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Pharm - Antifungals Flashcards

1
Q

Aspergillus is a

A

mold

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2
Q

Candida spp. and cryptococcus are

A

yeasts

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3
Q

Histoplasma, trychophyton, and blastomyces are

A

other fungi

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4
Q

Name some benefits of fungi

A

Source for many meds (statins, beta-lactam abx)
Food (edible mushrooms)
Insect control
Biotechnology
Decomposers

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5
Q

Invasive aspergillosis

A

Hyphae invade lung vasculature, resulting in thrombosis and infarction

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6
Q

Esophageal candidiasis

A

Spectrum from scattered plaque like lesions in mild disease to very shaggy esophagus in severe cases
Can cause invasive tissue infections, spread to tissues, blood (candidemia), and GU tract

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7
Q

Cryptococcosis

A

CNS involvement

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8
Q

Blastomycosis

A

Deep seated fungal infection

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9
Q

Histoplasmosis

A

Fungal infection of the lungs, often from inhalation of bird droppings

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10
Q

Onychomycosis caused by what fungus

A

Trychophyton rubrum

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11
Q

Murcormycosis, aka

A

Zygomycosis

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12
Q

Dermatophytoses, AKA

A

Tinea infection

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13
Q

How recognize a fungal infection

A

Symptoms (inflammatory response, fever)
Risk factors
Radiography
Serological testing
Tissue/blood culture

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14
Q

Galactomannan assay for

A

aspergillus

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15
Q

B-glucan used for

A

Candida

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16
Q

Why are fungal infections “challenging”?

A

Hard to diagnose
Potential for drug toxicity
Resistance
Aggressiveness of pathogens

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17
Q

Largest class of antifungals is

A

azoles

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18
Q

Name the classes of antifungals discussed

A

Azoles
Polyenes
Flucytosine
Echinocandins
Terbinafine
Tavaborale
Ibrexafungerp (new)

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19
Q

3 targets for antifungal meds

A

Cell membrane (ampho, nystatin, azoles, Terbinafine)
DNA synthesis (flucytosine)
Cell wall (echinocandins, ibxrexafungerp)

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20
Q

Fungistatic

A

Chemicals that inhibit fungal growth

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21
Q

Fungicidal

A

Capable of destroying fungi

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22
Q

Amphotericin B class

A

Polyene Macrolide antifungal

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23
Q

Ampho only available in what form

A

IV

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24
Q

Ampho long or short half life?

A

Long (15 days)

