Pharmacology - Antifungal Therapy - Christopher Miller

Question 1

Class: Flocuonazole

Answer 1

Triazole

Antifungal

Question 2

Class: Itraconazole

Answer 2

Triazole

Antifungal

Question 3

Class: Voriconazole

Answer 3

Triazole

Antifungal

Question 4

Class: Posaconazole

Answer 4

Traizole

Antifungal

Question 5

Class: Amphotericin B

Answer 5

Polyene macrolide

Antifungal

Question 6

Class: Nystatin

Answer 6

Polyene macrolide

Antifungal

Question 7

Class: Caspofungin

Answer 7

Echinocandin

Antifungal

Question 8

Class: Micafungin

Answer 8

Echinocandin

Antifungal

Question 9

Class: Anidulafungin

Answer 9

Echinocandin

Antifungal

Question 10

Use: Nystatin

Answer 10

Skin infections - Candida

Usually topical preparations

Question 11

MOA: Triazoles

Answer 11

Impede ergosterol synthesis through direct inhibition of the cytochrome P450 dependent enzyme 14-alpha-sterol-demethylase.

Ergosterol is an essential molecule of the fungal cell membrane. Inhibition of this stops fungal growth.

Question 12

Spectrum: Flunazole

Answer 12

Some candida;
Cryptococcus;
Endemic Mycoses (ie Histoplasmosis, Coccidiomycosis)

Question 13

Spectrum: Voriconazole, Itraconazole

Answer 13

Fluconazole spectrum PLUS

Aspergillus, broader Candida coverage

Question 14

Spectrum: Posaconazole

Answer 14

Voriconazole, Itraconazole spectrum PLUS Fusarium, Mucorales

Question 15

Adverse effects: Triazoles

Answer 15

Liver enzyme abnormalities

GI side effects

Question 16

What adverse effect is specific to Voriconazole?

Answer 16

Visual disturbances

Question 17

What triazole has the lowest drug interaction profile?

Answer 17

Fluconazole

Triazoles have crossover with mammalian CYP450 system

Question 18

Use: Fluconazole

Answer 18

Susceptible candidiasis;
Severe thrush/exophageal candidiasis;
Secondary treatment of (and prophylaxis of) cryptococcal meningitis

Question 19

Use: Itaconazole

Answer 19

Secondary treatment and prophylaxis of systemic histoplasmosis

Question 20

Use: Voriconazole

Answer 20

Invasive aspergillosis

Question 21

Use: Posaconazole

Answer 21

Prophylaxis of aspergillosis/candidiasis in immunocompromised patients

Question 22

MOA: Amphotericin B

Answer 22

Pores are formed in the fungal cell membrane, allowing leakage of K+ and Mg+

Question 23

Spectrum: Amphotericin B

Answer 23

Broad spectrum: Candida spp, Aspergillus spp. Zygomyces spp., Hystoplasma, Cryptococcus

Question 24

Use: Amphotericin B

Answer 24

Life-threatening invasive fungal infections; broad antifungal spectrum; (occasionally used with flucytosine in immunocompromised hosts)

Question 25

Adverse effects: Amphotericin B

Answer 25

Nephrotoxocity; Poor overall tolerability; Chronic: fall in renal function (may only be partially reversible); K+ Mg+ wasting; renal tubular acidosis

Question 26

Use: Echinocandins

Answer 26

* Candida infections * Refractory aspergillus infection * Esophageal candidiasis * Empiric antifungal therapy for febrile neutropenic patients **IV formulation only**

Question 27

MOA: Nystatin

Answer 27

Pores are formed in the fungal cell membrane, allowing leakage of K+ and Mg+

Question 28

Adverse effects: Echinocandins

Answer 28

Liver toxicity possible, requires monitoring;

Question 29

MOA: Echinocandins

Answer 29

Inhibit synthesis of Beta(1,3)-D-glucan, an essential component of the fungal cell wall

Question 30

MOA: Flucytosine

Answer 30

Prodrug converted by fungal enzyme to analog inhibitor of pyrimidine nucleotide synthesis

Question 31

Use: Flucytosine

Answer 31

Cryptococcal meningitis; Often in combination therapy; Oral only

Question 32

Spectrum: Flucytosine

Answer 32

Crytpococcus, some Candida spp

Question 33

Adverse effects: Flucytosine

Answer 33

Bone marrow issues - low WBCS; Liver toxicity; GI issues **Follow with blood levels**

Question 34

Class: Efinazonazole solution

Answer 34

Azole / Cell membrane synthesis inhibitor

Question 35

MOA: Efinazonazole solution

Answer 35

Inhibit ergosterol synthesis by inhibiting lanosterol demethylase

Question 36

Use: Efinazonazole solution

Answer 36

Candida; Tinea | ie toe fungus

Question 37

Adverse effects: Efinazonazole

Answer 37

Application site dermatitis, pain