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Pharm > Antifungals > Flashcards

Antifungals Flashcards

1
Q

Antifungals

A
  1. Candidiasis
  2. Coccidiodomycosis
  3. Cryptococcosis
  4. Histoplasmosis
  5. Pneumocystis
  6. Blastomycosis
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2
Q

Categories of antifungals

A

Systemic drugs for systemic infections:
* Amphotericin B
* Flucytosine
* Azoles-> Triazoles and Imidazoles
* Echinocandins

Oral systemic for mucocutaneous infections
* Greiseofulvin
* Terbinafine

Topical drugs for mucocutaneous infections
* Nystatin
* topical azoles->Clotrimazole and Miconazole
* Topical allylamines-> Terbinafine and naftifine

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3
Q

Diagnosis of fungal diseases

A
  • Clinical symptoms
  • serologic testing
  • histopathologic examination
  • culture of clinical specimens
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4
Q

Fungi vs Bacteria

A

Bacteria: cell wall of peptidoglycan
Fungi:
* cell wall of chitin and other polysaccharides
* Eukaryotic-> ribosomes and dna-> similar to human cells and not a good drug target
* Cell membranes= ergosterol not cholesterol thus a drug target

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5
Q

Overall targets

A
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6
Q

Amphotericin B

IV

A

MOA: disrupts cell wall-> electrolyte channel
Activity: most candida, aspergillus, mucorales, endemic mycoses
AE: Infusion, transient Nephrotoxicity, electrolyte abnormalities
ORAL DOC FOR PREGNANCY

USE FOR SERIOUS AND LIFE THREATENING

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7
Q

Flucytosine

A

MOA: interfering both dna and protein synth-> inside cell wall
USE: COMBO WITH AMPHOTERICIN B BC MONOTHERAPY IS HIGHLY RESTRICTED
avoid in pregnancy
AE: hematologic (high rbc), hepatitis, GI- n/v/d

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8
Q

Azoles

A
  1. Imidazoles
    * Ketoconazole- topical
    * Miconazole- topical
    * Clotrimazole-topical
  2. Triazoles (all oral)
    * Itraconazole
    * Fluconazole
    * Voriconazole
    * Isavuconazole
    * Posaconazole
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9
Q

Azoles general

A

Moa: cell membrane damage
AE: GI hepatotoxicity
avoid in prego
drug interactions: with CYP450

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10
Q

Imidazoles

A
  1. Clotrimazole- Myclex, Lotrimin
  2. Miconazole
  3. Ketoconazole
  4. Butoconazole
  5. Terconazole

spectrum against candida

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11
Q

Triazoles

A
  1. Itraconazole- BLASTOMYCOSIS, HISTOPLASMOSIS, SPOROTHRIX, risk of severe CHF- poor penetration into CSF
  2. Fluconazole-increased risk of miscarriage, GOOD CSF penetration
  3. Voriconazole- Primary for INVASIVE ASPERGILLOSIS with statins, cyclosporine, tacrolimus- HEPATOTOXIC, SKIN RASHES, SKIN CANCER SURVEILLANCE
  4. Isavuconazole- prodrug
  5. Posaconazole-prophylaxis for those with prolonged neutropenia - against candidiasis and aspergillosis

Drug interactions: Warfarin, oral hypoglycemics, benzodiazepines

NOT FOR PREGO

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12
Q

Imidazoles and triazoles AE

A

Itraconazole- hepatic failure and death
Fluconazole- Nausea, headache, rash, vomiting, SKELETAL AND CARDIAC DEFORMITIES IN INFANTS FROM PREGNANCY
Voriconazole- teratogenic, hepatotoxic, prolonged QT interval, visual and auditory hallucinations

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13
Q

Echinocandins

A
  1. Capsofungin- dissem and mucocut candidal infxn-> febrile neutropenia empiric
  2. Mycofungin- mucocutan candidiasis, and prophylaxis candida infxn in bm transplant
  3. Anidulafungin- esophageal candidiasis and invasive candidiasis
    MOA: inhibit beta d glucan synth
    AE: hepatotoxicity, inj site reactions, renal toxicities, cardiac toxic
    Fungicidal

no research on pregnancy

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14
Q

Griseofulvin

A

MOA: inhibit microtubule fxn-> mitotic spindle
binds to keratin precursor cells-> prolonged resistance to fungal invasion
Narrow antifungal spectrum, low clinical efficacy, prolonged duration
Spectrum: Dermatophytes- microsporum, epidermophyton, trichophyton-> common skin infxn (Tinea corpus, capitus, pedes, unguium, cruris)
AE: Headache, leukopenia, neutropenia, basophilia, monocytosis-> CHECK CBC, efficacy of combination oral contraceptive agents= reduce it

NOT OKAY IN PREGNANCY

FATTY MEAL FOR ABSORPTION

TX HAIR SKIN AND NAILS

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15
Q

Terbinafine

A
  • most commonly used topical drug for cutaneous dermatophyte infxn
  • ORAL FOR TINEA UNGUIUM (NAIL)
  • AVAILABLE OTC
  • MOA: reduce ergosterol biosynth
  • AE: LFTS MUST BE MONITORED DURING ORAL TX, rare toxic

Not for prego

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16
Q

Nystatin

A

MOA: induce membrane permeability-> intracellular leakage and cell death
Spectrum: candida, cryptococcus, histoplasma, coccidioides
AE: n/v/d
Uses: Oral thrush, Topical, Vaginal infxn

