Ch 42

Question 1

subcutaneous mycoses cause

Answer 1

puncture wounds contaminated with soil fungi

Question 2

polyene antibiotic names

Answer 2

• amphotericin B
• natamycin
• nystatin

Question 3

polyene antibiotic MOA

Answer 3

increase fungal plasma membrane permeability and extrude cytoplasmic contents

Question 4

amphotericin B

Answer 4

• only polyene for both systemic and subcutaneous mycoses

- most toxic antibiotic in use

Question 5

amphotericin B ADE

Answer 5

• 80% patients have renal toxicity
• acute liver failure
• cardiac arrhythmias
• hematopoietic toxicity
• infusion reactions

Question 6

nystatin

Answer 6

• active against candida

- available in topical or oral tablet/suspension

Question 7

natamycin

Answer 7

ophthalmic antifungal

Question 8

azoles MOA

Answer 8

inhibits 14 alpha-demethylase

Question 9

IV azoles

Answer 9

• fluconazole
• voriconazole
• posaconazole

Question 10

azole ADE

Answer 10

• increase LFT
• GI distress
• hematopoietic toxicity
• birth defects with fluconazole in 1st trimester but can be used short term for vaginal cadidiasis
• inhibits CYP3A4

Question 11

fluconazole

Answer 11

• excellent CSF penetration
• effective for candida UTI
• single dose regimen for vaginal candidiasis

Question 12

voriconazole

Answer 12

• 60 to 100 times more potent than fluconazole for candida
• used for serious systemic fungal infection
• oral bioavailability nearly equal to IV

Question 13

posaconazole

Answer 13

option for oral Rx for refractory systemic fungal infection

Question 14

ketoconazole

Answer 14

• oral and topical but oral rarely used

- topical for seborrheic dermatitis

Question 15

clotrimazole

Answer 15

• topical

- not effective for tinea capitis or toenail fungus

Question 16

allylamine

Answer 16

• terbinafine
• naftifene
• superficial dermatphyte infection
• onychomycosis

Question 17

echinocandins

Answer 17

-end in fungin

Question 18

caspofungin

Answer 18

• excellent against candida including azole resistant strains
• must be given IV
• once daily due to T1/2 of 11 hours
• well tolerated

Question 19

flucytosine

Answer 19

• incorporates into to fungal RNA to interfere with protein synthesis
• resistance develops rapidly when given alone
• usually given in conjunction with Ampho-B
• ADE: mild, but can be hematological toxicity or cardiac arrest

Question 20

griseofulvin

Answer 20

• standard treatment for tinea capitis
• can be used for nail infection
• well tolerated

Question 21

ciclopirox

Answer 21

• topical compound for dermatophytes

- includes nail lacquer for mild nail fungus

Question 22

tolnaftate

Answer 22

• OTC for tinea versicolor and mild dermatophyte skin infection
• not reliable for scalp or nailbed infection