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PHRM 865 > Exam 4 - Med Chem: Fungal > Flashcards

Exam 4 - Med Chem: Fungal Flashcards

1
Q

Fungi Overview:
Diverse Group of _________
_____ cell wall

A

eukaryotes

rigid

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2
Q

what are the two groups of fungi

A

yeast and mold…

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3
Q

Yeast or Mold?

grow as single cell

A

yeast

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4
Q

Yeast or Mold?

Divide asexually

A

yeast

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5
Q

Yeast or Mold?

Divide by budding/fission

A

yeast (aka asexually)

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6
Q

Yeast or Mold?

Filamentous multicellular aggregates (hyphae)

A

mold

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7
Q

Yeast or Mold?

Grow by elongation at their tips

A

mold

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8
Q

Yeast or Mold?

usually separated into cell like units by crosswalls called septa

A

mold

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9
Q

4 characteristics of pathogenic fungi?

A

can grow at high temperatures
able to reach target tissues…
able to digest and absorb components of human tissues
able to withstand/evade the immune system

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10
Q

3 types of fungal infections?

A

superficial/cutaneous
subcutaneous
systemic/invasive

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11
Q

what are examples of superficial/cutaneous fungal infections?

A

dermatophytosis (ringworm, jock itch, athletes foot)

onchomycosis (nail fungus)

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12
Q

what is a dimorphic fungi?

A

at room temperature it is hyphae (mold)

in humans or media that is 37 celsius it is yeast

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13
Q

Histoplasmosis:
is caused by a _______ fungi
comes from what thing in nature?
Spore or non spore forming?

A

dimorphic endemic
bat/bird droppings
spore

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14
Q

Blastomycosis:
caused by a ______ fungi
comes what thing in nature?

A

dimorphic endemic

rotting wood/soil

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15
Q

Candidiasis:
Yeast or mold?
Part of ______ flora
Can be invasive but typically is localized where??

A

yeast
normal human flora
mucous membrane

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16
Q

Risk Factors for Opportunistic fungal infections?

A 
immunosuppression...
burn wounds/trauma
central venous catheters
broad spec abx
diabetes
renal insufficiency requiring dialysis
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17
Q

Candida causes what diseases typically?

A 
Cutaneous candidiasis (diaper rash, athletes foot, jock itch)
Esophagitis
Onchomycosis (nail)
Oropharyngeal (thrush)
Vulvovaginitis
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18
Q

what women are at risk for vulvovaginitis?

A

diabetics
pregnant women
women treated with broad spec abx

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19
Q

3 disease states of Aspergillosis

A

opportunistic infections
allergic states..
Toxicoses

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20
Q

What drug is apart of the polyene antifungal class?

A

Amphotericin B

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21
Q 
Features of Amphotericin B:
Hydro, Lipo, or Amphi -philic?
\_\_\_\_\_ ring structure
Fungi - cidal or static?
Good or poor bioavailability?
A

Amphi!
Macrolide structure
cidal
POOR bioavail (use PO only if GI infection, use IV for systemic!)

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22
Q

MOA of Amphotericin B

A

it binds to ergosterol – leads to leakage of intracellular contents

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23
Q

what is egosterol

A

the main sterol in fungal cell membranes

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24
Q

ADEs of Amphotericin B?

A

V toxic..
Infusion Related rxn – reduce rate of infusion if issues: fever, chills, muscle spasms, vomiting, headahces and hypotension

Renal damage!!

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25
________ is a polyene drug that is similar to amphotericin B but is too toxic for systemic administration/only used for superficial fungal infections
Nystatin
26
what is a way to reduce nephrotoxicity of amphotericin?
put it in a lipid formulation
27
Egosterol Synthesis Pathway: | ________ --> ________ --> Egosterol
Squalene --> Lanosterol --> Egosterol
28
what two drugs/classes inhibit egosterol synthesis?
-Azoles and Terbinafine
29
terbinafine inhibits what enzyme?
squalene epoxidase (inhibits egosterol synthesis)
30
Terbinafine: | Fungi -cidal or -static
cidal | happens bc too much squalene bulidup!
31
Terbinafine is best for what disease states?
cutaneous/superficial fungal infections: | dermatophytes and onchomycoses
32
Key structure part of -Azoles
5 membered aromatic ring
33
-Azoles: | Fungi -cidal or -static
static
34
-Azoles: | inhibit ergosterol synthesis by inhibiting what enzyme?
14-alpha demethylase | aka what makes lanosterol into ergosterol
35
in general: what is the relationship between Azole antifungals and CYP450 enzymes
they are metabolized by the enzymes and they inhibit them
36
Voriconazole: metabolized by CYP_______ extensively (genetic polymorphisms will alter levels)
CYP 2 C 19
37
Ketoconazole: | potent ______ of CYP3A4
inhibitor
38
Ketoconazole: Will increase levels of _______ and _______ CYP3A4 _______ (ex: _______) will reduce ketoconazole levels
triazolam and cyclosporin levels increase CYP3A4: inducers; ex rifampin
39
Fluconazole: poor or good bioavailability? CSF penetration?
good bioavail | and yes CSF
40
which Azole causes visual disturbances in 30% of patients (flickering lights/zigzag lines) AND is teratogenic in animals
Voriconazole
41
Another antifungal drug class is called the Echinocandins: they are what type of molecule?
lipopeptide/ cyclic hexapeptide with fatty side chains
42
what drugs are antifungal lipopeptides/echinocandins
caspofungin micafungin anidulafungin
43
MOA of Echinocandins?
inhibit B(1/3) glucan aka a cell wall component by inhibiting Beta(1/3) glucan synthase
44
Echinocandins: | Fungi -cidal or -static
cidal
45
CYP interactions with Echinocandins?
none!!
46
_______ is an antifungal drug that is a pyrimidine analog/antimetabolite
Flucytosine (5-FC)
47
MOA of Flucytosine?
antimetabolite: inhibits thymidylate synthase / interferes with protein synthesis
48
Flucytosine --> _____ --> ______ (which mimics ______)
5-FC --> 5-FU --> F-FdUMP (mimics dUMP)
49
Flucytosine: Oral or IV? CSF? Metabolism?
oral ONLY good CSF renally eliminated (renal impairment = toxicity)
50
Griseofulvin: From a strain of ______ Fungi - cidal or -static Oral or IV?
penicillium static oral ONLY
51
MOA of Griseofulvin?
disrupts fungal microtubules
52
Tavaborole: | MOA?
inhibits leucyl transfer RNA synthetase (LeuRS) aka stops protein synthesis
53
Tavaborole: | what element is essential for its activity
Boron
54
Antifungal drug resistance: | typically transferred between strains - yes or no?
NO!
55
Antifungal drug resistance: | main acquired resistance seen to polyenes?
reduced egosterol content in membrane
56
Antifungal drug resistance: | main acquired resistance to Flucytosine
cytosine deaminase or UPRT (cytosine permease)
57
Antifungal drug resistance: | Common Azole acquired resistance mechanisms?
target site alteration Efflux pumps target enzyme upregulation Development of bypass pathways
58
``` Antifungal Toxicities: what drug(s) cause photopsia ```
voricaonzole
59
``` Antifungal Toxicities: what drug(s) cause renal toxicity ```
amphotericin B | Cyclodextrins (IV voriconazole)
60
``` Antifungal Toxicities: what drug(s) cause bone marrow suppresion ```
``` 5-FC Amphotericin B (anemia bc decrease EPO production) ```
61
``` Antifungal Toxicities: what drug(s) cause GI toxicity? ```
Itraconazole Posaconazole 5-FC
62
``` Antifungal Toxicities: what drug(s) cause QT prolongation ```
all Azoles
63
``` Antifungal Toxicities: what drug(s) case cardiomyopathy ```
intraconzaole
64
``` Antifungal Toxicities: what drug(s) cause infusion reactions ```
amphotericin B | Echinocandins
65
``` Antifungal Toxicities: what drug(s) cause hepatic toxicity ```
all azoles Amphotericin B 5-FC Echinocandins
66
``` Antifungal Toxicities: what drug(s) cause CNS issues ```
Voriconazle
67
``` Antifungal Toxicities: what drug(s) can cause a rash ```
all antifungal rxns
68
``` Antifungal Toxicities: what drug(s) can cause photosensitivity/malignancy ```
voriconazole
69
Antifungals and Pregnancy: | what antifungals are full on contraindicated?
voriconazole flucytosine griesofulvin
70
Antifungals and Pregnancy: | what antifungals should be avoided in pregnant women - ESPECIALLY in 1st trimester bc birth defects/miscarriage risk
Fluconazole (except single 150 mg dose not a problem tho) Itraconazole Posaconazole Isavuconazole

PHRM 865 (59 decks)

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