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Pharmacology Semester II > Exam III Anti-fungal Drug Names > Flashcards

Exam III Anti-fungal Drug Names Flashcards

1
Q

Yeast

A

Candida SP.**

Pneumocystis jyrovecii

Cryptococcus neoformans

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2
Q

Mold

A

Aspergillus SP.**

Mucor

Dermatophytes

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3
Q

Dimorphic

A

Blastomyces

Coccidiomycosis

Histoplasma

Sporotrichosis

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4
Q

Allylamines

A

4 Fines

Terbinafine

Butenafine

Naftifine

AmorolFine

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5
Q

Allylamine MOA

A

Inhibit Squalene -> no ergosterol synthesis (reducing fungal cell membrane)

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6
Q

Allylamine Coverage

A

Tinea (Cosporis/Pedis/Cruris)

Onychomycosis (Terbinafine)

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7
Q

Allylamine MISC facts

A

Terbinafine is the only one you can use for Onychomycosis

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8
Q

Polyenes

A

Nystatin (PO/Topical/Susp)

Amphotericin B Deoxycholate (AmB-d) (IV)

Amphotericin B​ Lipid complex (ABLC)

Liposomal Amphotericin B (L-AmB)

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9
Q

Polyenes MoA

A

Binds Ergosterol. Cell Leaks

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10
Q

Nystatin Coverage

A

Candida only

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11
Q

Amphotericin B (and Derivs) Coverage

A

Most Candida spp. and Aspergillus spp.

Most Fungi except no Fusarium spp. and A. Terreus

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12
Q

Amphotericin B ADRs/DDIs

A

Extremely nephrotoxic. Dose-Dependent decrease in GFR (monitor).

K, Mg, HCO3 wasting (electrolyte derangement)

Decreased EPO production. Avoid W/other nephrotoxic drugs

Acute Infusion RXN. (pre-medicate with APAP, or IBU, diphenhydramine +/- steroids, Rigors: meperidine)

Support with Fluids (Hydrate)

Thrombophlebitis (heparin), cardiac arrhythmias, and Rash

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13
Q

Amphotericin B DDIs worst to least.

A

AmB-d (base)

ABLC

(Less Nephrotoxic & Less infusion RXN)

L-AmB

(Less nephrotoxic & Less infusion RXN & better CNS penetration)

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14
Q

Imidiazoles

A

Clotrimazole

Ketoconazole

Miconazole

Econazole

Mebendazole

Oxiconazole

Sertaconazole

Sulconazole

Thiabendazole

CloK ME MOST azole

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15
Q

Ketoconazole (and other Imidazoles) MoA

A

Inhibit 14a-demethylase. No conversion of lanosterol to ergosterol. No CM synthesis.

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16
Q

Ketoconazole Coverage

A

Andida spp., blastomycosis, histoplasmosis (high failure)

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17
Q

Ketoconazole DDIs

A

CYP450/3A4 substrate ->CYP inhibition

Needs acidic gastric pH -> H2RA, PPI, antacid interactions

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18
Q

Ketoconazole MISC

A

Poor distribution into CSF and eye

Contraindicated in patients w/ hepatic impairment

Excreted in Feces

Available in many forms

Half-life 8 Hrs

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19
Q

Triazoles

A

Fluconazole (PO/IV/S)

Voriconazole (PO/IV/Drops)

Isavuconazole (PO/IV)

Itraconazole (PO/IV/S)

Posaconazole (PO/IV/S)

F VIIP

20
Q

Triazole MoA

A

Inhibit 14-a demethylase. No conversion of lanosterol to ergosterol. No CM synthesis.

21
Q

Fluconazole& Itraconazole coverage

A

NO

C. Glabrata

C. Krusei

Aspergillus (Fluconazole only)

Fusarium

Scedosporium

Zygomycetes

22
Q

Fluconazole ADR/DDI

A

Minor CYP3A4 / Moderate CYP2C9 inhibitor

If CrCL <50 half the dose.

