Antifungals

Question 1

Amphotericin B

Answer 1

Broad spectrum, limited b/c of toxitcity, standard of treatment for most serious mycoses

Question 2

Mucocutaneous

Answer 2

Yeast infection in mouth, Thrush

Question 3

Fungi MOR

Answer 3

Efflux pumps, impaired ergosterol binding, reduced permeabilty of cell membrane, alter P450 enzymes, overproduction of enzymes

Question 4

Amphotericin B available products

Answer 4

Funigizone, Abelcet, Amphotec, AmBisome

Question 5

Amphotericin B

Answer 5

fungicidal, ergosterol (cholesterol in fungus membrane), causes cell to be very leaky and die

Question 6

Amp-B Spectrum of coverage

Answer 6

Yeasts, Molds, resistance shown with some species as well.

Question 7

Amp-B ADR

Answer 7

Infusion related rxn’s or toxicity. (fever, chills, muscle spasms, vomiting, HA and hypotension) premedicate ADR symptoms to reduce ADR, slow infusion, give via central line (minimal-anemia/neurotoxic)

Question 8

Amp-B

Answer 8

risk increases with increased dose, give 1-2 grams, give w/ NS

Question 9

L-AmB (lipid version)

Answer 9

least nephrotoxicity, least infusion rxn’s

Question 10

Flucytosine

Answer 10

taken up by cell, converted to 5-FU and other metabolites, oral, inhibits DNA and RNA synthesis

Question 11

Flucytosine

Answer 11

rarely used, Cryptococcal meningitis and Chromoblastomycosis, NOT as a mono-therapy

Question 12

Flucytosine ARD

Answer 12

Bone marrow toxicity w/ anemia, leukopenia, thrombocytopenia (decrease in platelets), incr. LFT, enterocolitis

Question 13

Diflucan

Answer 13

Fluconazole

Question 14

Sporanox

Answer 14

Itraconazole

Question 15

Nizoral

Answer 15

Ketoconazole

Question 16

Vfend

Answer 16

Voriconazole

Question 17

Noxafil

Answer 17

Posaconazole

Question 18

Imidazoles

Answer 18

ketoconazole, miconazole, clotrimazole, older, more drug-drug interactions

Question 19

Triazoles

Answer 19

Fluconazole, voriconazole, posaconazole, itraconazole

Question 20

Azole MOA

Answer 20

inhibit enzyme that eventually leads to ergosterol synthesis, inhibits fungal P450 enzymes

Question 21

Azole Spectrum of Activity

Answer 21

Broad, Candida, Aspergillus, Dermatophytes

Question 22

Azole ADR

Answer 22

NVD

Question 23

Ketoconazole

Answer 23

shampoo for dandruff, absorption is pH dependent, metabolized in liver, increase LFT, excreted in bile

Question 24

Ketoconazole

Answer 24

IMPOTENCE, rash, pruritis, alopecia, menstrual irregularities,

Question 25

Itraconzaole

Answer 25

pH dependent, oral, WF that is acidic, for onychomycosis

Question 26

Itraconazole Drug Interactions

Answer 26

antacids, H2 blockers, PPI's, rifampin decreases itraconazole

Question 27

Fluzonazole

Answer 27

Candida, absorption NOT pH dependent, good CSF penetration (60-80%), NOT for aspergilius

Question 28

Fluconazole ADR

Answer 28

less of the common ADR 100-800mg daily

Question 29

Vfend

Answer 29

treatment of choice for Aspergillosis, on empty stomach, 30% GET VISUAL DISTURBANCES W/IN 30MIN, LASTS FOR 30 MIN

Question 30

Vfend ADR

Answer 30

QTc prolongation, more interactions than other newer azoles, Loading dose required

Question 31

Poscanazole

Answer 31

broadest spectrum of all, suspension, tablet, IV, give w/ full high fat meal

Question 32

Poscanazole

Answer 32

broadest spectrum of all, suspension, tablet, IV, give w/ full high fat meal

Question 33

Miconazole/Clotrimazoel

Answer 33

for thrush, dermatophytic infections (Tinea corporis, pedis, cruris)

Question 34

Know MOA for all

Answer 34

Echinocandins- inhibit component of cell wall

Question 35

Echinocandins

Answer 35

overall well tolerated w/ minor GI side effects and flushing

Question 36

Candidas

Answer 36

Capsofungin, for neutropenic therapy, slow rate of infusion and pre-medicate with antihistamine, DOES NOT INHIBIT CYP450, load w/ 70mg then continue w/ 50mg daily

Question 37

Mycamine

Answer 37

(Micafungin), similar to Candidas, 150mg daily for esophageal candidiasis, 50mg prophylaxis

Question 38

Eraxis

Answer 38

(anidulafungin), invasive or deep-tissue candidiasis, NO SIGNIFICANT DRUG INTERACTIONS, IV

Question 39

Others

Answer 39

Griseofulvin (must use for 2-6 weeks), Terbinafine (Lamisil) for at least 12 weeks, Nystatin- for oral thrush