Antifungals

Question 0

Amph B SE

Answer 0

Azolemia: increased creatinine
Nephrotoxic
Can lead to irrevers kidney damage

Question 1

Amphotericin B

Answer 1

Broad
Systemic
No CSF

Question 2

Azolemia is a side effect of

Answer 2

Amph B

increased creatinine

Question 3

Does renal and hepatic impairement interfere with Amph B dosing?

Answer 3

No

Question 4

Amph B MOA

Answer 4

binds to ERGOSTEROL (but doesn’t inhibit its synthesis) - and creates pores - depolarization)

Question 5

Depolarization of bacterial membrane is MOA of 2 drugs:

Answer 5

Amph B and Daptomycin

Question 6

Flucocytosine (+Amp B) is DOC for

Answer 6

Cryptococcus

Question 7

Flucytosine MOA

Answer 7

prodrug converted to 5FC -> inhibits DNA and RNA synthesis -> CIDAL????

Question 8

which drugs penetrate CSF?

Answer 8

Flucocytosine

Fluconazole

Question 9

Depressed bone marrow is SE of 2 drugs:

anemia, leukipenia, thrombocytopenia

Answer 9

Flucocytosine

Cloramphenicol

Question 10

2 major side effects of Flucocytosine

Answer 10

Depressed bone marrow (anemia, etc)

Increased liver enzymes: ALT AST (reversed if stop tx)

Question 11

Ketoconazole 2 main SE

Answer 11

Gynecomastia: inhibited adrenals and testes (breasts in males)
High drug interactions bc it inhibits P450 leading to other drugs accumulating in the system

Question 12

Ketoconazole MOA

Answer 12

Inhibits SYNTHESIS of ergosterol -> increased permiability and decreased fungal growth -> static

Question 13

Fluconazole DOC or good for

Answer 13

fungal meningitis

Good CFS

Question 14

Voriconazole (+ Amp B) is DOC

Answer 14

Invasive Aspergillus

but… invasive aspergillus in refractory pts is tx’d by CASPofungin

Question 15

Voriconazole SE

Answer 15

VISUAL
High drug interactions: it inhibits P450 and is metabolized by P450
Polymorphism to Gene: High met’m= low [ ]
Low met’m=high [ ]

Question 16

Visual side effect is seen in

Answer 16

Voriconazole

reversible

Question 17

Vori and Intraconaoles are metabolized by

Answer 17

Liver

Question 18

Echinocandins are and MOA

Answer 18

fungins

MOA: inh synthesis of B (1,3) D-Glucan (component of CW) -> CIDAL

Question 19

What is the DOC for invasive Aspergillus in refractory pts

Answer 19

CASPAfungin

Question 20

which drug has low drug interactions and no kidney toxicity

Answer 20

CASPAfungin (very attractive option)
but can have elevated liver enzymes
Cleared by liver

Question 21

Mica(fungin) and ANIdul(fungin) are similar to

Answer 21

Caspofungin

Question 22

Griseofulvin DOC for

Answer 22

ONYCOmycosis

Ring worm/dermatophytosis

Question 23

2 SE of griseofulvin

Answer 23

Acute intermittent PORPHYRIA (increased heme and not made properly)
Liver Failure (don't give to pts with liver failure)

excreted: feces

Question 24

griseofulvin DOC

Answer 24

• binds to microtubules of fungi->destroys mitotic spindle -> STATIC
• binds to keratin in skin (food source for fungi)

Question 25

Turbanalene MOA

Answer 25

inhibits converstion of squalene to ERGOSTEROL (inh sterol synthesis) -> CIDAL
(increased squalene is toxic to fungi)

Question 26

Nystatin is primarily used for (but DOC is different)

Answer 26

GI Candida (orally) and topical candida
DOC: CAspafungin OR (and?) Amph B
Is GI candida same as systemic candida?

POLYENE AB (like Amp B)