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PM3A > (PM3A) Fungal Infections & Anti-fungal Drugs > Flashcards

(PM3A) Fungal Infections & Anti-fungal Drugs Flashcards

1
Q

What does ‘mycoses’ refer to?

A

Fungi

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2
Q

What are the two types of structure of fungi?

Give examples.

A

(1) Single cell - yeasts - Candida spp.

(2) Filamentous - Multicellular - mould - Aspergillus spp.

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3
Q

What are the two types of infection that can be contracted from fungi?

A

(1) Localised - acute

(2) Systemic

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4
Q

What is a major difference in the structure of a fungal cell, in comparison to a human (animal) cell?

A

Fungal cells have a cell wall

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5
Q

What is the structure of a fungal cell wall, from innermost to outermost level of structure?

A

(1) Nucleus
(2) Cell membrane: ergosterol & beta1-3 glucan synthase
(3) Cell wall: beta1-6 glucans and beta1-3 glucans
(4) Mannoproteins

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6
Q

What are the main anti-fungal drug categories?p a a e f g

A

(1) Polyenes
(2) Azoles - imidazoles & triazoles
(3) Allylamines (+ amorolfine)
(4) Echinocandins
(5) Flucytosine
(6) Griseofulvin

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7
Q

(1) Which route of administration is used for amphotericin B? Is this toxic?

(2) Which other route(s) of administration for amphotericin B would be toxic?

A

(1) Oral - not toxic

(2) IV - highly toxic

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8
Q

What are two types of polyene?

A

(1) Amphotericin B

(2) Nystatin

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9
Q

When is oral amphotericin B used?

A

Oral candida

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10
Q

When is IV amphotericin B used?

A

Life-threatening systemic infections

e.g. cryptococcal meningitis

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11
Q

(1) Describe the spectrum of activity for amphotericin B.

(2) What does this mean?

A

(1) Broad

(2) Kills most fungi

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12
Q

Describe the bioavailability for oral amphotericin B.

A

Poor oral bioavailability

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13
Q

What are/ is the administration route(s) for nystatin.

A

Local/ topical

  • Oral suspension for oral infections
  • Cream for candida of skin
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14
Q

(1) Describe the spectrum of activity for nystatin. b

(2) What does this mean?

A

(1) Broad

(2) Kills most fungi

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15
Q

Can nystatin be taken orally? Give reasons for your answer.

A

No - it is topical

(1) Absorbed poorly orally
(2) Nephrotoxic
(3) Neurotoxic

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16
Q

Describe the mechanism of action of polyenes.
e
Give 2 examples of polyenes.

A

(1)
- Bind to ergosterol in the cell membrane
- Binding forms pores in the cell membrane
- Pores cause leakage of K+ and Mg2+
- Leakage leads to lysis (cell death)

(2) Nystatin and amphotericin B

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17
Q

(1) How many types of azole are there?

(2) What are they called?

A

(1) 2 types

(2) Imidazoles and triazoles

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18
Q

Give 2 types of imidazole.

Name ONE brand for each.

A

(1) Miconazole - e.g. Daktarin

(2) Clotrimazole - e.g. Canesten

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19
Q

What is/ are the route(s) of administration for imidazoles?

A

Usually topical

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20
Q

What is a superficial mycoses?

A

Fungal infection of the upper layers of the skin

Can also include nails

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21
Q

What is another name for superficial mycoses?

A

Cutaneous mycoses

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22
Q

(1) Describe the spectrum of activity of imidazoles.

(2) What does this mean?
n

A

(1) Dermatophytes & candidiasis

(2) Narrow spectrum - have specific clinical indications

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23
Q

What is the ‘oromucosal’ route of administration?

A

Gel placed directly onto the gums and cheek

Drug is absorbed directly into bloodstream

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24
Q

(1) How many types of triazole are there?

(2) Name them.

A

(1) 4 types

(2)
- Fluconazole
- Itraconazole
- Voriconazole
- Posaconazole

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25
Q

What is/ are the administration route(s) of fluconazole? What is the general indication for each?

A

(1) Capsule - systemic

(2) Liquid - systemic

(3) IV - systemic

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26
Q

What generic drug is the brand Sporanox?

A

Itraconazole

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27
Q

What is/ are the route(s) of administration for triazoles?

