Drugs Three Last Time

Question 1

Amphotericine B mechanism of action

Answer 1

Bind ergosterol and disrupt fungal cell membrane by making it leak intracellular content especially K+

Question 2

Example of polyene antibiotic

Answer 2

Amphotericin B

Question 3

Amphotericin B spectrum

Answer 3

Broad for fungi such as histoplasma, cryptococcus, candida, DOC for most systemic mycoses in life threatening fungal infections especially

Question 4

Amphotericin B ADRs

Answer 4

Renal toxicity, infusion related thrombophlebitis

Question 5

Amphotericin B resistance

Answer 5

Very rare, only after long term exposure fungi reduce ergosterol content in cell membrane

Question 6

Amphotericin B drug interactions

Answer 6

Use with other nephrotoxic drugs increases risk of injury to the kidneys

Question 7

Flucytosine is almost always used in combo with…

Answer 7

…amphotericin B

Question 8

Flucytosine spectrum

Answer 8

Narrow, candida and cryptococcus species

Question 9

Flucytosine mechanism of action

Answer 9

Taken up by cell and converted via cytosine deaminase to 5-fluorouracil that then disrupts DNA and RNA synthesis (only in organisms that have cytosine deaminase, humans and many fungi do not)

Question 10

Flucytosine absorption

Answer 10

GI route

Question 11

Flucytosine ADRs

Answer 11

• Hematologic bone marrow depression

- Hepatotoxicity

Question 12

Example of pyrimadine analog

Answer 12

Flucytosine

Question 13

Examples of azoles

Answer 13

• Fluconazole
• Itraconazole
• Ketoconazole
• Posaconazole
• Voriconazole
• Isavuconazole

Question 14

Azoles mech of aciton

Answer 14

Inhibit synthesis of ergosterol disrupting fungal cell wall

Question 15

Azoles ADR

Answer 15

Inhibit hepatic p450 enzymes increasing plasma levels of many drugs

Question 16

Ketoconazole spectrum

Answer 16

Many fungi causing systemic, and some causing superficial infections

Question 17

Ketoconazole absorption

Answer 17

PO

Question 18

Fluconazole spectrum

Answer 18

Primarily candidiasis and cryptococcus

Question 19

Fluconazole absorption

Answer 19

PO

Question 20

Fluconazole is generally less toxic but has the same effectiveness as….

Answer 20

ketoconazole

Question 21

Itraconazole spectrum

Answer 21

Broad, Blastomycosis, histoplasmosis, onychomycosis, aspergillosis

Question 22

Cisapride interacts with what to increase risk of torsades de pointes

Answer 22

Intraconazole

Question 23

Itraconazole ADR

Answer 23

Neg inatropic effect

Question 24

Miconazole

Answer 24

Topical treatment because of toxicity rarely given for systemic infections (must be IV)

Question 25

Voriconazole spectrum

Answer 25

Broad spectrum - blastomycosis - histoplasmosis - onchyomycosis - aspergillosis

Question 26

Posaconazole spectrum

Answer 26

Asprgillus and candida including resistant infections

Question 27

Posaconazole absorption

Answer 27

PO

Question 28

Isavuconazole spectrum

Answer 28

Aspergillus and mucormycosis

Question 29

Isavuconazole ADR

Answer 29

Steven Johnson syndrome

Question 30

Echinocandins mechanism of action

Answer 30

Disruption of fungal cell wall

Question 31

Echinocandins spectrum

Answer 31

Narrow, aspergillus and candida species

Question 32

Echinocandins absorption

Answer 32

IV only

Question 33

Echinocandin examples

Answer 33

- anidulafungin - caspofungin - microfungin

Question 34

Caspofungin spectrum

Answer 34

Invasive aspergillosis in patients intolerant to other treatments and systemic candida

Question 35

Caspofungin is generally better tolerated than...

Answer 35

...amphoB

Question 36

Tinea pedis/cruris/corporis/capitis treatment

Answer 36

Topical treatment such an azole

Question 37

Vulvovaginal candidiasis treatment

Answer 37

PO fluoconazole

Question 38

Oral candidiasis treatment

Answer 38

Topical agents such as miconazole, or in immunocompromised patient fluconazole or ketoconazole

Question 39

Clotrimazole

Answer 39

DOC for dermatophytic infections and candiasis of skin, mouth and vagina, can cause stinging when applied

Question 40

Griseovulvin

Answer 40

PO treatment for superficial mycoses by implanting into the keratin of the cells