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Infectious Disease > Fungal Pharmacology > Flashcards

Fungal Pharmacology Flashcards

1
Q

What are the three species of fungi that cause human infection?

A

Trichophyton, Microsporum, Epidermophyton

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2
Q

What are the topical azole antifungals?

A

Clotrimazole (Lotrimin) ointment; (Desenex) powder, Miconazole (Micatin, Monostat Derm), Ketoconazole (Nizoral)

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3
Q

What are the indications for topical azole antifungals?

A

Tinea corporis, tinea cruris, tinea pedis, cutaneous candidiasis.

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4
Q

What are CI of topical azole antifungals?

A

Pregnancy, lactation. Use with caution in liver failure. Ketoconazole not for use in asthma patients or history of sulfa allergy

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5
Q

What are indications and CI of clotrimazole?

A

Cutaneous candidiasis (topical), Vulvovaginal candidiasis (topical), Oropharyngeal candidiasis (oral). CI: Hypersensitivity

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6
Q

What are adverse effects of clotrimazole?

A

Topical: vulvovaginal burning. Oral: Abnormal LFTs, Pruritus, N/V

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7
Q

What are indications/CI of mycostatin?

A

Cutaneous and mucocutaneous infections caused by Candidia. Oral and intestinal Candidia infections. CI: Hypersensitivity to mycostatin

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8
Q

What are adverse effects of mycostatin?

A

Contact dermatitis. Stevens-Johnson syndrome. Oral: N/V, diarrhea

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9
Q

What are the systemic azole antifungals?

A

Ketoconazole (Nizoral), Itraconazole (Sporanox), Fluconazole (Diflucan)

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10
Q

Why is ketoconazole restricted to treatment of life threatening fungal infections?

A

hepatotoxicity, decreased adrenal corticosteroid secretion, QT prolongation, inhibitor of CYP450 (many drug interactions)

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11
Q

What potential life threatening infections could ketoconazole be used for if all other options failed?

A

Blastomycosis, coccidiomycosis, histoplasmosis, chromomycosis, paracoccidioiodmycosis. Should NOT be used for candida or dermatophyte infections

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12
Q

What are indications for Itraconazole (Sporanox)?

A

Aspergillosis, Blastomycosis, Esophageal and oropharyngeal candidiasis (oral soln), Coccidioidomycosis, Histoplasmosis, Onychomycosis

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13
Q

What are CI to itraconazole (Sporanox)?

A

Hypersensitivity. Use of other drugs that need CYP450 system. Ventricular dysfunction (negative inotrope): will further reduce ejection fraction
CHF. Pregnancy or intend to become pregnant

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14
Q

What are the pharmacodynamics of itraconazole?

A

Requires gastric acidity. Better absorbed with food (capsule). Solution better absorbed on an empty stomach. 99.8% protein bound. Half life is about 21 hours

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15
Q

What are adverse effects of itraconazole?

A

Nausea, diarrhea, Edema, Headache, Rash, Abnormal LFTs, Heart failure, Arrhythmia, Hearing loss

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16
Q

What monitoring is needed with itraconazole?

A

Baseline liver function tests. Monthly LFTs. Serum concentrations to assure therapeutic levels after 2 weeks of therapy

17
Q

What are indications for Fluconazole (Diflucan)?

A

Blastomycosis-CNS. Candidiasis-Candidemia, endocarditis, oropharyngeal, prophylaxis, vaginal.
Coccidioidomycosis-Meningitis, pneumonia, prophylaxis. Crypococcosis-Meningitis, pneumonia

18
Q

What are CI to fluconazole?

A

Hypersensitivity. Coadministration of CYP3A4 substrates which may lead to QT prolongation (cisapride, primozide or quinidine)

19
Q

What are the pharmacokinetics/dynamics of fluconazole?

A

Good penetration into CSF, eye, peritoneal fluid, sputum, skin and urine. Half life is 30 hours

20
Q

What are some commonly used drugs the fluconazole interacts with?

A

statins, viagra, warfarin, sulfonylureas, PPIs, antihypertensives, benzos, macrolides, fentanyl

21
Q

What are adverse effects of fluconazole?

A

Pregnancy category C/D, Headache, dizziness, N/V, diarrhea, Elevated LFTs, QT prolongation

22
Q

What monitoring needs to be done with fluconazole?

A

Baseline liver function tests. Periodic liver function, renal function, and potassium

23
Q

What are indications for Terbinafine (Lamisil)?

A

Oral/systemic formulation-Oncychomycosis, Tinea capitis. Topical-Tinea pedis, Tinea cruris, Tinea corporis

24
Q

What are the pharmacodynamics/kinetics of Terbinafine (Lamisil)?

A

half life 36 h. Distribution to the sebum and skin. 99% plasma bound. Hepatic metabolizm

25
Q

What are some significant drug interactions with terbinafine (Lamisil)?

A

for the oral formulation it interferes with metroprolol and tramadol

26
Q

What are SE of Terbinafine (Lamisil)?

A

ORAL-Headache, Diarrhea, Elevated LFTs. TOPICAL-Burning, Contact dermatitis, Dryness, Pruritus, Rash

27
Q

What are indications of Griseofulvin?

A

Most commonly used for tinea capitis. Also used for tinea infections of the skin, hair and nails

28
Q

How should griseofulvin be administered?

A

Fatty meal (peanut butter or icecream) can increase GI absorption. With food or milk to decrease GI upset

29
Q

What are CI of Griseofulvin?

A

Liver failure, Porphyria, Pregnancy (category X). penicillin allergy has potential for cross reactivity.
Breast feeding not recommended

30
Q

What monitoring needs to be done with Griseofulvin?

A

Renal fxn, liver fxn, CBC to watch for granulocytopenia

31
Q

What are potential drug interactions of Griseofulvin?

A

Warfarin, oral contraceptives, barbiturates, cyclosporine. If taken w/alcohol can cause N/V, dizziness, palpitations

32
Q

What are the indications for amphotericin B?

A

severe systemic and CNS infections that are progressive and potentially life threatening

33
Q

What are SE of amphotericin B?

A

Anaphylaxis, infusion reaction, leukoencephalopathy (damage to brain white matter), nephrotoxicity

34
Q

What needs to be monitored with amphotericin B?

A

renal and liver function, electrolytes, PT/PTT, CBC

35
Q

What are drug interactions with amphotericin B?

A

aminoglycosides, antifungal agents, corticosteroids, cyclosporine

Infectious Disease (17 decks)

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