Antifungals

Question 0

Two names of polyenes

Answer 0

Nystatin ( topical)

Amphotericin

Question 1

MOA of these drugs is to bind ergosterol in fungal cell membrane leading to cell death

Answer 1

Polyenes

Question 2

Which candidia species is not sensitive to amB

Answer 2

C. lusitaniae ( lusitaniae sinks amB like the boat)

Question 3

Other formulations of AmB .. Which one has the least Nephrotoxicity and infusion rxn

Answer 3

Liposomal Amphotericin b ) LAmB

The amp b colloidal dispersion is the worst and worst than the conventional AmB . The lipid complex is ok but lamb is better

Question 6

This Azoles is used for onychomycosis

Answer 6

Itraconazole

Question 7

Amphotericin toxicities and pk and pd

Answer 7

(Bind ergosterols in cell wall)
SE: Nephrotoxicity
Electrolyte wasting
Infusion related reactions

• poorly absorbed that’s why given IV , high distribution ( low in CNS) , concentration dependent

Question 8

Inhibit fungal cytochrome p450 decreasing ergosterol formation

Answer 8

Azoles

Question 9

What is the spectrum for amp b

Answer 9

Candidia, cryptococcus neoformans , dimorphic fungi and many molds

Question 10

This Azoles doesn’t work against molds

Answer 10

Fluconazole

Question 11

Inhibit beta 1,3-glucan synthase

Answer 11

Echinocandins

Question 12

Azoles effective against ASPERGILLUS

Answer 12

Itraconazole , voriconazole

Question 14

What is flu console ineffective against

Answer 14

C. Glabrata, c. Krusei, ( glide and cruise past fluconazole) aspergillus and molds

Question 16

What is the big issue with Azoles

Answer 16

Drug interactions

Question 17

What Azoles can you use for fungal UTIs

Answer 17

Fluconazole - excreted renally

Question 18

Adverse reactions with Azoles

Answer 18

Hepatoxicity , rash and drug interactions

Question 19

This Azole can be used to treat aspergillus, dematiaceous molds and dimorphic fungi

Answer 19

Itraconazole

Question 20

Name the 5 major Azoles

Answer 20

Fluconazole, itraconazole,voriconazole , posaconazole, ketoconazole

Question 21

Azoles are fungicidal to what and fungi static to

Answer 21

Fungicidal to molds and fungistatic to yeast . They are time dependent

Question 22

This azole is used for invasive aspergillosis, invasive candidiasis, esophageal candidiasis and febrile neutropenia

Answer 22

Voriconazole

Question 23

This drugs SE are visual effects ( purple fringe on stuff, wiggly lines) to hepatotoxicity to visual hallucinations

Answer 23

Voriconazole

Question 24

This drugs main activity is against dermatophytes

Answer 24

Terbinafine

Question 25

Safe for use in pts with renal issues

Answer 25

Echinocandins ( caspofungin, micafungin, anidulafungin)

Question 26

Used in the treatment of candidiasis and prophylaxis but not c. kruseii and c. glabrata

Answer 26

Fluconazole

Question 27

What’s the spectrum of the echinocandins

Answer 27

Candida but weak against C. parapsilosis
Active against ASPERGILLUS

Ineffective again CRYPTOCOCCUS and many molds

Fungicidal vs yeasts and pseudo static vs molds ( makes weird balls that don’t reproduce but don’t die either )

Question 28

This azole was only approved for prophylaxis of fungal infections

Answer 28

Posaconazole

Question 29

Interesting facts about posaconazole

Answer 29

Must be eaten with high fat meal or acidic beverage . ( new IV and oral tablets just approved so won't use the suspension form anymore) Yeasts including candidia and cryptococcus Molds including aspergillus and zygomycetes

Question 30

Number 1 treatment for candida if susceptible

Answer 30

Fluconazole

Question 31

This drug inhibits squalene epoxidase preventing synthesis of ergosterol

Answer 31

Terbinafine

Question 33

Pharmokinetics and adverse effects of echinocandins

Answer 33

IV only - poor bioavailability No CNS distribution Not really eliminated Concentration dependent SE - very well tolerated rxns are rare Hepatotoxicity , infusion related rxn ( red man syndrome ) and phlebitis if given peripherally so give centrally.

Question 35

Ketoconazole

Answer 35

Poor oral absorption, used topically , occasionally orally. Don't use systemically

Question 36

Name the antimetabolite

Answer 36

5-flucytosine (5-FC)

Question 37

What is C. glabrata susceptible to

Answer 37

Flucytosine, and candins and kinda to AmB

Question 38

What is C. kruseii resistant or kinda resistant to

Answer 38

fluconazole itraconazole , 5-FC and can be resistant to AmB

Question 39

These drugs are used in combo therapy for cryptococcal meningitis

Answer 39

AmB and 5-FC

Question 40

This drug concentrates in the nails ,fat and skin

Answer 40

Terbinafine

Question 41

Where is terbinafine metabolized and excreted

Answer 41

40% bioavailable bc if 1st pass effect . Metabolized in liver but metabolites are excreted renally . Non linear elimination half life goes from 12 hrs to 200 hours after repeated dosing

Question 42

Terbinafines SE

Answer 42

Hepatotoxicity, neutropenia, Stevens-Johnson syndrome

Question 43

Inhibits fungal mitosis via interaction with microtubules

Answer 43

Griseofulvin

Question 44

All you need to know about griseofulvin

Answer 44

Used for dermatophytes BUT never use because headaches are very common

Question 45

What is c. lusitaniae resistant to

Answer 45

AmB

Question 47

What are the adverse effects of 5-FC

Answer 47

Bone marrow suppression - dose related | GI intolerance, rash, hepatotoxicity

Question 49

Used in onychomycosis

Answer 49

Terbinafine

Question 51

This azole has the worst side effects and Can cause heart failure, qt prolongation and the absorption is so bad you never really know if it was absorbed or not .

Answer 51

Itraconazole

Question 55

This is the number one treatment for aspergillus

Answer 55

Voriconazole

Question 57

Caspofungin , micafungin, anidulafungin

Answer 57

Echinocandins .. All work equally

Question 63

What is the big issue with voriconazole a pk

Answer 63

It's non- linear and there is a disproportional increase in concentration with increase in dose so be careful . It has a high intra and inter patient variability so might need to check the trough levels