy; fluconazole is given by mouth for unresponsive infections; it is effective and is reliably absorbed. Itraconazole may be used for infections that do not respond to fluconazole. Topical therapy may not be adequate in immunocompromised patients and an oral triazole antifungal is preferred.

Question 11

Mild localised fungal infections of the skin (including tinea corporis, tinea cruris, and tinea pedis) respond

Answer 11

topical therapy:

Question 12

Tinea capitis is treated

Answer 12

systemically : griseofulvin

terbinafine can be used

Question 13

Oral terbinafine is not effective for

Answer 13

pityriasis versicolor.

Question 14

systemic treatment of onychomycosis,

Answer 14

Terbinafine and itraconazole have largely replaced griseofulvin

Question 15

candiduria

Answer 15

presence of candidiasis in the urine treated with oral fluconazole

Question 16

which triazole is associated with liver damage

Answer 16

Itraconazole has been associated with liver damage and should be avoided or used with caution in patients with liver disease;

Question 17

griseofulvin is used for

Answer 17

ffective for widespread or intractable dermatophyte infections but has been superseded by newer antifungals, particularly for nail infections. It is the drug of choice for trichophyton infections in children. Duration of therapy is dependent on the site of the infection and may extend to a number of months.

Question 18

terbinafine is used for

Answer 18

e drug of choice for fungal nail infections and is also used for ringworm infections where oral treatment is considered appropriate.