antifungals

Question 1

mechanism of amphotericin B

Answer 1

binds to ergosterol in fungal cell membranes, increases the permeability

Question 2

mechanism of triazoles

Answer 2

inhibit 14-a-sterol demethylase, prevent ergosterol synthesis, leading to the accumulation of 14-a-methylsterols

Question 3

mechanism of echinocandins

Answer 3

inhibit formation of glucans in fungal cell wall

Question 4

amphotericin B renal damage

Answer 4

worse in sodium depletion

reduced by “sodium loading” using boluses of normal saline before and after AmB infusion

Question 5

voriconazole PK

Answer 5

non-linear PK

makes for challenging drug monitoring due to unpredictable nature of plasma conc vs time profile

Question 6

which azole is uniquely associated with phototoxicity & skin cancer

Answer 6

voriconazole

Question 7

rifampin causes a ______ of voriconazole and isavuconazole

Answer 7

decrease in AUC

Question 8

which formulation of amphotericin displays reduced rates of nephrotoxicity

Answer 8

liposomal

Question 9

where is fluconazole resistance most frequently observed

Answer 9

C. glabrata

universal in C. krusei

Question 10

what is the mechanism of ibrexafungerp

Answer 10

inhibits beta-1,3-D-glucan synthase, an essential component of the fungal cell wall (same target as echinocandins

Question 11

all azoles are inhibitors of _____

Answer 11

CYP3A4

Question 12

caspofungin drug interactions

Answer 12

tacrolimus

rifampin, phenytoin, dexamethasone (caspo dose increase)

Question 13

amphotericin drug interactions?

Answer 13

synergistic nephrotoxicity

Question 14

which drug is the exception to the azoles being eliminated via hepatic metabolism

Answer 14

fluconazole

Question 15

adverse effects of azoles

Answer 15

LFT elevations
QT prolongation

Question 16

which azole is administered with a high fat meal/nutritional supplement when given as an oral suspension

Answer 16

posaconazole

Question 17

which azole has a more pronounced increase in QT

Answer 17

isavuconazole

Question 18

which echinocandin is adjusted dose in severe hepatic dysfunction

Answer 18

caspofungin

Question 19

ibrexafungerp is presently only approved for ___

Answer 19

vulvovaginal candidiasis

Question 20

amphotericin B oral absorption

Answer 20

very poor– note the huge size of the molecule

Question 21

true/false: the conventional amphotericin formulations are interchangeable with lipid-based formulations

Answer 21

false