Antifungals

Question 1

Types of anti fungal

Answer 1

TIPO

Triazole
Imidazole
Polyene

Other

Question 2

Examples of triazole

Answer 2

For systemic infections

Fluconazole
Itraconazole
Poscanozole
Voriconazole

Question 3

Examples of imidazol

Answer 3

Clotrimazole
Miconazole
Ketoconazole
Econazole

Treat skin and vagunal

Question 4

Polyene anti fungal examples

Answer 4

Nystatin (oral and skin infection)

Amphoterecin (IV) systemic infections

Question 5

Other antifungal examples

Answer 5

Terbinafene (skin and nails)

Griseofulvin

Question 6

Why is amphotericin brand specific

Answer 6

Different IV preps - liposomal, liposomal pegylated, lipid complex

Question 7

What monitoring with amphotericin

Answer 7

Renal - nephrotoxic
Hepatic
FBC

Question 8

What is fluconaze used for

Answer 8

Thrush - 150mg dose one off

Question 9

What is oral ketoconazole used for

Answer 9

Cushing syndrome - prevents release of cortisol so lowers cortisol but can cause hepatoxiciry

Question 10

Vorticonazole side effects

Answer 10

Skin cancer - lesions - avoid sunlight
Photosensitivity
Need to measure liver before weekly for a month then monthly

Question 11

Which patients must carry alert card

Answer 11

Those on voriconazole and they must report if they get skin burns asap to doctor

Question 12

Vorticonazole monitoring

Answer 12

Hepatic function before then weekly for a month then monthly

Question 13

Fluconazole side effects

Answer 13

QT prolongation
Skin reaction
Liver disease
GI probs
N&V

Question 14

Itraconazole side effects

Answer 14

Heart failure
Jaundice

Question 15

Itrazonazole interaction

Answer 15

With antacids
- the drug needs a acidic pH to work but antacids don’t do the opposite

Question 16

Which antibiotics to avoid with parental route

Answer 16

Neomycin and amphoterican

Question 17

Why to avoid fast infusion with amphiterican

Answer 17

Causes arrythmia

Question 18

Guidance on prescribing amphotwriocn

Answer 18

Administer dose and monitor for 30 mins as risk of anaphylaxis

Can give prophylactic antipyretics or steroids if patient previously had adverse reaction

Question 19

What to monitor with ketoconazole

Answer 19

ECG
Electrolytes (hyponatraemia, hypoglycaemia)

Hypotension
Anorexia
Vomiting
Hepatic disorders
Adrenal function

Question 20

Types of fungal infections

Answer 20

Tinea corpis - skin
Tinea pedis - athlete foot
Tinea unguim - fungal nail
Tinea capitis - scalp

Question 21

Treatment of tinea capitis

Answer 21

oral griseofulvin or terbinafine
Can add on topical ketoconazole (twice weekly for 2-4 weeks)

Imidizole cream under 5 daily for 1 week

If culture trichophyton tonsuran then continue terbinafine

If culture microsporum then use griseofulvin

Review after 4-8 weeks

Question 22

Treatment for athletes foot - tinea pedis

Answer 22

Topical miconazole, clotrinazole 1% or terbinafene

Can add hydrocortisone 1% daily for 7 days if inflammation

If doesn’t work then oral terbinafine or griseofulvin

Question 23

Duration of terbinafene 1%

Answer 23

12+
Apply 1-2 times a day for 7 days

Question 24

Duration of clotrimazole 1%

Answer 24

3/4 times daily for 4 weeks

Question 25

Duration of miconazole 2%

Answer 25

Twice daily for 2-6 weeks and cont for 10 days after lesion heal

Question 26

Duration of econazole 1%

Answer 26

BD until lesions heal