A

Depends on infection site

Can be capsule/ oral suspension/ IV/ tablet

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28
Q

(1) Describe the spectrum of activity for triazoles.b

(2) What does this mean?

A

(1) Broad

(2) Can be used for Candida/ Cryptococcus/ Aspergillus

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29
Q

What type of drug is most appropriate for aspergillus, both generally and specifically? v

A

(1) Generally: Azoles - Triazoles

(2) Specifically - voriconazole/ posaconazole

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30
Q

Describe the mechanism of action for azoles. 3 f

A

(1) Targets Cytochrome P450

(2) Thus interferes with ergosterol (cell membrane) biosynthesis

(3) Disrupts plasma membrane - fungistatic

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31
Q

What does fungistatic mean?

A

Used to describe an anti-fungal drug which disrupts the plasma membrane of fungi

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32
Q

(1) What type of anti-fungal drug is terbinafine?

(2) What is a brand of it?

A

(1) Allylamine

(2) Lamisil

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33
Q

(1) Describe the spectrum of activity of allylamines.
d
(2) What does this mean in clinical practice?
n r

A

(1) Usually dermatophytes

(2) Nail infections & ringworm

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34
Q

Describe the mechanism of action of allylamines. se

A

(1) Inhibits squalene epoxidase

(2) Inhibition of squalene epoxidase prevents production of lanosterol

(3) Prevents ergosterol synthesis

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35
Q

Is an allylamine fungistatic or fungicidal?

A

Both

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36
Q

What is amorolfine?

A

A synthetic morpholine

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37
Q

Describe the spectrum of activity of amorolfine.
b dy
What does this mean?

A

Broad

Mainly dermatophytes and yeast

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38
Q

Describe the mechanism of action of amorolfine. 2

A

(1) Inhibits 2 enzymes

(2) Inhibition of enzymes means ergosterol biosynthesis is halted

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39
Q

Is amorolfine considered fungicidal or fungistatic?

A

Usually fungicidal

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40
Q

Give an example of an echinocandin.

A

Caspofungin

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41
Q

What is/ are the route(s) of administration for an echinocandin?

A

IV - once a day

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42
Q

(1) Describe the spectrum of activity of echinocandins.b

(2) What does this mean in clinical practice?

A

(1) Broad

(2) Used for serious systemic infections - Candida/ Aspergillus

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43
Q

For which fungal infection is an echinocandin specifically NOT indicated? Why?

A

For Cryptococcus

Not for central nervous system

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44
Q

Describe the mechanism of action of echinocandins.

A

(1) Inhibits 1-3 beta-glucan synthase

(2) Prevents production of 1-3 beta-glucan

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45
Q

Are echinocandins considered to be fungicidal or fungistatic?

A

Fungicidal

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46
Q

What is/ are the route(s) of administration for flucytosine?

A

(1) Oral

(2) IV

47
Q

Where are is flucytosine well absorbed, where other anti-fungal drugs are not?

A

Cerebrospinal fluid - CSF

48
Q

(1) Describe the spectrum of activity of flucytosine. n

(2) What does this mean in clinical practice? Include indications. sc

A

(1) Narrow

(2)
- Used in combination with other anti-fungal drugs
- For severe Candida/ Cryptococcal systemic infections

49
Q

Describe the mechanism of action of flucytosine.

A

(1) Metabolised into fluorouracil (5-FU)

(2) Fluorouracil (5-FU) disrupts RNA/ DNA synthesis

50
Q

Is flucytosine considered fungicidal or fungistatic?

A

Fungistatic

51
Q

What is griseofulvin?

A

A type of benzofuran

Type of anti-fungal drug

52
Q

What is/ are the route(s) of administration of griseofulvin?

A

Oral

Tablets or oral suspension

53
Q

(1) Describe the spectrum of activity of griseofulvin.n

(2) What does this mean in clinical practice?

A

(1) Narrow/ limited

(2) Used for dermatophytes - e.g. Tinea capitis

54
Q

Describe the mechanism of action of griseofulvin. pm

A

(1) Binds to polymerised microtubules

(2) Inhibits mitosis of fungal cell

(3) Inhibits fungal growth

55
Q

Is griseofulvin considered to be fungistatic or fungicidal?

