fungal infections (mycoses)

Question 1

What are the two types of fungal infections (mycoses)?

Answer 1

Systemic and Superficial.

Question 2

Which type of mycoses is less frequent but more serious?

Answer 2

Systemic mycoses.

Question 3

How are systemic mycoses classified?

Answer 3

Opportunistic and Non-opportunistic.

Question 4

What is the drug of choice (DOC) for systemic mycoses?

Answer 4

Amphotericin B.

Question 5

Why is Amphotericin B considered highly toxic?

Answer 5

Causes infusion reactions, nephrotoxicity, electrolyte imbalances, and bone marrow suppression.

Question 6

How is Amphotericin B administered?

Answer 6

IV only.

Question 7

What are the adverse effects of Amphotericin B?

Answer 7

Infusion reactions, nephrotoxicity, hypokalemia, phlebitis, bone marrow suppression, delirium, hypotension, hypertension, wheezing, hypoxia, and rare cases of seizure, anaphylaxis, dysrhythmias, acute liver failure, nephrogenic diabetes insipidus.

Question 8

How can infusion reactions from Amphotericin B be prevented?

Answer 8

Pretreat with IV diphenhydramine & acetaminophen; may also give IV meperidine & dantrolene.

Question 9

How is nephrotoxicity minimized with Amphotericin B?

Answer 9

Administer 1L of normal saline (NS).

Question 10

What should be monitored when using Amphotericin B?

Answer 10

CBC, hematocrit (Hct), and electrolytes.

Question 11

What conditions require caution when using Amphotericin B?

Answer 11

Pregnancy/lactation, impaired renal function, anemia, electrolyte imbalances, bone marrow suppression.

Question 12

What drugs interact with Amphotericin B?

Answer 12

Other nephrotoxic drugs, Flucytosine.

Question 13

What class of antifungals is used for systemic mycoses and is less toxic than Amphotericin B?

Answer 13

Azoles.

Question 14

How do azoles work?

Answer 14

Inhibit CYP450 enzymes.

Question 15

How are azoles administered?

Answer 15

Some are oral (po), some are IV, and some can be both.

Question 16

What are the adverse effects of azoles?

Answer 16

GI effects, headache, hepatotoxicity, cardiac effects (QT prolongation or shortening, CHF).

Question 17

What are the common types of superficial mycoses?

Answer 17

Candida infections (vulvovaginal, oral/thrush), dermatophytic infections (ringworm), and onychomycosis (nail infections).

Question 18

How are superficial mycoses usually treated?

Answer 18

Topical or oral antifungals.

Question 19

How is vulvovaginal candidiasis treated?

Answer 19

1-3 days of topical antifungals or a one-dose fluconazole (oral).

Question 20

What are the treatment options for oral candidiasis (thrush)?

Answer 20

Topical or oral antifungals: Clotrimazole, Miconazole, Nystatin; severe cases may require Fluconazole, Posaconazole, Itraconazole.

Question 21

What are the treatment options for tinea infections?

Answer 21

Topical or oral antifungals.

Question 22

Which antifungal agents are used for tinea capitis?

Answer 22

Oral, Topical, Ketoconazole (shampoo).

Question 23

Which takes longer to treat: toenail or fingernail onychomycosis?

Answer 23

Toenail infections take longer.

Question 24

What are the main adverse effects of topical azoles?

Answer 24

Local irritation.

Question 25

What are the adverse effects of oral azoles?

Answer 25

Systemic effects including hepatotoxicity, GI effects, HA , and cardiac issues (QT pronlongation, CHF, QT shortening)

Question 26

How is Nystatin used for fungal infections?

Answer 26

for superficial po or topical AE: po-N/V/D; topical-local irritation

Question 27

What are the adverse effects of oral Nystatin?

Answer 27

Nausea, vomiting, diarrhea (N/V/D).

Question 28

What are the adverse effects of topical Nystatin?

Answer 28

Local irritation.

Question 29

How is Griseofulvin best absorbed?

Answer 29

When taken with a fatty meal.

Question 30

What are the adverse effects of Griseofulvin?

Answer 30

Transient headache, rash, GI effects.

Question 31

What are the adverse effects of oral Terbinafine, Naftifine, and Butenafine?

Answer 31

Headache, diarrhea, dyspepsia, abdominal pain, skin reactions, taste disturbances, liver failure.

Question 32

What is the class of antifungal drugs that includes Caspofungin, Micafungin, and Anidulafungin?

Answer 32

Echinocandins.

Question 33

How are echinocandins administered?

Answer 33

IV only.

Question 34

What infections do echinocandins treat?

Answer 34

Narrow-spectrum activity for systemic Aspergillus and Candida infections.

Question 35

How do echinocandins interact with the CYP450 system?

Answer 35

They act as substrates, meaning they can be affected by other CYP450 drugs.

Question 36

What are the adverse effects of echinocandins?

Answer 36

Fever, phlebitis, headache, rash, nausea/vomiting, flushing, pruritis.