Tinea & Onchomycosis

Question 1

What is the MOA for azoles?

Answer 1

prevents ergosterol from being incorporated into the fungal cell wall

Question 2

Adverse effects of itraconazole?

Answer 2

1. Negative inotropic action: heart failure, ventricular dysfunction, co-admin w/ drugs
2. hepatoxicity
3. CI w/ CYP interaction drugs and pregnancy (cat C)
4. distributed in breast milk so CI postpartum

Question 3

What are common adverse effects of Fluconazole, posaconazole, voriconazole?

Answer 3

1. QT prolongation
2. Hepatotoxicity
3. CI in pregnancy
4. Penetrate through CSF especially Fluconazole
5. All CYP3A4 interactions

Question 4

What’s different about Fluconazole?

Answer 4

Also, 2C9 and 2C19. eliminated renally so dose adjustment needed

Question 5

What’s different about Posaconazole?

Answer 5

must be given w/ full meal or acidic carbonated drink for adequate bioavailability; Also Pgp

Question 6

What’s different about Voriconazole?

Answer 6

also 2C9 and 2C19; visual disturbances (optic neuritis); increased photosensitivity

Question 7

MOA of Terbinafine?

Answer 7

inhibits squalene synthesis for ergosterol

Question 8

Adverse effects of Terbinafine?

Answer 8

transient lymphopenia and neutropenia –> do routine CBCs; category B drug

Question 9

What is different about terbinafine compared to most of the other anti-fungal drugs?

Answer 9

rarely hepatoxicity reported

Question 10

MOA of Naftifine?

Answer 10

blocking sterol biosynthesis via inhibition of the squalene 2,3-epoxidase enzyme; allylamine; anti-inflammatory properties leads to vasoconstriction

Question 11

adverse effects of Naftifine?

Answer 11

don’t combine w/ topical azoles

Question 12

MOA of ciclopirox?

Answer 12

blocks fungal transmembrane transport, depleting essential substrates, and interferes w/ DNA and RNA synthesis. No direct action

Question 13

Adverse effects of ciclopirox and amorolfine?

Answer 13

HSR/allergy

Question 14

MOA of amorolfine?

Answer 14

inhibits ergosterol synthesis