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Pharmacology > Antifungals > Flashcards

Antifungals Flashcards

1
Q

Is griseofulvin fungistatic or fungicidal?

A

Fungistatic

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2
Q

What are the contraindications to griseofulvin?

A

Hypersensitivity
Pregnancy (Cat D) / lactation
- Males can’t father children 6 months
Severe liver disease
Photosensitivity disorders e.g. SLE

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3
Q

How is griseofulvin dosed in adults and children?
What dosing instructions should be given?

A

Adults: 500mg-1g daily (pedis, nails)
Children: 20mg/kg/daily (max 1g daily)
Take after meal with milk

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4
Q

What drug interactions occur with griseofulvin?

A

Antacids/H2 antagonists (reduced absorption)
Alcohol (disulfuram like reaction)

Griseofulvin reduces concentration of OCP & Warfarin (CYP450 enzyme inducer)

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5
Q

What are the adverse effects of griseofulvin?

A

Common: GI effects, dysguesia, headache, photosensitivity, menstrual irregularities, liver disturbance, blurred vision, teratogenicity

Serious: TEN, SLE, leukopenia, serum sickness-like reaction

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6
Q

What is the MOA of griseofulvin?

A

Disrupts fungal cell microtubule function

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7
Q

What are the contraindications to terbinafine?

A

Hypersensitivity
Lactation
Severe liver disease
Psoriasis
Lupus erythematous
Renal insufficiency (CrCl <50) —> 125mg daily

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8
Q

How is terbinafine metabolised and what drugs interact with it?

A

CYP2D6

SSRI, MAOi, TCA, antipsychotics, doxepin

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9
Q

What are the side effects of terbinafine?

A

Common:
GI effects
Headache, dizziness, arthralgia, fatigue
Skin rash, pruritus
Dysgeusia
Deranged LFTs

Rare/serious: lupus erythematosus, photosensitivity, psoriasis, SJS/TEN, alopecia, pancreatitis, liver failure, cytopaenias

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10
Q

What is the pregnancy category,
And can Terbinafine be used in pregnancy and/or lactation?

A

Category B1

Pregnancy - Yes
Lactation - No

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11
Q

What is the weight-based dosing of terbinafine in children?

A

> 40kg 250mg daily
20-40kg 125mg daily
10-20kg 62.5mg daily

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12
Q

What is the MOA of fluconazole?

A

Blocks synthesis of ergosterol (component of the fungal cell wall)

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13
Q

What are the contraindications to fluconazole?

A

Hypersensitivity
Pregnancy/lactation
Severe hepatic or renal disease
Cardiac disease
- heart failure
- QT prolongation
- dysthymias

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14
Q

What are the adverse effects of fluconazole?

A

GI effects, headache
Hepatotoxicity
QT prolongation
SCAR
Anaphylaxis

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15
Q

How is fluconazole dosed in
a. Onychomycosis
b. Tinea
c. Pityriasis versicolor
d. Candidiasis

A

a. 150mg weekly (6-9 months fingernails and 12-18 months toenails)

b/c. 150mg weekly or 50mg daily for 2-6 weeks

D. 150mg stat, can repeat 3 days later

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16
Q

What is the MOA of itraconazole?

A

Blocks ergosterol synthesis

Fungistatic

17
Q

What are the contraindications to itraconazole?

A

Hypersensitivity
Pregnancy
Severe liver disease
Cardiac
- congestive heart failure
- QT prolongation
- dysrhythmias

18
Q

What are the drug interactions for itraconazole?

A

CYP3A4 substrates/inducers/inhibitors
Drugs that
- prolong QT
- anti-arrythmics
- reduce cardiac output/heart rate

19
Q

What are the adverse effects of itraconazole?

A

Common: GI effects, headache, URTI sx, transaminitis, hyperlipid/triglyceridemia

Rare/serious:
Skin: EM/SJS/TEN, leukocytoclastic vasculitis, urticaria/angiooedema
CNS: insomnia, somnolence, peripheral neuropathy
Endo: gynaecomastia, impotence
CVS: hypertension, CCF, APO
GI: hepatitis, pancreatitis
Haem: cytopaenias

20
Q

How is itraconazole dosed?
a. Fungal nail infection
b. Tinea corporis
c. Pityriasis versicolor
d. VV candidiasis

A

a.
Regular: 200mg daily 3 months
Pulse: 200mg twice daily for 1 week per month for 2-4 months
b. 200mg twice daily for 1 week
c. 200mg daily for 1 week
d. 200mg daily for 3 days

21
Q

What baseline and ongoing monitoring is required for itraconazole?

A

Baseline: LFTs
Follow-up: LFTs every 4-6 weeks

Pharmacology (13 decks)

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