A

Fungistatic

56
Q

What are the common side effects of griseofulvin?rnva

A
  • Rash
  • Urticaria
  • Nausea
  • Vomiting
  • Anorexia
57
Q

Which anti-fungal drug(s) act on the ergosterol in the cell membrane of the fungal cells?

A

(1) Polyenes

(2) Allylamines

(3) Azoles

58
Q

What is candidiasis?

A

A fungal infection

59
Q

Is candidiasis a common/ rare/ very rare etc. infection?

A

Most common fungal infection in the UK

60
Q

What types of candidiasis infection are there? atgp

A

(1) C. albicans
(2) C. tropicalis
(3) C. glabrata
(4) C. pseudotropicalis

61
Q

What is/ are the potential cause(s) of candidiasis?

A

(1) Broad-spectrum antibiotics

(2) Immunodeficiency

62
Q

Are the symptoms of candidiasis normally localised or systematic?

A

Localised

63
Q

Where are sites of infection for candidiasis?

A

(1) Skin
(2) Mucosae - e.g. vaginal/ oral thrush
(3) Nails - e.g. onchomycosis

64
Q

What is onchomycosis?

A

Candidiasis infection of the nails

65
Q

What are the common symptoms of candidiasis infections?

A
  • Pain
  • Itching
  • Creamy curd-like plaques on mucosal surface
  • Bleeding upon removal of mucosal surface
66
Q

What is indicated if a candidiasis if the fungal infection is systemic?

A

Immunocompromised patient

67
Q

How is a candidiasis infection diagnosed?

A

(1) Clinical features - symptoms
(2) Laboratory culture

68
Q

What is/ are the treatment(s) for candidiasis? 2 types

A

(1) Azoles:
- Imidazoles: clotrimazole - Canesten - topical
- Triazoles: fluconazole - Canesten - oral
(2) Polyenes:
- Nystatin
- Amphotericin B - IV for systemic candidiasis

69
Q

What types of vulvovaginal candidiasis are there?

A

(1) Vulvitis
(2) Vaginal/ vulvovaginal

70
Q

What is vulvitis?

A

Inflammation of the vulva due to infection

71
Q

What is the treatment for vulvitis candidiasis? ck

A

Topical imidazole creams
- e.g. clotrimazole BD/ TDS
- e.g. ketoconazole OD/ BD

72
Q

What is the treatment for vaginal candidiasis?

A

Intravaginal cream/ pessary:
- e.g. clotrimazole
- e.g. miconazole

73
Q

What is the treatment for vulvovaginal candidiasis in 12-15 year old girls?

A

Topical imidazole

Oral + intravaginal options are not used

74
Q

What is oncomycosis?

A

Candidiasis infection of the nail

75
Q

What are the symptoms of oncomycosis (candidiasis infection of the nail)?

A
  • Nail appears abnormal + discoloured
76
Q

How is oncomycosis (candidiasis infection of the nail) diagnosed?

A

(1) Clinical features - symptoms
(2) Confirmed with microscopy + cultures

77
Q

What self-care is recommended for those with oncomycosis (candidiasis infection of the nail)?

A

(1) Good hygiene
(2) Fitting footwear
(3) Clipping nails
(4) Avoid damp + moisture
(5) Avoid nail trauma

78
Q

What is the general treatment guidelines for oncomycosis (candidiasis infection of the nail)?

A

(1) Topical - amorolfine 6 months for nail
Topical - amorolfine - 9-12 months for toes

(2) Oral anti-fungal if topical is unsuccessful OR contraindicated

79
Q

What is the first line treatment for oncomycosis (candidiasis infection of the nail)?it

A
  • Itraconazole
  • 200mg
  • BD
  • 1 week duration
80
Q

What is Candida auris?

A

A fungal infection

Similar to C. albicans

81
Q

What causes thrush?

A

Also known as candidiasis

C. albicans

82
Q

What is of particular note regarding Candida auris?

A

It has multi-drug resistance

Only discovered in 2009

83
Q

What causes invasive candidiasis?

A

C. auris

Candida auris

84
Q

What does Candida auris (C. auris) cause in infection?

A

Invasive candidiasis

e.g. bloodstream infections

85
Q

What is fungemia?

A

Fungal infection of the blood

Presence of fungus in the bloodstream

86
Q

What is dermatophytosis?