17
Q

Thrush tx

A
  1. Nystatin
  2. Clotrimazole troches
  3. Fluconazole
18
Q

1st line tx of fungal diseases

A
  1. Histoplasmosis- amphotericin
  2. Blastomycosis- self limited
  3. Coccidiodomycosis- extrapulmonary disease- amphotericin b and meningitis is fluconazole
  4. Crytococcosiss- Amphotericin B with flucytosine
  5. Candida- depends on location
  6. Aspergillosis- Voriconazole
19
Q

Yeast infection

A

OTC: gyne-lotrimin, monistat
uncomp: Fluconazole
Complicated: Fluconazole, Nystatin, Amophotericin B or Flucytosine
Prego: imidazole vaginally

20
Q

Combination topicals

A

fungal infxn with inflamm dermatitis
Ex: Lotrisone= clotrimazole and betathasone or Mycolog 2- nystatin and traimcinolone

21
Q

Malaria Plasmodium overall

A
  • immigrants or people from endemic countries
    1. Chloroquine drug of choice, resistance growing but prophylax for Caribbean/CA
    2. Quinin/quinidine- kills schizonts-> increasing resistance seen
22
Q

Plasmodium species

A
  1. P. falciparum
  2. P. Vivax
  3. P. Malariae
  4. P. Ovale
23
Q

Prophylaxis for malaria

A

Chloroquine- for susceptible
Doxycycline

24
Q

Metronidazole (Flagyl)

A

Antibiotic, antiprotozoal, antiparasitic- broad spectrum
some anaerobic coverage
MOA: loss of helical dna-> breakage
Contraind: PREGNANCY AND USE OF DISULFRAM WITHIN PAST 2 WKS

Care with anticoags and dilantin

25
Q

Metronidazole indications

Flagyl

A
  1. Amebiasis
  2. BVaginosis due to Gardnerella
  3. Diverticulitis
  4. gyn assoc pelvic infxn
  5. trichomoniasis
  6. CDiff assoc diarrhea
  7. Giardiasis
  8. Surgical site infxn
26
Q

Bacterial vaginosis

A

Itchy, redness, gray white or yellow discharge, fishy smell, vaginal bleeding after sex

Metronidazole
if allergic: Clindamycin cream

27
Q

Strawberry red cervix

A

Trichomonas infxn

28
Q

Diarrhea, abdominal pain-> Giardia

A
  1. Tinidazole
  2. Metronidazole used off label

untreated water/pools in kids

29
Q

Metronidazole/tinidazole patient education

A
  • metallic taste
  • ALCOHOL WILL MAKE YOU SICK
  • MC nausea
  • avoid propylene glycol products-> soft drinks, sweet tea, artificial sweeteners, marinades and dressings, frosting, food colorings, baked goods
30
Q

SE of anti parasitics

A
  • GI
  • peripheral neuropathies
  • flushing
  • headache
  • hematuria
  • hypotension
  • myelosuppression
31
Q

Helminthes

A
  1. Cysticerscosis
  2. Neurocysticercosis

Uncooked pork
Caused by tapeworm Taenia solium
complication: invasions in CNS

TX:
1. Neurocystercosis 1st with surgery
2. Helminth second + Albendazole

32
Q

Albendazole

Antihelminthic

A

MOA: degeneration of cytoplasmic microtubules in intestinal cells of helminths
warning: Bone marrow suppression and transaminase elevates
NOT FOR PREGNANCY IN 1ST TRIMESTER
SE: INCREASED INTRACRANIAL PRESSURE, alopecia, nausea, fever
Followup mri every 6 months for cystic lesions resolution

33
Q

Pinworms

A

Mebendazole
2nd line: Albendazole- safe, minimal SE
DOC for ascariasis, enterobius
PT ed: shower, clena laundry
* keep fingernails short, children wash their hands

1st line: Pyrantel pamoate (Pin-X)- otc

34
Q

Ectoparasites

Pediculosis (lice) and scabies

A

insecticides
scabies- intense itching in fingerwebs and feet, burrow underskin and channel
1. Permethrin cream- kids over 2 months- kills scabies mite and eggs (DOC FOR SCABIES)
2. Oral ivermectin- over 30% of body area
3. crotamiton lotion- adults
4. sulfur ointment- children under 2 months
5. Lindane lotion- toxic to nervous system- only for tx failures

35
Q

Scabies and adjunctive measures

A
  • tx rec for all household members at the same time
  • bedding adn clothing during 3 days b4 tx should be washed and dried
  • or store in closed plastic bag for several days to a week
  • can return to work, child care, school, work the day after tx
36
Q

Lice infestation

Pediculosis and Pthiriasis

A
  1. Launder all used in last 2 days in hot water
  2. plastic bag for 2 weeks
  3. vacuum
  4. rinse all pediculicides from hair over a sink
37
Q

Pediculosis and pubic lice OTC

A
  1. Pyrethrins with piperonyl butoxid-> kills only live lice not unhatched eggs- 2 yrs and older
  2. Permethrin lotion 1%- kill live not eggs (nits), 2 months and older
38
Q

lice prescription tx

A
  1. Benzyl alcohol lotion 5%- kills lice but not eggs $$$
  2. Ivermectin lotion 0.5%-prevents new hatched lice from surviving
  3. Malathion lotion 0.5%- kills lice and partially ovicidal
  4. Spinosad 0.9% topical suspension- kills lice and eggs $$$$$
39
Q

Pneumocystis Jirovecii (carinii) Pneumonia (PJP)

MC OI in pts with AIDS

80% will have pjp at some point

A

Fungus with protozoan characteristics
SXS: fever, dyspnea, tachypnea, rales/rhonchi, nonproductive cough
DX: identification of organism in induced sputum or specimen
untreated= dead
TX: Trimethoprim-sulfamethoxazole (cotrimoxazole)

Pharm (9 decks)

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