Final: Anti-Fungals

Question 1

What are the 3 anti-fungals we can prescribe? What is most common anti-fungal that we will prescribe?

Answer 1

1) Natamycin
2) Amphoteracin B
3) Polyhexamethylene biguanide (PHMB)

Will prescribe Natamycin most commonly.

Question 2

What is the cell wall of fungi made of? What is cell membrane made of?

Answer 2

Cell wall: Chitin
Well Membrane: Ergosterol

Question 3

What are the most common yeast infection of the eye?

Answer 3

Candida

Question 4

What are the 2 most common mold infections of the eye?

Answer 4

Aspergillus
fusarium

Question 5

What 2 antifungals are known as the polyenes? What is their mechanism of action?

Answer 5

Natamycin and Amphoteracin B
Increase fungal cell membrane permeability

Question 6

True of False:
If patient has a fungal infection, taper them off steroids quickly when treating.

Answer 6

True

Question 7

True of False:
Oral anti-fungals can be added to a topical anti fungal to be more effective.

Answer 7

True

But isn’t common.

Question 8

What medication do you first prescribe for fungal keratitis? What is the dosage? Is it suspension, solution, or ointment?

Answer 8

5% Natamycin
One drop, every 1 to 2 hours, can taper over 4 to 6 weeks. May take 1-2 weeks to see the clinical response.
Suspension, must shake!

Question 9

Is natamycin broad spectrum or narrow spectrum?

Answer 9

Broad spectrum

Question 10

What is the only FDA approved topical anti-fungal?

Answer 10

Natamycin

Question 11

What is the percent of amphoteracin B for treatment of fungal keratitis? What is it best for? How would you prescribe it?

Answer 11

0.15%
One drop every 1-2 hours
Best for Non-filamentous and yeast infections

Question 12

True or false:
Amphoteracin B is not toxic to the cornea.

Answer 12

False; amphoteracin B is toxic to the cornea

Question 13

if you’re not able to prescribe natamycin for a fungal infection, what would your next alternative be?

Answer 13

0.15% Amphoteracin B

Question 14

What is the drug of choice for Acanthamoeba Keratitis? What is the dosing?

Answer 14

Polyhexamethly biguanide 0.02% (must be compounded)
1 drop every 1 hour

Question 15

What is the drug of choice for Acanthamoeba Keratitis? What is the dosing? What else would you give the patient and have them do?

Answer 15

Polyhexamethly biguanide 0.02% (must be compounded)
1 drop every 1 hour
Discontinue CL wear in both eyes
Oral NSAID or narcotic oral analgesic usually needed