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Pharm: Antifungals/Antivirals > Antifungals > Flashcards

Antifungals Flashcards

1
Q

What are the classes of Antifungals?

A

Polyenes, Azoles, Antimetabolites, Allylamines, Echinocandins

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2
Q

What medications belong in the Polyenes class?

A

Amphotericin, Nystatin

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3
Q

What medications belong in the Azoles class? (a lot)

A

Fluconazole, Itraconazole, Voriconazole, Posaconazole, Isavuconazonium sulfate, Ketoconazole, Efinaconazole (Terconazole, Butoconazole, Clotrimazole, Miconazole nitrate, Triconazole)

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4
Q

Which medications belong to the Allylamine class? What are they most commonly used for?

A

Terbinafine, Nafifine, Butenafine; SKIN

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5
Q

Which medications belong to the Antimetabolite class?

A

Flucystosine

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6
Q

Which medications belong in the Echinocandins class?

A

Caspofungin, Anidulafungin, Micafungin

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7
Q

Why is Amphotericin called Amphoterrible?

A

Because it has so many adverse drug reactions

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8
Q

What is Amphotericin indicated for?

A

progressive, potentially life threatening fungal infections, disseminated candidiasis in immunocompromised patients, meningitis

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9
Q

What is Amphotericin a second line treatment for?

A

aspergillosis and leishmaniasis

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10
Q

What is a benefit of Amphotericin in regards to its spectrum?

A

It is the broadest spectrum of the antifungals

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11
Q

What does Amphotericin bind to in fungal cells that allows it to damage cell membranes?

A

Ergosterol

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12
Q

Is Amphotericin fungicidal, fungistatic, or both? What does that depend on?

A

both; concentration of medication in tissues and susceptibility of organism

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13
Q

What are some warnings or precautions that you should make sure to inform any patient of before prescribing them Amphotericin? What is a warning and precaution that you as a prescriber should pay attention to when writing out this Rx?

A

Pregnancy Category B
Nephrotoxicity (can cause permanent damage)
As a prescriber, beware of confusing Amphotericin B with Amphotericin B Liposomal (Ambisome) in cancer patients/infectious disease.

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14
Q

What can be done to prevent nephrotoxicity when prescribing patients Amphotericin?

A

close monitoring, interrupt therapy, decrease dosage, and increase dosing interval (also hydrate and replenish Na+)

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15
Q

What are some of the many Adverse Drug Reactions of Amphotericin?

A

Infusion reactions, anaphylaxis, leukoencephalopathy, HA, NVD

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16
Q

What can you do to avoid an infusion reaction in patients who are being administered Amphotericin?

A

premedicate and run the dose slowly (fast infusion can cause hypotension, hypokalemia, arrhythmia, and shock)

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17
Q

Amphotericin is excreted (quickly/slowly) by the ____

A

slowly (weeks to months); kidneys

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18
Q

Amphotericin is highly _____-bound

A

protein

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19
Q

Nystatin works by binding to ergosterol in fungal ____ _____

A

cell membranes

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20
Q

Nystatin is fungistatic, fungicidal, or both?

A

both

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21
Q

Nystatin should be prescribed to patients who have extreme ____ ____, oral ___, and ____ candidiasis.

A

diaper rash; candidiasis; vulvovaginal

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22
Q

When being prescribed to patients with extreme diaper rash, Nystatin is commonly combined with ___ to increase its effectiveness, even though the combination of an anti-fungal with a ____ medication is commonly contraindicated.

A

triamcinolone; steroid

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23
Q

Nystatin is a pregnancy category ___ medication.

A

C

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24
Q

Some ADRs of nystatin include

A

Common: NVD, cramps, rash, hypersensitivity and Rare: Stevens Johnson Syndrome, urticaria

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25
Q

Nystatin is excreted unchanged in the ___, so it does not affect the ____ .

A

feces; kidneys

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26
Q

All Azoles are ___ inhibitors, that increase the permeability of the fungal ____ ___, resulting in cell death.

A

CYP 450; cell membrane

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27
Q

Azoles are fungistatic, fungicidal, or both?

