Antifungals/Antiprotazoal Flashcards

1
Q

Mechanism of amphotericin B

A
binds ergosterol (unique to fungi)
forms membrane pores that allow leakage of electrolytes
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2
Q

Use of amphotericin B

A

serious, systemic mycoses
Crypto - w/wo flutocytosine for meningitis
Blasto, Histo, Candida, Mucor

Intrathecally for fungal meningitis

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3
Q

what electrolytes should you supplement with amphotericin B use?

A

K+ and Mg2+ because of altered renal tubule permeability

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4
Q

Toxicity of amphotericin B

A
fever/chills
hypotension
nephrotoxicity
arrhythmias
anemia
IV phlebitis
hydration decreases nephrototixicty
liposomal amphotericin decreases toxicity
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5
Q

Mechanism of nystatin

A

same as amphotericin B

topical use only as too toxic for systemic use

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6
Q

Use of nystatin

A

“swish and swallow” for oral candidiasis (thrush); topical for diaper rash or vaginal candidiasis

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7
Q

Mechanism of flucytosine

A

inhibits DNA and RNA biosynthesis by conversion to 5-fluorouracil by cytosine deaminase

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8
Q

Use of flucytosine

A

systemic fungal infections (especially meningitis caused by cryptococcus) in combination with amphotericin B

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9
Q

Toxicity of flucytosine

A

bone marrow suppression

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10
Q

Name the azoles

A

clotrimazole, fluconazole, itraconazole, ketoconazole, miconazole, voriconazole

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11
Q

Mechanism of the azoles

A

inhibit fungal sterol (ergosterol) synthesis by inhibiting cytochrome p450 enzyme that converts lanosterol to ergosterol

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12
Q

Use of azoles

A

local and less serious systemic mycoses

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13
Q

Use of fluconzaole

A

chronic suppression of cryptococcal meningitis in AIDS patients and candidal infections of all types

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14
Q

Use of itraconazole

A

blastomycoses, coccidioides, histo

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15
Q

Use of clotrimazole and miconazole

A

topical fungal infections

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16
Q

Mechanism of terbinafine

A

inhibits the fungal enzyme squalene epoxidase

17
Q

Use of terbinafine

A

dermatophytoses (especially onychomycosis - fungal infection of finger or toe nails)

18
Q

Toxicity of terbinafine

A

GI upset, headache, hepatotoxicity, taste disturbance

19
Q

Name the echinocandins

A

anidulafungin, caspofungin, micafungin

20
Q

Mechanism of echinocandins

A

inhibit cell wall synthesis by inhibiting synthesis of beta-glucan

21
Q

Use of echinocandins

A

invasive aspergillosis, Candida

22
Q

Toxicity of echinocandins

A

GI upset, flushing (by histamine release)

23
Q

Mechanism of griseofulvin

A

interferes with microtubule function, disrupts mitosis

deposits in keratin-containing tissues (e.g. nails)

24
Q

Use of griseofulvin

A

oral treatment of superficial infections; inhibits growth of dermatophytes (tinea, ringworm)

25
Q

Toxicity of griseofulvin

A

teratogenic, carcinogenic, confusion, headaches, increased cytochrome p-450 and warfarin metabolism

26
Q

Use of pyrimethamine

A

toxoplasmosis

27
Q

Use of suramin and melarsoprol

A

trypanosoma brucei

28
Q

Use of nifurtimox

A

T. cruzi

29
Q

Use of sodium stibogluconate

A

Leishmaniasis

30
Q

Drugs to treat scabies and lice

A

permethrin
malathion
lindane

31
Q

Mechanism of permethrin

A

blocks Na+ channels –> neurotoxicity

32
Q

Mechanism of malathion

A

acetylcholinesterase inhibitor

33
Q

Mechanism of lindane

A

blocks GABA channels –> neurotoxicity

34
Q

Mechanism of chloroquine

A

blocks detoxification of heme into hemozoin

heme accumulates and is toxic to plasmodia

35
Q

Use of chloroquine

A

tx of plasmodial species other than P. falciparum (frequency of resistance in P. falciparum is too high)

36
Q

Mechanism of resistance to chloroquine

A

membrane pump that decreases intracellular concentration of drug

37
Q

Tx of resistant malaria?

A

arthemether/lumefantrine or atovaquone/proguanil

38
Q

Tx for life-threatening malaria?

A

quinidine (in US) or quinine (elsewhere) or artesunate

39
Q

Name antihelminthic drugs

A

mebendazole, pyrantel pamoate, ivermectin

diethylcarbamazine, praziquantel