Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

BL and DD final > DD Antifungals > Flashcards

DD Antifungals Flashcards

1
Q

Polyenes

A

Amphotericin B (Fungizone)

Nystatin (Mycostatin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

MOA of:
Amphotericin B (Fungizone)
Nystatin (Mycostatin)

do they display selective toxicity?

A

Binds to ergesterol in fungal cell membrane pores = leakage of cellular material and eventual death.

Not super selective toxicity because it binds to cholesterol in mammal cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

ROA of
Amphotericin B (Fungizone)
Nystatin (Mycostatin)

A 
Amphotericin B (Fungizone) - IV, Topical
Nystatin (Mycostatin) - Topical
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Route of excretion of Polyenes

A 
Amphotericin B (Fungizone)
Nystatin (Mycostatin)
  • Mainly through biliary tract (slow renal)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Spectrum of use: Amphotericin B (Fungizone)

A

Broad spectrum,
opportunistic
and systemic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Spectrum of use: Nystatin (Mycostatin)

A

Candidal infections of:
skin,
mucous membranes,
GI/Vaginal tract

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Pharmacokinetic properties of Amphotericin B (Fungizone)

A

Rapidly sequestered in tissues,
little released to CNS,

λ = 15 days (terminal)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Adverse rxn of Amphotericin B (Fungizone)

A

VERY TOXIC DRUG!!!

1) Nephrotoxicity - main issue, nearly all patients get this
2) Infusion-related toxicity - chills, fever, vomiting with IV use
3) Anemia - 75% due to BM depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Pharmacotherapeutic Advantages of polyenes

A

Drug of choice for life-threatening systemic fungal infections.

-Used as initial therapy, then replaced with azoles
(gotta watch out for nephrotoxicity)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Adverse rxn of Nystatin (Mycostatin)

A

Mild and transient GI upset

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Echinocandins (3)

A

Anidulafungin (Eraxis)

Capsofungin (Cancidas)

Micafungin (Mycamine)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

MOA of Echinocandins

A

Inhibit synthesis of β (1,3) D-glucan, disrupt cell wall synthesis.
High selective toxicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

ROA of Echinocandins

A

IV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Route of Excretion of Echinocandins

A

Renal & Hepatic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Spectrum of Echinocandins

A

Broad spectrum.
Invasive candida
Invasive aspergillosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

For Echinocandins: what do we do to dose if:

  1. Pt has hepatic insufficiency?
  2. Pt has renal dysfunction?
  3. Pt is taking CYP450 inducer?
A
  1. reduce dose (liver can’t break it down fast enough)
  2. no dose change needed
  3. Increase (bc it gets processed too fast)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Adverse rxns of echinocandins?

A

Histamine-mediated symptoms (rash, facial swelling)

and nausea, vomiting, headache , fever, phlebitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Which antifungal is best used in patients with aspergillosis that are refractory or intolerant to other therapies (amphotericin B, itraconazole)?

A

Echinocandins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Triazoles

A

Fluconazole (Diflucan)
Itraconazole (Sporanox)
Voriconazole (Vfend)
Terconazole (Terazole)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

MOA of triazoles

-Fungistatic or cidal?

A

Fungistatic - highly specific

inhibition of fungal cytochrome P450 = ↓ Ergosterol synthesis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Which triazole is administered topically?

A

Terconazole (Terazole)

rest are oral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Which triazole is excreted via hepatic?

A

Itraconazole (Sporanox)
Voriconazole (Vfend)
Terconazole (Terazole)

*Fluconazole (Diflucan) is the only renal one

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Spectrum of Use: Fluconazole (Diflucan)

A

Candidiases (vaginal, esophageal, oropharyngeal)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Spectrum of Use: Itraconazole (Sporanox)

A

Broad spectrum. Aspergillosis, histoplasmosis, sporotrichosis.

25
Q

Spectrum of Use: Voriconazole (Vfend)

A

aspergillosis

26
Q

Spectrum of Use: Terconazole (Terazole)

A

Broad spectrum

27
Q

What do we do to dosing if renal is impaired and we are using:
Fluconazole (Diflucan)?
Itraconazole (Sporanox)?

A

Fluconazole (Diflucan) - reduce dosing

Itraconazole (Sporanox) - dosing dont matter yo, its hepatic excretion

28
Q

Which antifungals can enter CNS?

A

Fluconazole (Diflucan) - A triazole ergosterol synthesis inhibitor

Flucytosine (Ancobon) - a nucleic acid inhibitor

29
Q

Pharmacokinetic properties of triazoles?

which one is best absorbed with food?

A

All are 30-40 hours

30
Q

Adverse rxn of triazoles?

A

Very well tolerated
Some-ish GI distress, rash, headaches.
Worse in HIV pts

31
Q

Which triazole can have transient visual changes?