A

both

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28
Q

Fluconazole is most commonly indicated for use against:

A

YEASTS!, candidiasis, and cryptococcal meningitis

29
Q

Fluconazole can be used off label to treat:

A

cryptococcal PNA

30
Q

Fluconazole’s dosage should be adjusted in patients who have ___ issues

A

renal

31
Q

ADRs of a majority of Azoles include:

A

QT prolongation and arrythmias

32
Q

Fluconazole has a (long/short) half life

A

long

33
Q

Itraconazole has a broader spectrum, and in addition to yeasts, can be used to treat ___, such as ____.

A

mold; histoplasmosis

34
Q

Itraconazole can be used to treat ___ in patients who did not respond well to Fluconazole originally.

A

oropharyngeal/esophageal candidiasis

35
Q

Itraconazole can be used to treat ___ as a 2nd line option

A

aspergillosis

36
Q

Itraconazole is a pregnancy category ___

A

C

37
Q

Voriconazole, like itraconazole, is of broad spectrum, and covers infections due to both ___ and ___

A

yeasts and molds

38
Q

Voriconazole is the drug of choice (DOC) for treating____

A

invasive aspergillosis

39
Q

Voriconazole is a pregnancy category ___

A

D

40
Q

When adminstering Voriconazole IV, we should be concerned for the patient’s ____ function

A

renal

41
Q

_______ is the broadest spectrum -azole and covers yeast and mold

A

Posaconazole

42
Q

Posaconazole is best for the treatment of aspergillum and candida in patients who are ___

A

immunocompromised

43
Q

Posaconazole can be used to treat yeast infections in patients where there has been resistance to ____

A

fluconazole

44
Q

Isavuconazonium sulfate is a ___ that is used for specific ___ infections, such as ___ and ____

A

prodrug; fungal; aspergillosis and mucormycosis

45
Q

The only thing that we really need to know about ketoconazole is that it is ____

A

not used anymore due to too many ADRs

46
Q

Efinaconazole is administered (PO/IV/topically/IM)

A

topically

47
Q

Efinaconazole is indicated for patients who have ___

A

onychomycosis

48
Q

Beware, if using efinaconazole, a patient may develop ___

A

an ingrown toenail, and application site irritation

49
Q

How many weeks does it take for efinaconazole to take full effect?

A

48 freaking weeks

50
Q

Terbinafine, Naftifine, and Butenafine are all ___, and are indicated for the treatment of ___

A

allylamines; onychomycosis, tinea cruris/pedis/corporis

51
Q

Terbinafine is fungicidal/fungistatic/both

A

fungicidal

52
Q

What are some ADRs of terbinafine?

A

diarrhea, abd pain, LFT abnormalities, and dysgeusia

Rare: Stevens Johnson, TEN

53
Q

Terbinafine is ___ soluble and thus distributes well into the ___, ___, and ___

A

lipid; nails, skin, fat

54
Q

ADRs of Naftitine and Butenafine include

A

burning, stinging, itching, rash

55
Q

Flucytosine must be _____ due to resistance

A

used in conjunction with other drugs

56
Q

Flucytosine is an ____ drug that inhibits ___ and ___ synthesis

A

antimetabolite; fungal protein synthesis and DNA synthesis

57
Q

Flucytosine is indicated for ___ and is sometimes used as a chemotherapy agent

A

very severe Fingal infections (candida, strep, crytococcus meningitis)

58
Q

Flucytosine is a pregnancy category ___

A

C

59
Q

Taking flucytosine can cause

A

NVD, rash, elevated LFTs

60
Q

Echinocandin medications work by ____

A

weakening fungal cell wall

61
Q

Echinocandins are used to treat ___ infections

A

severe, invasive fungal infections such as candida and aspergillus

62
Q

ADRs of echinocandins include

A

NVD, infusion reactions

63
Q

The really super duper thing about Echinocandins that makes Dr. Murfin really excited is that fact that Echinocandins do NOT have ____

A

P450 interactions (doesn’t cause drug interaction problems)

64
Q

Cyclopirox is indicated for use in patients with ___ infections

A

dermatophyte (tinea, onychomycosis, candida)

65
Q

Ciclopirox is fungicidal/fungistatic/both

A

fungicidal

66
Q

Ciclopirox is a pregnancy category ___

A

B :)

67
Q

Tavoborole inhibits_____

A

fungal protein synthesis

68
Q

Using Tavoborole topically can cause ADRs such as ____

A

application site exfoliation, erythema, dermatitis, and ingrown toenail

Pharm: Antifungals/Antivirals (15 decks)

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