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Pharmacology > Antifungals > Flashcards

Antifungals Flashcards

1
Q

amphotericin B MOA

A

cidal
interacts with ergosterol in fungal membrane, results in pore formation that increases permeability which leads to cell death

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2
Q

DOC for most systemic fungal infections

A

Amphotericin B

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3
Q

amphotericin B infusion toxicites

A

chills, fevers, muscle spasms, vomiting, headache

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4
Q

amphotericin B cumulative toxicities

A

powerful nephrotoxic agent (azotemia, BUN and crea)

can lead to irreversible kidney damage

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5
Q

MOA for flucytosine

A

metabolic antagonism of fungal DNA and RNA

converted to 5-fluorouracil which interferes with synthesis

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6
Q

DOC for cryptococcus infections

A

Flucytosine + Amp B (synergistic)

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7
Q

Does flucytosine penetrate CNS?

A

Yes

All flu drugs are good CNS penetrators

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8
Q

toxicities of flucytosine

A

depression of bone marrow, GI disturbances, elevation of AST or ALT

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9
Q

MOA for “azole” antifungals

A

static

inhibits synthesis of ergosterol and eventually inhibition of fungal growth

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10
Q

spectrum for ketoconazole

A

broad spectrum, good for topical infections

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11
Q

ketoconazole toxicities

A

inhibitor of P450 system, gynecomastia and impotence, prolonged QT

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12
Q

ketoconazole contraindications

A

acute or chronic hepatic disease

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13
Q

fluconazole penetration

A

penetrates well into other bodily fluids, particularly CSF

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14
Q

Fluconazole in HIV patients?

A

good for suppressive and/or prophylactic therapy in HIV patients

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15
Q

Toxicities of fluconazole

A

potent inhibitor of CYP2C9, but less drug interactions than other azoles, headache (due to CNS penetration)

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16
Q

DOC for aspergillus

A

voriconazole + amp B

17
Q

voriconazole penetration

A

moderate CSF penetration

18
Q

voriconazole toxicities

A

is both metabolized and inhibits P450s (metabolized in reverse order), visual impairment that is reversible

19
Q

spectrum of itraconazole

A

similar to ketoconazole but has greater activity against aspergillus

20
Q

toxicities of itraconazole

A

potent inhibitor of CYP3A4, GI effects, N/V/D, abd pain

21
Q

bioavailability of itraconazole

A

capsules: better absorption with meal or soda

oral solution: better absorbed on empty stomach

22
Q

spectrum of isavuconazonium

A

mucormycosis and invasive aspergillosis

23
Q

toxicities of isavuconazonium

A

CYP3A4, nephrotoxicity, dose dependent decrease in QT interval

24
Q

spectrum for posaconazole

A

aspergillus and candida

25
Q

toxicities of posaconazole

A

CYP3A4, other toxicities are not well known due to the drug being very new

26
Q

MOA of echinocandins

A

inhibits synthesis of B(1,3)-D-glucan, which is a major fungal cell wall component

27
Q

what makes caspofungin a good drug?

A

lack of nephrotoxicity and few drug interactions

28
Q

caspofungin for aspergillosis?

A

yes, in refractory patients that are resistant to azoles or amp B

29
Q

griseofulvin MOA

A

static

binds to microtubules of certain fungi and destroys mitotic spindle structure

30
Q

DOC for onychomycosis

A

griseofulvin

31
Q

route for griseofulvin

A

ORAL only

32
Q

what is griseofulvin mostly used for

A

dermatophytosis infections of skin, hair, nails

33
Q

griseofulvin toxicities

A

headache, disulfuram-like effects, photosensitivity

34
Q

griseofulvin contraindications

A

acute intermittent porphyria, hepatocellular failure, pregnancy and men 6 months prior to fathering a child

35
Q

terbinafine MOA

A

cidal

interferes with sterol biosynthesis, squalene monooxygenase

36
Q

route for terbinafine

A

oral or topical

37
Q

spectrum for nystatin

A

primarily used for candida infections

38
Q

what are the two polyene antibiotics we learned

A

amp B and nystatin

Pharmacology (7 decks)

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