A

Voriconazole (Vfend)

32
Q

Triazole Best for vaginal candidiases when patients have failed topical treatment

A

Fluconazole (Diflucan)

33
Q

Drug of choice if systemic drug needed for dermatophytoses and onychomycosis

A

Itraconazole (Sporanox)

*note: oral terbinafine is also used for onychomycosis

34
Q

Drug of choice for serious invasive aspergillosis

A

Voriconazole (Vfend)

35
Q

Imidazoles

A

Ketoconazole (Nizoral)
Clotrimazole (Lotrimin)
Miconazole (Monistat)

36
Q

MOA of imidazoles

-Fungistatic or -cidal?

A

Inhibits P450-dependent enzyme (14α-demethylase) = ↓ ergesterol levels.

Alters membrane permeability. Fungistatic/-cidal depending upon concentration

37
Q

Route of administration of imidazoles:
Ketoconazole (Nizoral)
Clotrimazole (Lotrimin)
Miconazole (Monistat)

A

Ketoconazole (Nizoral) - Oral, IV and Topical

Clotrimazole (Lotrimin) - Topical

Miconazole (Monistat) - Topical

38
Q

Route of excretion of Imidazoles

A

Hepatic and Breast Milk

  • remember amantadine and rimantadine (antivirals) are also excreted in breast milk
39
Q

Ketoconazole (Nizoral) Spectrum

A

Broad spectrum. Chronic mucocutaneous candidiasis, systemic fungal infections

40
Q

Clotrimazole (Lotrimin)
Miconazole (Monistat)
- Spectrum

A

Oral and vaginal candidiasis

41
Q

Which category of antifungals :

may antagonize amphotericin; poorly absorbed, maximal at low pH; crosses placenta

A

Imidazoles

42
Q

Imidazoles: Adverse Reactions

A

1) Anorexia, nausea, rash, dizziness,
2) hepatotoxicity - avoid if liver dysfunction,
3) Teratogenic. NO PREGNANCY.
4) inhibit mammalian testosterone synthesis → gynecomastia, decreased libido

43
Q

MOA of: Terbinafine (Lamisil)

- fungistatic or cidal?

A

Interferes with ergesterol synthesis by inhibiting squalene oxidase.
Fungicidal

44
Q

MOA of: Flucytosine (Ancobon)

A

Converted to 5’fluorouracil which interferes with DNA synthesis and causes cell death. High selective toxicity

45
Q

MOA of: Griseofulvin (Fulvicin)

- Fungistatic or cidal?

A

Binds microtubules inhibiting mitosis. Interferes with cell wall components. Fungistatic

46
Q

MOA of: Pentamidine (Pentam)

A

Inhibits protein and nucleic acid synthesis

47
Q

Fungi lacking cytosine deaminase can cause resistance against which drug?

A

Flucytosine (Ancobon)

  • remember it gets converted to 5’fluorouracil which interferes with DNA synthesis and causes cell death.
48
Q

ROA of :
Terbinafine (Lamisil)
Pentamidine (Pentam)

A

Terbinafine (Lamisil): Oral or Topical

Pentamidine (Pentam): IV, IM, and Inhalation

49
Q

Route of Excretion
Terbinafine (Lamisil)
Griseofulvin (Fulvicin)

A

Terbinafine (Lamisil): Hepatic

Griseofulvin (Fulvicin): Fecal

50
Q

Spectrum of Use: Terbinafine (Lamisil)

A

Oral = onychomycosis;

Topical = athlete’s foot (tinea cruris corporis)

51
Q

Spectrum of Use: Flucytosine (Ancobon)

A

treat serious infxn of: cryptococcosis, candidiasis, chromoblastomycosis

52
Q

Spectrum of Use: Griseofulvin (Fulvicin)

A

Severe dermatophytosis (superficial) skin, hair, nails

53
Q

Spectrum of Use: Pentamidine (Pentam)

A

Broad spectrum against protozoa

54
Q

Adverse Reactions:

Terbinafine (Lamisil)

A

Rash, GI upset, headache, taste disturbances

55
Q

Adverse Reactions:

Flucytosine (Ancobon)

A

skin rashes

prolonged use →bone marrow suppression

56
Q

Adverse Reactions:

Griseofulvin (Fulvicin)

A

Hypersensitivity, GI upset, headache, mental confusion

57
Q

Which 3 antifungals interferes with CYP450 drug metabolism?

A

Triazoles
Imidazoles
Terbinafine

58
Q

Which antifungal is teratogenic?

A

Imidazoles! Griseofulvin

59
Q

Which antifungal is best for P. jirovici pneumonia in AIDS?

A

Pentamidine

BL and DD final (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions