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AntiFungals Flashcards

1
Q

Polyenes

A

Ampthotercin B, Nystatin

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2
Q

Ampho B- MOA

A

Binds egosterol to disrupt fungal membrane

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3
Q

Ampho-B role of deoxycholate

A

Must be compexed to deoxycholate for solubitliy

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4
Q

Ampo- B- admin

A

IV, Intrathecally, bladder wash

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5
Q

Ampo B - uses

A

Systemic fungal infections

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6
Q

Ampo-B-AE

A

Attacks renal cells and RBC’s, K, Mg, HCO3 wasting- hydrate and monitor, Infusion related- fever, chills, riggor, hypotenstion, myalgia, arthralgia, HA- premedicate with APAP, NSAIDS and others Thrombophlebitis- prevent with heparin. Amenia- suppresses EPO

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7
Q

Ampho-B- newer preps

A

Better formulations dec nephrotoxicity and allow larger doses BUT don’t do anything for rigor and infusion rxnmuch more expensive

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8
Q

Nystatin- MOA

A

binds to ergosterol and disrupts membrane

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9
Q

Nystatin- Uses

A

oral, vaginal, skin candidiasis

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10
Q

Nystatin- Admin

A

topical swish and swallow not orally absorbed

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11
Q

Nystatin- AE

A

not many

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12
Q

Pyrimidines

A

Flucytosine

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13
Q

Flucytosine- MOA

A

Flucytosine –> 5- Flurouridylic acid via cytosine deaminase–> inhibits translation, 5- Flurodeoxyuridylic acid –> inhibits thymylate synthase –> inhibits DNA synthesis

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14
Q

Flucytosine- Uses

A

used with Amphoteracin B for cryptococcal meningitis, Never use alone, resistance develops to quickly

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15
Q

Flucytosinse- administration

A

Oral

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16
Q

Flucytosine- distribution

A

well absorbed orally

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17
Q

Flucytosine- 1/2 life

A

3-6 hrs

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18
Q

Flucytosine- Excretion

A

Renal

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19
Q

Flucytosine- AE

A

Bone marrow suppression GI- N/V/D. Livertoxicity- reversible

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20
Q

Echinocandins

A

Caspofugin, Micafugin, Andidafugin

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21
Q

Echinocandins- MOA

A

inhibit beta 1,3 glucan synthesis- inhibit cell wall production

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22
Q

Echinocandins- Admin

A

IV

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23
Q

Echninocandins- uses

A

systemic Candida or Apergillus infections

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24
Q

Echinocandins - drug interactions

A

Cyclosporine inc blood levels of Caspofugin

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25
Echinocandins- Protein binding
Highly protein bound
26
Echinocandins- CNS penetration
Minimal
27
Echinocandins- AE
Histamine related rxns- warmth, swelling, rash, Headache, Hepatotoxicity
28
Griseofluvin- MOA
Inhibits mitotic spindle formation. Binds to human keratin which prevents invasion of fungus. Infected cells slough off eventually non-infected keratinocytes at the basal layer eventually replace
29
Griseofluvin- Admin
Oral- best with fatty foods
30
Griseofluvin- uses
Fungal infections of: Hair, skin, and nails
31
Griseofluvin- 1/2 life
1 day
32
Griseofluvin- Excretion
Renal
33
Griseofluvin- AE
Headache, Hepatotoxicity, Neuro/leuckopenia, basophilia, photosensitivity, GI, Rash
34
Griseofluvin- Effect on enzymes
Inducer
35
Griseofluvin- Drug interactions
Inc metabolism of Warfarin and Oral contraceptives
36
Terbinafine- MOA
binds squalene epoxidase --> inhibits ergosterol synthesis
37
Terbinafine- Admin
Oral
38
Terbinafine- Uses
Mycoses of nails, drug accumulates in the nail beds
39
Terbinafine- T 1/2
400 hrs b/c accumulates in hair, skin, and fat and slowly releases
40
Terbinafine- Protein binding
High
41
Terbinafine- AE
Well tolerated. Uncommon AE- GI, hepatatoxicity, stevents Johnson syndrome
42
Terbinafine- drug interactions
Cimetidine- increases levels of Terbinafine
43
Azoles- Types
Imidazoles, Triazoles
44
Imidazoles
Ketoconazole, Clotrimazole, Miconazole, Econazole, Butoconazole, Oxiconazole
45
Imidazoles- Admin
All topical except Ketoconazole which is for systemic
46
Triazoles
Terconazole, Itraconazole, Fluconazole, Voriconazole, Poscanzole
47
Triazoles- Admin
All systemic except for Terconazole which is topical
48
Azoles- MOA
bind 14 alpha demethylase --> inhibit ergosterol synthesis
49
Azoles- CYP450
inhibitors
50
Azoles- Uses
Mostly, topical, but some systemic. Superficial infections- ringworm, candidiasis, tinea versicolor/ nigra, fungal keratitis. NOT FOR NAIL/HAIR-THOSE REQ SYSTEMIC
51
Ketoconazole- Admin
Oral. Require acidic environment for absorption. Drugs that inhibit acidity in the stomach dec absorption (Histamine2 and PPI)
52
Ketoconazole- CYP450
Inhibitor Inc levels of other drugs
53
Ketoconazole- AE- hormonal effects
Hormonal due to CYP450 inhib- dec libido, gynecomastia, menstral irregularities. Blocks androgen, cortisol, aldosterone syntehsis and adronergic receptor antagonist
54
Ketoconazole- AE- non hormonal
GI- dose dependent rash, hepatotoxicity
55
Itracanazole- Admin
Oral, IV
56
Itraconazole- Uses
Candida, Aspergillus
57
Itraconazole- absorption
GI absorption- empty stomach and acid
58
Iraconazole- AE
GI, Rash, LFTs. hypoTG, Hypokalemia
59
Itraconazole- drug interactions
Fatal arrhythmia if given with cisapride or quinidine
60
Intriconazole- Liver enzyme
Potent CYP3A4 inhibitor
61
Fluconazole- Admin
Oral, IV
62
Fluconazole- Use
Candida
63
Fluconazole- absorption
not affected by food
64
Fluconazole- AE
Reversible alopecia, GI, Rash, LFTs
65
Fluconazole- Contraindications
Pregnancy- results in fatal skeletal and cardiac muscle deformities
66
Voricaonazole- Admin
Oral, IV
67
Voriconazole- Uses
Candida, Aspergillus
68
Voriconazole- t1/2
variable- dependson drug concentration, non linear kinetics
69
Voriconazole- liver enzymes
Potent CYP3A4 inhibitor--> drug interactions
70
Voriconazole- AE
Visual changes, Cardiovascular, CNS, Rash, LFTs
71
Posconazole- admin
Oral- w/full meals
72
Posconazole- Uses
Candida, Apergillus, Zygomycetes
73
Posconazole- liver enzymes
CYP3A4- moderate inhibitor
74
Posconazole- AE
Cardiovacular- HTN, hpokalemia. CNS- headache, dizziness. GI, LFTs

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