fungal infections

Question 1

name some examples of triazole antifungals

Answer 1

Fluconazole, Itraconazole , Voriconazole, Posaconazole

Question 2

which triazole antifungal should be avoided or used with caution in patients with liver disease

Answer 2

Itraconazole. because it has been associated with liver damage

Question 3

which triazole antifungal is very well absorbed after oral administration and largely excreted unchanged in the urine

Answer 3

fluconazole

Question 4

what are the imidazole antifungals : (clotrimazole, econazole, ketoconazole + tioconazole) used to treat

Answer 4

local treatment of vaginal candidiasis and for dermatophyte infections (fungal skin infections)

Question 5

why has the use of oral ketoconazole (except for cushing’s syndrome) been suspended

Answer 5

the risk of hepatotoxicity associated with oral ketoconazole is greater than the benefit in treating fungal infections (except in cushing’s syndrome)

Question 6

what is Nystatin used for

Answer 6

Nystatin is used for oral thrush

• also used for Candida albicans infection of the skin
• note Nystatin is not absorbed from the gastrointestinal tract and is applied locally (as a suspension) to the mouth for treating local fungal infections*

Question 7

what is the drug of choice for fungal nail infections

Answer 7

Terbinafine

• it is also used for ringworm infections where oral treatment is considered appropriate.

Question 8

what is the first choice treatment for Aspergillosis (a respiratory fungal infection)

Answer 8

• first choice: Voriconazole

amphotericin B is an alternative first-line treatment when voriconazole cannot be used.

Question 9

what is Amphotericin B used for

Answer 9

the treatment of systemic fungal infections and is active against most fungi and yeasts

Question 10

which formulations of amphotericin B are significantly less toxic

Answer 10

Lipid formulations of amphotericin B (Abelcet® and AmBisome®)

• note: When given parenterally amphotericin B is toxic and side-effects are common*

Question 11

what is Griseofulvin used for

Answer 11

It is the drug of choice for trichophyton infections (athlete’s foot, ringworm, jock itch, and similar infections of the nail, beard, skin and scalp) in children

• it is used for widespread or intractable dermatophyte infections (but not as common now due to newer antifungals).

Question 12

why is Amphotericin B prescribed by brand name

Answer 12

because formulations are not interchangeable

Question 13

why is a test dose of Amphotericin B recommended before treatment is started

Answer 13

because anaphylaxis can occur with any intravenous amphotericin B product

Question 14

what may you need to consider when Miconazole oral gel is given for oropharyngeal candidiasis (oral thrush)

Answer 14

Systemic absorption may follow use of miconazole oral gel and may result in significant drug interactions

Question 15

when is Fluconazole given for oral thrush

Answer 15

oral thrush infections that do not respond to topical therapy or when topical therapy cannot be used

note: Itraconazole can be used for fluconazole-resistant infections

Question 16

which patients should not use over-the-counter miconazole oral gel (Daktarin)

Answer 16

patients taking warfarin as they interact

Miconazole greatly increases the anticoagulant effect of warfarin