Tinea and onchomycosis

Question 1

For widespread tinea infections, what can be used?

Answer 1

terbinafine; itraconazole; fluconazole;

Question 2

localized tinea infection Tx

Answer 2

Azoles; terbinafine; naftifine; ciclopirox

Question 3

Tx for onychomycosis

Answer 3

terbinafine; itraconazole; fluconazole

Question 4

Tx for onchomysis topical

Answer 4

ciclopirox; amorolfine

Question 5

What is the MOA for ciclopirox?

Answer 5

blocks fungal transmembrane transport and depletes essential substrates thus interfering with DNA/RNA synthesis (high [ ] cause intracellular leakage)

Question 6

does Ciclopriox have effects on the fungal cell wall?

Answer 6

NO=> does not inhibit synthesis or cause lysis

Question 7

What are significant toxicities with systemic Azole admin?

Answer 7

organ dysfxn; contraindication in concurrent disease or drug (CYP) interactions

Question 8

What are the advantages and disadvantages of topical tx of azoles?

Answer 8

Tx occurs w/o significant systemic toxicity but not suitable for all infections

Question 9

Ketoconazole use is limited for what reasons?

Answer 9

Hepatoxicity; adrenal insuffiency; DDI with CYP

Question 10

What is a DDI of fluconazole, posaconazole and voriconazole?

Answer 10

CYP 3A4 interactions

Question 11

Which drugs affect 2C9 and 2C19?

Answer 11

fluconazole; voriconazole

Question 12

Posaconazole affects what type of activity?

Answer 12

P-gp activity

Question 13

What are ADEs associated with fluco, posacon and voricon -azoles?

Answer 13

QT prolongation and dysrhythmias; hepatotoxicity; elevated LFTs

Question 14

What are specific ADEs of voriconazole?

Answer 14

visual disturbances (optic neuritis: color change, photophobia); photosensitizes the skin in SCC and melanoma

Question 15

Can flucon, posacon and voricon reach the CSF?

Answer 15

yes (dep on molec weight and P-gp affinity):

Flucon > voricon > itracon

Question 16

What is significant for administration with posaconazole?

Answer 16

MUST be with full meal or acidic carbonated drink for adequate bioavailability

Question 17

What is the effect of flucon, posacon and voricon in pregnancy?

Answer 17

contraindicated in pregnancy (Cat C)

Question 18

What is the elimination of fluconazole?

Answer 18

renal

Question 19

Dose adjustment with fluconazole?

Answer 19

yes with organ dysfxn

Question 20

Metabolism of flucon, posacon and voricon

Answer 20

extensie hepatic metab

Question 21

Terbinafine metabolism

Answer 21

hepatic (long half life)

Question 22

terbinafine elimination

Answer 22

renal

Question 23

What ADEs are associated w/ oral terbinafine usage

Answer 23

lymphopenia and neutropenia

Question 24

What patients should avoid taking terbinafine?

Answer 24

immunosuppressed => cause opportunistic infections

Question 25

admin of amorolfine

Answer 25

topical only with limited absorption

Question 26

Terbinafine use in pregnancy

Answer 26

category B so risk is very little

Question 27

MOA for naftifine?

Answer 27

anti-inflam via inhibition of inflam mediators such as PG, LTs and histamines => causes vasoconstriction

Question 28

Naftifine static or cidal

Answer 28

locally cidal against G+ and G-

Question 29

Metabolism of naftifine (topical)

Answer 29

hepatic

Question 30

elimination of naftifine (topical)

Answer 30

renal

Question 31

Contraindications for naftifine use

Answer 31

Hx of hypersensitivity to drug or co-formulated materials

Question 32

What should naftifine not be used with?

Answer 32

topical azoles

Question 33

Why cant topical azoles and naftifine be used together?

Answer 33

pharmacodynamic interference=> inhibits sterol production at earlier points so will diminish effectiveness

Question 34

DDI with naftifine

Answer 34

no systemic DDI

Question 35

Ciclopirox admin

Answer 35

topical only but limited absorption

Question 36

Possible ADE with ciclopirox or amorolfine

Answer 36

hypersensitivity/allergy to drug or co-formulation materials; irritate if on skin abrasions

Question 37

MOA of amorolfine

Answer 37

inhibits ergosterol synthesis

Question 38

What are BBW with itraconazole?

Answer 38

heart failure; ventricular dysfunction; co-admin w/ drugs

Question 39

MOA of itraconazole?

Answer 39

negative inotropic action (decrease force of heart contraction)

Question 40

Metabolism of itraconazole

Answer 40

extensive hepatic

Question 41

elimination of itraconazole

Answer 41

renal

Question 42

Contraindications of itraconazole

Answer 42

concurrent drugs with CYP interaction; liver dysfxn/hepatic toxicity => monitor LFTs; post-partum

Question 43

Pregnancy and itraconazole

Answer 43

Cat C but congenital deformities present

Question 44

Post-partum and itraconazole

Answer 44

distributed in breast milk