Antifungals

Question 1

binds to ergosterol and creates a pore
often used before treatment with an azole
adverse: nephrotoxicity, hypotension/hypertension, hypokalemia, fever, chills, hypoxia

Answer 1

amphotericin B

Question 2

inhibits 14-alpha-sterol demethylase, impairing synthesis of ergosterol

Answer 2

Azoles

Itraconazole
ketoconazole
fluconazole
voriconazole
posaconazole

Question 3

deaminated to 5-fluorouracil and 5-FUMP is incorporated into RNA
may also be metabolized to 5-Fdump which inhibits TS impairing DNA synthesis
Adverse: bone marrow depression
Resistance: can be rapid & is by decreased activity of fungal deaminases or permeases

Answer 3

flucytosine

Question 4

DOC for coccidioidal meningitis

Answer 4

fluconazole -> diffuses into body fluids, including sputum & has fewest interactions with liver CYPs

Question 5

which azole is associated with serious hepatotoxicity?

Answer 5

itraconazole

DOC for P bransiliensis, C immitis, B dematitidis, H capsulatum

Question 6

which azole is associated with narrow spectrum & many adverse effects (inhibition of CYP450 & decreasing the effects of other drugs)

Answer 6

ketoconazole

Question 7

used for aspergillosis and pneumocystis

Adverse: teratogen; interferes with oral birth control

Answer 7

voriconazole