23
Q

Fluconazole MISC

A

Wide distribution

CNS Penetration

Halflife 30 hrs 98-125 in renal impairment

24
Q

Voriconazole coverage

A

NO

Scedosporim

Zygomycetes

25
Q

Voriconazole ADR/DDI

A

NVD Liver dysfunction

Visual abnormalities

HA

Substrate and inhibitor of CYP3A4/2C9/2C19

Reduced Bioavailability w/ high fat meals

26
Q

Voriconazole Misc

A

Good CNS

Monitor

SCr

Electrolytes

LFTs (Nephrotoxic)

Ophthalmic exam if > 4 weeks therapy

QTc for prolongation

27
Q

Isavuconazole coverage

A

Invasive Aspergillosis

Mucormycosis

28
Q

Isavuconazole ADR/DDI

A

Loading Dose

QT shortening

Nephrotoxic

GI

Hypotension

Hypo K/Mg

Inhibition: CYP3A4, P-glycoprotein, OCT-2

29
Q

Isavuconazole Misc

A

Best bioavailability

Half life 130 Hrs

No Renal/Hepatic dosing

Administered as Prodrug Isavuconium

Monitor LFTs

30
Q

Fluconazole & Itraconazole coverage

A

NO

C. Glabrata

C. Krusei

Aspergillus (Fluconazole only)

Fusarium

Scedosporium

Zygomycetes

31
Q

Itraconazole ADR/DDI

A

99% protein bound

Capsule or solution, no change

Renal adjustment

32
Q

Itraconazole MISC

A

Capsules with food

Suspension without food

33
Q

Posaconazole Coverage

A

NO

Scedosporium

34
Q

Posaconazole ADR/DDI

A

Potent 3A4 Inhibitor

Inhibitor & substrate P-glycoprotein

GI

HA

Hepatotoxic (rare)

QT Prolongation

Hemolytic Uremic Syndrome

35
Q

Posaconazole MISC

A

Higher oral bioavailability w/food

DEC absorption w/ PPIs, H2RA

Oral Slow-Onset

No renal adjust

Monitor: SCr, electrolytes, LFTs

36
Q

Echinocandins

A

Caspofungin

Anidulafungin

Micafungin

CAM Fungin

37
Q

Echinocandin MoA

A

Inhibit glucan synthesis in Cell wall -> cell Wall ruptures

Good distribution, poor CNS penetration

38
Q

Echinocandin coverage

A

Invasive Candidiasis

Empiric coverage in netropenic fever (immunocompromised fever)

Fungicidal against most Candidiasis spp

Fungistatic vs Aspergillus

39
Q

Caspofungin ADR/DDI

A

CYP inducers reduce dose -> increase dose

Cyclosporin may increase AUC by 35%

Reduces tacrolimus (immunosuppressant) levels by 20%

40
Q

Micafungin ADR/DDI

A

Increases concentration of Sirolimus (anti-transplant rejection drug)

Increases AUC and Cmax of nifedipine

41
Q

Anidulafungin ADR/DDI

42
Q

Echinocandin MISC

A

Well tolerated

No renal adjust

Extensive half-life, once daily dosing

97-99% protein bound

43
Q

Flucytosine Coverage

A

ALL Candida EXCEPT C. Krusei

Cryptococcus neoformans

Aspergillus sp.

44
Q

Flucytosine MoA

A

Anti-metabolite (decreases DNA synthesis)

Has synergy, usually Co-administered

45
Q

Flucytosine ADR/DDI

A

Never use alone (resistance develops quickly)

Synergy w/ Amphotericin B.

NVD

Bone Marrow Suppression (dose-dependent avoid other suppressors)

Enterocolitis

Hepatotoxicity (avoid other nephrotoxic agents)

46
Q

Flucytosine MISC

A

Admin over 15 min w/food to limit N/V

Monitor: CBC/SCr/LFTs and serum levels (especially in pts w/poor renal)

Pharmacology Semester II (21 decks)

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