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Year 1: Patho/Pharm > AntiFungals > Flashcards

AntiFungals Flashcards

1
Q

3 Forms of Fungi

A
  1. Yeast (Ex. Candidia)
  2. Dimorphic fungi (Ex. histoplasmosis)
  3. Molds (Ex. Aspergillus)
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2
Q

Antifungal medications

A
  1. Azoles
    - Clotrimazole
    - fluconazole
    - ketoconazole
    - miconazole
    - terconazole
    - efinaconazole
  2. Polyenes
    - Nystatin
  3. Other
    - Terbinafine
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3
Q

Azoles
Mechanism of action

A

Inhibition CYP450

Inhibit synthesis of ergosterol (required for cell membrane)

Disrupt fungal cell membrane

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4
Q

Polyene
Mechanism of action

A

Binds to ergosterol and disrupts the fungal cell membrane

Fungal cell membrane leaks cations (potassium)

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5
Q

SE of Azoles

A

Prolonged QT interval

Cardiac suppression (Fatal - Irtaconazole)

Hepatic necrosis (Fatal - Ketoconazole)

Stephen Johnsons Syndrome, hypersensitivities

Nausea, vomiting, HA, visual disturbances

Rashes, topical irritation and erythema

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6
Q

Azole contraindications

A

Cardiac disease (QT interval, Irtaconozole - cardiac supression)

Liver disease (Ketoconazole)

Pregnancy (Avoid systemic antifungals)

Do not breast feed on ketoconazole due to hepatotoxicity

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7
Q

Azole Drug interactions

A

Inhibits CYP3A4
- phenytoin, carbamazepine, warfarin, digoxin toxicity

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8
Q

Azole Monitoring

A

Assess for
- pregnancy
- liver disease
- cardiac disease

Pre-monitoring
- Liver enzymes
- ECG for QT interval (or QT prolonging drugs)

Education
- Monitor for S&S of liver failure, rash/SJS,

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9
Q

Azole coverage

A

Systemic and superficial mycoses infections

Ketoconazole - systemic mycoses in patients not tolerant of amphotericin B

Fluconazole - candidiasis, histoplasmosis (yeast and dimorphic)

Irtaconazole - aspergillus, histoplasmosis/blastomycosis (molds and dimorphic)

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10
Q

Polyene antibiotics

A

Nystatin PO

Amphotericin B (IV)

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11
Q

Amphotericin B mechanism of action

A

Binds ergosterol
disrupts fungal cell membrane, leaks

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12
Q

Amphotericin B SE

A

All patients experience

  1. Infusion reactions
    - Fever, chills, nausea, HA

Pre-treatment with : diphenhydramine and tylenol

  1. Renal toxicity
    - Total dosage < 4g

Pre-treatment with:
1L NS during infusion

  1. Bone marrow supression

*Stays in body years later

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13
Q

Amphotericin B pre-treatment and monitoring

A

CBC
WBC
CrCl and BUN

SE:
- Bone marrow suppression
- renal toxicity

Acetaminophen
1L NS

SE:
Infusion reaction rigors, fever, HA and nephrotoxicity

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14
Q

Alternative prescription if the patient does not tolerate amphotericin

A

Ketoconazole PO
Monitor for fatal hepatotoxicity

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15
Q

Amphotericin B drug interactions and contraindications

A

Caution in prescribing nephrotoxic drugs

  • NSAIDS
  • glucocorticoids/cyclosporins
  • nephrotoxic antibiotics (Ex. vancomycin, aminoglycosides (tobramycin, gentamycin, amikacin, etc.)
  • MRI/CT contrast agents
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16
Q

Which anti-fungal medication is given only in life threatening situations

A

Amphotericin B

17
Q

Why do Azoles have more SE than terbinifine ?

A

Azoles bind ergosterol which is similar in structure to cholesterol

Inhibits CYP450

Eukaryotic cell is similar to the human cell (cholesterol and CYP450)

18
Q

Examples Yeast Infections

A

Candidia

Dermatophyte (Tinea = ring worm)

19
Q

Different locations of Tinea infections

A

Tinea corpus (body)

Tinea capitus (hair/scalp)

Tinea onychomycosis (nails)

Tinea pedis (foot)

Tinea Versicolour (body)

Tinea Cruris (Jock)

20
Q

Terbinafine mechanism of action

A

Inhibits squaline epoxide

accumulation of squaline in the fungal cells results in cell death

*less SE

21
Q

Terbinafine SE

A

Hepatotoxicity

HA, N/V, GI upset, Rash

Sensory disturbances - smell, taste, hearing

22
Q

Which Tinea infections require systemic vs. topical treatments

A

Tinea capitus (scalp)

Tinea Onychomycoses (nails)

Treatment:
Oral terbinafine
Oral griseofulvin

23
Q

Griseofulvin mechanism of action

A

deposits in kerokinocytes of hair and nails

inhibits microtubules and mitosis

hair and nails grows in resistant to fungus

24
Q

Nystatin mechanism of action

A

Polyene anti-fungal

Binds to ergosterol and disrupts fungal cell membrane

*Not absorbed systemically

25
Q

Why is Nystatin not as effective

A

Only targets candidia

Not absorbed systemically

26
Q

Nystatin spectrum

A

Candidia

27
Q

Azole spectrum

A

Yeast
Dimorphic fungi
- Fluconazole
- ketoconazole

Molds
- ketoconazole
- irtaconazole

28
Q

Amphotericin B spectrum

A

Yeast
Dimorphic fungi
Molds
Systemic infections, life threatening

29
Q

SE Nystatin

A

GI Upset in high dosages

30
Q

What is Gentian Violet

A

Caution patients
Known to cause cancer
Naturalist solution to fungal infection

31
Q

Yeast infection transmission

A
  • mastitis
  • oral thrush in newborns
  • STI

Year 1: Patho/Pharm (39 decks)

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