Sketchy Pharm: Azoles

Question 1

List some of the azoles.

Answer 1

• Clotrimazole
• Ketoconazole
• Fluconazole
• Voriconazole
• Miconazole
• Itraconazole

Question 2

Recall that fungal membranes utilize _____________.

Answer 2

ergosterol

In this scene, ergosterol is symbolized by the emerald wall around the city.

Question 3

Azoles inhibit __________________.

Answer 3

the synthesis of ergosterol from lanosterol, which is accomplished by fungal CYP450 (like how the “LANe closed” sign is preventing the munchkins from bringing supplies to build the emerald wall; also, Dorothy’s house landed on a car with the CYP bumper)

Question 4

Which azoles inhibit CYP450?

Answer 4

All of them do, but voriconazole does so more than others (which fits in this Sketch, because the vortex is what brought the house to crush the car)

Question 5

What side effect is unique to voriconazole?

Answer 5

Blurry flashes of light and loss of color vision (like the blurred light patches in the tornado and the sepia background)

Question 6

Voriconazole is one of the main treatments for ______________.

(two answers)

Answer 6

Aspergillosis (like the scarecrow coming out of the sepia scene) and Candida esophagitis (like the Canadian flag behind the tornado)

Question 7

Fluconazole is often used for _______________.

three answers

Answer 7

• Vaginal candidiasis (snowball to crotch)
• Oropharyngeal candidiasis (easily scraped off snow covering ground)
• Cryptococcal meningitis (flying monkey on crypt)
• Esophageal candidiasis (esophagus gutters full of snow)

Question 8

Which azole is often used for CNS infections?

Answer 8

Fluconazole

Think of the FLying monkeys wearing the meningitis helmets.

Question 9

Which azole is best at treating dimorphic fungi infections?

Answer 9

Itraconazole (like the good wITch and her butterfly wings)

Another mnemonic: “ITraconazole for fungi with two ITerations”

Question 10

Which azole is used topically?

Answer 10

Clotrimazole and miconazole

(Think of the TIN man –who represents TINea corporis –next to the lion getting a CLOse TRIM. Also, the lion is holding the cone close, saying “it’s My CONe!”)

Question 11

_______________ is not often used systemically because of its potent CYP inhibition.

Answer 11

Ketoconazole (like the TIN man using the KEy to unlock the kidney lock)

Question 12

Which enzyme is inhibited by ketoconazole?

Answer 12

17,20-desmolase (the enzyme that converts cholesterol to pregnenolone)

Question 13

Ketoconazole is used systemically for _______________.

Answer 13

Cushing’s disease (represented by the moon face in the witch’s book)

Question 14

What side effect is unique to ketoconazole?

Answer 14

Gynecomastia (because it prevents the synthesis of androgens)