A

Ringworm

87
Q

What are the species of filamentous fungi? e m t d

A

(1) Epidermophyton

(2) Microsporum

(3) Trichophyton

(4) Dermatophyton

88
Q

What are the symptoms of ringworm (dermatophyton)?

A
  • Red scaly lesions on skin
  • Nail discolouration and thickening
  • Hair loss and scarring
  • Itchy
  • Not usually painful
89
Q

How is ringworm (dermatophytosis) diagnosed?

A

Culture of:
- Skin scrapings
- Nail clippings
- Hair samples

90
Q

What is the treatment for head/ scalp ringworm (dermatophytosis)? g ti

A

Systemic griseofulvin

+ topical imidazole

91
Q

What is the treatment for skin ringworm (dermatophytosis)?

A

Topical imidazoles
- clotrimazole
- miconazole
- ketoconazole

92
Q

What is the treatment for nail ringworm (dermatophytosis)?

A

Same as candidiasis
- Itraconazole
- 200mg
- BD
- 1 week duration

Oral terbinafine if unsuccessful or contraindicated

93
Q

What is aspergillosis?

A

Fungal infection of the lungs

IF SEVERE:
Can affect heart/ brain skin/ if immunocompromised

94
Q

What are the symptoms for aspergillosis?

A

(1) Wheezing
(2) Breathlessness - SOB
(3) Fatigue
(4) Cough
(5) Malaise

95
Q

How is aspergillosis diagnosed?

A

(1) Sputum culture
(2) Bronchoalveolar lavage - washing of a cavity
(3) Antigen detection

96
Q

What is the treatment for aspergillosis?v

A

(1) 1st line: voriconazole

(2) Can add bronchodilators + steroids if required

(3) Surgery

(4) Avoid further exposure

97
Q

What is pityriasis versicolor?

A

A common fungal skin infection

98
Q

What is/ are the cause(s) of pityriasis versicolor?

A

Malassezia

Yeast - normally found on skin

99
Q

What are the symptoms of pityriasis versicolor?

A
  • Changes in colour to patches of skin
  • Itchy
100
Q

How is pityriasis versicolor diagnosed?

A

(1) Skin scraping

(2) Clinical examination

101
Q

What is the treatment for pityriasis versicolor?

A

(1) Topical anti-fungal creams for 2-3 weeks

(2) Oral anti-fungals only used in treatment failure

102
Q

What is histoplasmosis?

A

A fungal lung infection

103
Q

How is histoplasmosis transmitted?

A

Inhalation of H. capsulatum spores

104
Q

What are the symptoms of histoplasmosis?

A

(1) Cough
(2) Flu-like symptoms
(3) Chronic infection - resembles TB

105
Q

How is histoplasmosis diagnosed?

A

Lab diagnostics:
- Blood antibodies
- Cultures

106
Q

What is the treatment for histoplasmosis?

A

(1) Oral itraconazole

(2) IF SEVERE: IV amphotericin B

107
Q

What is a cryptococcal infection?

A

Fungal infection

Usually of the lungs

108
Q

(1) How many types of Cryptococcal infection are there?

(2) What are they and what causes them?

A

(1) 2 types

(2)
- Lung infection - Cryptococcus neoformans
- AIDS - Cryptococcal meningitis

109
Q

(1) Are Cryptococcal infections common?

(2) When are they most common?

A

(1) No. Uncommon

(2) In immunocompromised patients - low CD4 count

110
Q

What are the symptoms of a Cryptococcal infection?

A
  • Fever
  • Fatigue
  • Dry cough
  • Headache
  • Blurred vision
  • Confusion
  • Nausea
  • Chest pain
  • Skin rash
111
Q

How is a Cryptococcal infection diagnosed?b c s u

A

Clinical tests:
- Blood
- Cerebrospinal fluid
- Sputum
- Urine screening/ culture

112
Q

What is the treatment for Cryptococcal infections?

A

(1) Amphotericin B + flucytosine - IV for 2 weeks

(2) Followed by oral fluconazole - 8 weeks

113
Q

(1) How many mechanisms of anti-fungal resistance are there?

(2) What are they?

A

(1) 4 types

(2)
- Altered drug metabolism
- Efflux pumps
- Change in protein target
- Prevention of drug entry

PM3A (36 decks)

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