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25
Ampho dose adjust for renal or hepatic function?
No
26
Amphotericin MOA
Binds to and disrupts ergosterol in fungal cell membrane
27
Amphotericin coverage
Broad, including yeasts, cryptococcus, histoplasma, blastomyces, aspergillus
28
Adverse effects of Amphotericin
“Amphoterrible” Infusion related symptoms: fever, chills, rigors, hypotension
29
How to reduce adverse effects of ampho?
Prophylaxis with acetaminophen, Benadryl, hydrocortisone
30
________ used to treat rigors associated with Ampho
Meperidine
31
Adverse effects of chronic Ampho use
Renal toxicity Hepatic toxicity
32
Describe the purpose of “lipid” ampho?
Created to improve tolerability Abelcet Amphotec Ambisome (liposomal amphotericin) Reduces toxicity by being packaged with hydrophilic portions
33
Clinical use of ampho
For “life-saving” use of nasty fungal infections
34
Ambisone is considered 1st line ALTERNATIVE option for
invasive aspergillus
35
Flucytosine only available in what form
Oral pills
36
Flucytosine large or small Vd
Large (enter CNS)
37
Flucytosine MOA
Taken up by fungal cells, converted to 5-FU and then 5-FdUMP and 5-FdUTP (inhibiting fungal DNA and RNA synthesis)
38
Flucytosine has synergistic action with ampho, so it is often used in combo to treat
Cryptococcus and Candida meningitis
39
Adverse effect of Flucytosine?
Myelosuppression (Anemia, thrombocytopenia, leukopenia) Potentially hepatotoxic
40
Flucytosine mostly used clinically to treat
Cryptococcal meningitis
41
Flucytosine mono or polytherapy?
Usually polytherapy
42
Imidazoles have a 5 membered ring with a __________ in the X position
C
43
Triazoles have a 5 membered ring with a ______________ in the X position
N
44
Name the imidazoles
Ketoconazole Miconazole Clotrimazole
45
Name the triazoles
Fluconazole Itraconazle Voriconazole Posaconazole Isavuconazole
46
Azoles MOA
Inhibit fungal sterol (ergosterol) synthesis by inhibiting the cytochrome P-450 enzyme that converts Lanosterol to ergesterol (Cell Membrane)
47
Azoles - fungistatic or fungicidal?
Fungistatic
48
Adverse effects of azoles
GI upset LFTs?
49
Which azole is known to worsen heart failure?
Itraconazole
50
Azole drug interaction
CYP 450 inhibitors (usually 3A4)
51
Ketoconazole used for
Seborrheic derm, athlete’s foot, ringworm
52
“Unexpected” use for Ketoconazole
Oral tablets for prostate cancer
53
How is oral itraconazole best absorbed?
With Coca Cola beverage
54
Itraconazole coverage
Candida, Aspergillus and others
55
Itraconazole used in the management of
Onychomycosis (amongst other things)
56
Fluconazole usually tolerated ________ and has a ________ Vd
Well, high
57
Primary clinical use of Fluconazole
Tx and prophylaxis of coccidiodal and cryptococcal meningitis Also first line for mild cases of candidemia
58
Fluconazole has no activity against
Aspergillus
59
Fluconazole has resistance seen in
C. kruse, C. glabrata and others
60
Voriconazole has excellent oral
bioavailability
61
Voriconazole adverse effects
Hepatic toxicity, rash, and visual changes
62
Voriconazole coverage
Broad Candida (including invasive) Aspergillus (1st line for invasive)
63
Posaconazole coverage
Candida Aspergillus Other molds
64
___________ is approved for prophylaxis of fungal infections in immunosuppressed patients
Posaconazole
65
________ considered 1st line for esophageal candidiasis
Posaconazole
66
Isavuconazole is a ___________
pro drug
67
Isavuconazole is 1st line alternative for invasive
Aspergillus
68
IV form of Isavuconazole requires administration through a
inline filter (to remove particles)
69
Topical azole antifungals useful for
Vulvovaginal yeast infection Athlete’s foot Diaper rash
70
Efinaconazole
Topical azole antifungal used for Onychomycosis
71
Efinaconazole is applied once daily for ___________ weeks
48
72
Tavaborole
Topical solution approved for Onychomycosis
73
Echinocandins active against
Candida and Aspergillus
74
Echinocandins only in what form
IV
75
Echinocandins MOA
Disrupts cell integrity and leads to cell death
76
Echinocandins are _______ against Candida
Fungicidal
77
Echinocandins are _________ against Aspergillus
Fungistatic
78
Adverse effects of Echinocandins
GI effects Flushing reactions
79
Echinocandins potential for drug interactions
Much less than azoles Caspofungin Micafungin Anidulafungin
80
Main use for Echinocandins
1st option for moderately to severely ill patients with invasive candidiasis
81
Ibrexafungerp
Considered fungicidal against Candida
82
Terbinafine
Both cream and pill form 1st option for Onychomycosis Monitor LFT’s
83
Terbinafine MOA
Interferes with ergosterol synthesis via the inhibition of the fungal enzymes squalene epoxidase
84
Tolnaftate
Creams, powders, and sprays Used for treatment of athlete’s foot and other superficial fungal infections No activity against Candida
85
Nystatin
Polyene antifungal Active against Candida Can be cream, powder, or oral rinse
86
Factors to include when choosing antifungal treatment
Organism Site of infection Severity of infection Response to previous therapy
87
Guidelines for fungal treatments
IDSA
88
Need to consider pt _________ function before prescribing antifungals
Organ (liver/kidney)
89
Azoles and Ibrexafungerp are category ____________ on the pregnancy status chart
C or D
90
What drug can actually shorten QTc?
Isavuconazole

Didactic Year (24 decks)

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