chemotherapy part 2 (1) Flashcards
Fungi
- Fungi: Yeasts, Molds: _____
- Surgical, ICU, Prostheses, IV catheters, HIV
- __________, cancer, and transplant pts
- _______ infections
- traditional diagnostics: culture
- NEW: PCR, Western blot, antigen detection
mycoses
immunosuppressat
oppurtunistic
Fungal Infections -fungal infections are divided into 3 main groups: 1 2 3
superficial mycoses
subcutaneous mycoses
systemic mycoses
Amphotericin B
- ______ antifungal that works by binding to membrane. sterols (______) in fungal cell membranes, resulting in increased cell permeability, cell leakage,and death
- May cause damage to host cells as well (______)
- ______ spectrum ________
- used only for treating progressive and potentially fatal _______ infections because of its severe adverse. effects
- _________ patients with fungal pneumona, cryptococcal meningitis and histoplasmosis
polyene ergosterol cholesterol broad fungicidal system immunocompromised
Potential Adverse Effects of Amphotericin B
2 types of Adverse reactions
1) ___________-related reactions - chills, fever, headache, nausea, vomiting. Premedication advised with _________. drugs, steroids and antipyretics. slow the infusion rate.
2) cumulative _________ - __________ is severe (20% of pataients), _____ occurs which is irreversible. there may also be anemia, leucopenia, and severe ______ and magnesium loss
infusion anti-inflammatory toxicity nephrotoxicity ATN potassium
clinician responsibilities
- adminsiter before infusion of other. ____, to decrease adverse effects and to identify effects
- administer a 1 mg test before full dose
- keep patient well _______
- monitor electrolytes, CBC, and renal and hepatic function throughout therapy
- educate patients of the likelihood of transfusion reaction and other adverse effects
- ________ amphotericin B: a newer drug delivery system which uses a _____ vesicle to carry Amphotericin to target _____ in the body and then preferentially bind to _________
drugs hydrated liposomal lipid organs ergosterol
________
- related to Amphotericin B
- used only as ______ therapy
- not used _______ because of its toxicity
- used to treat topical ______ and oral ______ infections (Candida infections)
- oral suspension of Nystatin should be ______ through the mouth and then spit out, as directed by prescriber
- currently available as ointments, crams, mouthwash and suppositories
- oropharyngeal thrush, vaginal candidiasis
Nystatin topical systemically vaginal fungal swished
Azole antifungals
-classification: 2 classes
1) _________: ketoconazole, clotrimazole, miconazole
- oral and _____
- GI absorption of these does not occur in _________ or when a patient is receiving ____ or ____
2) _______ - itraconazole, fluconazole, voriconazole
- oral and _______
- ________: prodrug, convered in acidic environment into hydroxyitraconazole which inhibits 14 alpha sterol demethylase
- achieves high levels in the meninges/ significance???
imadazoles topical achlorhydria H2 blockers, PPIs Triazoles IV
crosses BBB
Potential Adverse Effects of Azole antifungals
- common adverse effects include GI disturbances, headache, and dizziness
- _________ areata and ________
- increased levels of _______, _______, _______
- decreased ________ levels: carbamazepine and isoniazid
- mild elevation in _____ enzymes may occur, which usually returns to pretreatment levels after drug therapy is over:
- patient should avoid alcohol
alopecia, stevens johnson
amitrytline, phenytoin, warfarin
fluconazole
liver enzymes
_______
- new class of antifungal agents that inhibit fungal ______ synthesis
- fungi cell wall: _____, ________
- _______ are carbhohydrate polymers that are cross linked w other fungal cell wall components
- inhibition of Beta 1-3 Glycan of the fungal cell:
- __________(Cancidas) for treatment of Candida and Aspergillus
- _________: esophogeal, oropharyngeal and invasive candidiasis
- used in hematopoietic stem cell transplantation patients
- adverse effects include headache, fever, phlebitis at injection site, abnormal LFTs
echinocandins chitin, Beta-D glucan beta glucans caspofungin micafungin
Other Antifungal agents:
1) . ___________
- deposited in _____ precursor cells of skin, hair, and nails, where it disrupts ________ function and inhibits _______ growth
- induces CYP450 to reduce _______ and ________ concentration
- absorption enhanced w fatty foods
2) ____________
- a synthetic Allylamine used for _________
- _______ because it interferes with ergosterol synthesis
- used for ________ and ________
Grisofulvin keratin microtubule dermatophyte warfarin, oral contraceptives Terbinafine oncyomycosis fungicidal tinea corporis, tinea cruris
azoles: fluconazole (diflucan)
- inhibits enzyme lanosterol 14 a-demethylase
- this enzyme converts _____ to _____
- depletion of _____ in fungal membrane disrupts the structure and functions of fungal membrane
- greater affinity for ergosterol than _____
- esophageal, oropharyngeal, vulvovaginal candidiasis
- _____ fungal infections: histoplasmosis and aspergillosis
- used in HIV-AIDS
- oral/ IV dosage
lanosterol ergosterol ergosterol cholesterol systemic
