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Antifungals Flashcards

1
Q

polyene (names)

A

amphotericin B

nystatin

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2
Q

polyene MOA

A

bind ergosterol –> damage cell mem

can be fungistatic or cidal

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3
Q

amphotericin B indication

A

progressive/severe fungal infections
systemic fungal infect
GI infect by candida

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4
Q

amphotericin B ADRs

A 
infusion rxn
nephrotoxicity (esp if immunocomp)
hypotension
tachycardia
fever/chills
hypokalemia, hypoMg
anorexia, N/V/D/cramp
decrease renal fnx

binds human cholest too…

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5
Q

amphotericin B CI

A

not during breast feeding

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6
Q

amphotericin B drug interactions

A 
nephrotoxic agents
some chemo/aminoglycosides
cyclosptrines
pentamidine
steriods --> hypoK
digoxin
imadazoles
flucytosine
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7
Q

nystatin indication

A

candidiasis (intestinal, oral, vulvovaginal)

diaper dermatitis

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8
Q

nystatin CI

A

preg cat C

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9
Q

nystatin ADRs

A

N/V/D (only D with large dose)
abd cramp
rash, urticaria (rare)
SJS (rare)

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10
Q

nystatin caution

A

avoid sex til done
avoid tampons, etc
avoid tight things

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11
Q

antifungal azoles (names)

A

fluconazole, itraconazole, voraconazole, posaconazole, ketoconazole, isavuconazium sulfate, efinconazole

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12
Q

antifungal azole MOA

A

inhib P450 (3A4 & 2C9) and the conversion of lanosterol –> ergosterol
–> increase cell mem perm
fungicidal

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13
Q

fluconazole indications

A

candidiasis
cryptococcal meningitis
intertriginous candidia (off label)

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14
Q

fluconazole ADRs

A

generally mild
1 dose: HA, N/V/D, dyspepsia, abd pn, metallic taste
multi-dose: N/V/D/pn, liver probs (rare)
QT prolongations

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15
Q

fluconazole CI

A

preg cat C (except the 1 pill for vag infect –> cat C)

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16
Q

itraconazole indication

A 
pulm and extrapul blastomycosis
histoplasmosis
aspergillus
onychomycosis
oral/esoph candidiasis
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17
Q

itraconazole ADRs

A 
neuropathy
hepatic failure (rare)
hearing loss (rare)
gynecomastia (rare)
N/V
rash
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18
Q

itraconazole CI

A

taking trazolam or midazolam
heart failure/venricular dysfunction
breast feeding

preg cat C

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19
Q

itraconazole caution

A

CHF
use of Ca channel blockers
long T1/2

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20
Q

voriconazole indication

A

invasive aspergillus
disseminated candidiasis
esophageal candidiasis
serious infect

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21
Q

voriconazole ADRs

A 
visual distrubances
fever/chills
N/V
rash
HA
abnormal LFT
tachycardia
hallucination
infusion rxn
SJS/TEN
photosensitivity
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22
Q

voriconazole CI

A

preg cat D

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23
Q

voriconazole caution

A

P450 at 3A4, 2C19, 2C9 metab

24
Q

posaconazole indication

A

saved for immunocompromised pts

oropharyngeal condidiasis

25
Q

posaconazole ADRs

A

fever
N/V/D
HA
elevated LFTs

26
Q

ketoconazole indication

A

systemic candidiasis and other bad dz

itraconazole has taken over for keto :(

27
Q

ketoconazole ADRs

A 
photophobia
impair hormone production
N/V/D/on
HA
dizzy
suicidal/depression
thrombocytopenia, hemolytic anemia, leukopenia
fatal hepatotoxicity
pruritis
long QT
28
Q

isavuconazium sulfate indications

A

invasice aspergillus
mucormycosis (bad infect)
IV only

29
Q

isavuconazium sulfate ADRs

A 
elevate LFT
infusion rxn
SJS/TEN
N/V/D
peripheral edema
hypoK
30
Q

efinconazole indication

A

onychomycosis

31
Q

efinconazole ADRs

A

ingrown toenail
site dermatitis
site pain
site vesicles

32
Q

allylamine (names)

A

terbinafine
naftadine
butenafine

33
Q

allylamine MOA

A

inhib production of lanosterol

fungicidal

34
Q

terbinafine indication

A

onychomycosis (esp in DM)

tinea cruris

35
Q

terbinafine ADRs

A 
diarrhea
dyspepsia
abd pn
LFT abnormalities
rash, pruritis
dysguesia
SJS/TEN (rare)
36
Q

terbinafine caution

A 
liver fnx (get baseline and monitor)
T1/2 starts at 12 hrs, ends at 200-400 hours
37
Q

naftadine/butenafine indication

A

tinea infection

38
Q

naftadine/butenafine ADRs

A

burning
stinging
itching
rash

39
Q

pyrimidine (names)

A

flucytosine

40
Q

flucytosine MOA

A

goes into DNA, converted into 5-FU in the cell
inhib fungal prot and DNA synthesis
with amph B –> more effective

41
Q

flucytosine indication

A

candida: septicemia, endocarditis, UTI, pulm infect
cryptococcus: meningitis, pulm infect, UTI

42
Q

flucytosine ADRs

A 
leukopenia, thrombocytopenia
rash
N/V/D
elevated LFT
ADRs = worse in post chemo/AIDS pts
43
Q

flucytosine caution

A 
increased toxic (and effect) with amph B
used alone --> resistant fungi fast
44
Q

echinocandins (names)

A

caspofungin
anidulafungin
micafungin

45
Q

echinocandins MOA

A

inhib beta-glucan synthase –> affect cell wall synthesis –> lysis

46
Q

echinocandins indication

A

severe (basic) infect (ie candida/aspergillus)

47
Q

echinocandins ADRs

A

N/V/D

infusion rxn

48
Q

griseofulvin drug intercation

A

oral contraceptives
ETOH
P450 3A4 inhib (maybe)

49
Q

griseofulvin MOA

A

inhib cell mitosis

50
Q

griseofulvin indication

A

tinea infect

NO candidia!

51
Q

griseofulvin ADRs

A

lots of neuro: HA, neuropathy, fatigue, rash, etc

52
Q

ciclopirox indication

A

onychomycosis

53
Q

ciclopirox ADRs

A

burn
itch
irritate

54
Q

tavoborale MOA

A

inhibit fungal prot synthesis

55
Q

tavoborale indication

A

onychomycosis

56
Q

tavoborale ADRs

A

site exfoliation
dermatitis
ingrown toenail

Pharm (11 decks)

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