Fungal

Question 1

Which fungi are opportunistic?

Answer 1

Aspergillus and Candida Albicans

Question 2

Which fungi cause systemic disease?

Answer 2

Coccidiodies
Histoplasmosis
Blastomycosis
Cryptococcus

Question 3

What is the target of anti-fungals?

Answer 3

cell wall

ergosterol (a sterol unique to fungi)

Question 4

What is MOA of Amphotericin B?

Answer 4

binds ergosterol and forms leaky pores in fungal membrane?

Question 5

What is clinical application for Amphotericin B? What form is used for systemic infection?

Answer 5

IV form
Opportunistic: 
Aspergillus, 
Candidemia :
Systemic:
Coccidiodies
Histoplasmosis 
Blastomycosis 
Cryptococcus

Question 6

What are ADE of amphotericin?

Answer 6

Nephrotoxicity

Infusion site rxn’s : fever, muscle spasms, chills, hypotension

Question 7

What is MOA of flucytosine? What form is it given in?

Answer 7

interferes with RNA and DNA synthesis in fungi

Oral form given

Question 8

What are the clinical applications of flucytosine?

Answer 8

Treats cryptococcus and chromoblastomycosis inflections

Question 9

What are ADE of flucytosine?

Answer 9

Renal excretions

Myelosuppression

Question 10

What is MOA for Azoles?

Answer 10

inhibit the P450 enzyme system in fungi to stop production of ergosterol

Question 11

What is the disadvantage to using azoles?

Answer 11

If used long term can develop resistance

Question 12

Which azole is used to treat aspergillosis?

Answer 12

Voriconazole

Question 13

Which azole can cause visual disturbances and is a class D pregnancy?

Answer 13

Voriconazole

Question 14

Which azoles are used to treat blastomycosis?

Answer 14

itraconazole and fluconazole

Question 15

Which azole is used to treat mucormycosis?

Answer 15

posaconazole

Question 16

How is dermatophytosis treated? mycosis?

Answer 16

topical or oral azoles

oral/parenteral azoles

Question 17

T/F Most azoles undergo hepatic metabolism?

Answer 17

True

Question 18

Which azole is eliminated in urine unchanged?

Answer 18

Fluconazole

Question 19

What are ADE of azoles?

Answer 19

GI upset and rash

Question 20

Why is ketaconazole rarely used?

Answer 20

inhibits hepatic and adrenal P450 dependent enzymes

Question 21

what are the 4 ways of azole resistance

Answer 21

1. mutation or upregulation of P450 enzymes-decreases binding of azoles
2. increased efflux proteins pump that push the drug out the cell
3. alteration to anti fungal drug proteins
4. alteration to membrane sterols
5. reduced permeability

Question 22

What is MOA of echinocandins?

Answer 22

Caspofungin: prototype

work at the cell wall to stop production of B 1-3 glucan to causes apoptosis (disrupts cell wall synthesis)

Question 23

What is the clinical application of echinocandins? What form is it given in?

Answer 23

Candida, Aspergillus, replaces amphotericin during febrile neutropenia
IV only

Question 24

What is mode of elimination for echinocandins?

Answer 24

GI elimination, you adjust the dose if liver issues but not necessary for renal

Question 25

What are ADE of echinocandins?

Answer 25

facial swelling, itchiness, histamine release

Question 26

What is MOA of terbinafine?

Answer 26

stops epoxidation of squalene

Question 27

What is the clinical application of terbinafine?

Answer 27

mucocutaneous fungal infections

?accumulates in keratin

Question 28

What is pharmacokinetics of terbinafine?

Answer 28

oral, long duration of action

can last weeks

Question 29

What are ADE of terbinafine? (2)

Answer 29

GI upset, headache