Treatment of fungal infections

Question 1

Vaginal Candida (single oral dose)
 -	Also for Candida in urinary tract and oropharynx

Answer 1

Fluconazole

Question 2

creams/suppositories for vaginal candidiasis

- Toxicity of topical preps.: burning, itching, irritation

Answer 2

Miconazole

Question 3

Mechanism for Miconazole

Answer 3

inhibit sterol 14α-sterol demethylase

fungistatic

Question 4

Miconazole is used for:

Answer 4

Oral or vaginal candidiasis
not nails available topically
mech like fluconazole

Question 5

Toxicity of Miconazole

Answer 5

allergic/irritation reactions

- Oral form toxicity: may cause abnormal liver function tests (15%),

Question 6

Use of Itraconazole

Answer 6

• Oropharyngeal and esophageal candidiasis

Question 7

Almost exclusively for Candida of skin, mucous membranes, G.I. tract, vaginal infections
- Mechanism similar to amphotericin B

Answer 7

Nystatin

Question 8

Mech of Nystatin

Answer 8

Nystatin (lika amphoB)

binds ergosterol

Question 9

Side effects of Nystatin

Answer 9

tastses NASTY and GI

Question 10

Amphotericin B
(does it work for dermatophytes?)

Answer 10

topical formulation for cutaneous or mucosal
Candida -
not effective against dermatophytes

Question 11

For fungal eye infections, e.g. conjunctivitis, keratitis, blepharitis
• especially those caused by Fusarium, Cephalosporium, Aspergillus

Answer 11

Natamycin

Question 12

Natamycin must be used in conjuction with

Answer 12

appropriate surgical measures

Question 13

Toxicity caused by Natamycin

Answer 13

conjunctival chemosis and hyperemia, allergic in nature

Question 14

Mech of Natamycin

Answer 14

lipophilic and binds ergosterol

Question 15

type of Dermpatophytic infections:

Answer 15

(Trichophyton, Epidermophyton, Microsporum)

Question 16

Terbinafine (Lamisil):

Answer 16

topical, for dermatophytes

Question 17

Use: this lacquer is the only topical Rx for fungal nail infections

Answer 17

Ciclopirox

(ciclops only has nails… everyint e

Question 18

Ciclopirox mechanism

Answer 18

possibly inhibits metal-dependent enZ by chelating metal ions

Question 19

Tolnaftate

Answer 19

-tx dermapthophytes (not Candida); no significant absorption,
few toxic reactions; thought to inhibit fungal ergosterol synthesis

Question 20

Mech of Tolnaftate

Answer 20

inhibit fungal ergosterol synthesis

Question 21

Terbinafine

Answer 21

12 week therapy for nail infections~ shorter then other dermatophyte infections
superior to grisefulvin for nail infections

Question 22

Mech of Terbinafine

squaline for 12 weeks and 2x6 = 12

Answer 22

inhibits fungal squalene epoxidase; non-competitively; lotsa squalene damages fungal cell membranes; fungicidal

Question 23

blocks fungal squalene epoxidase

accumulation of squaline damages cell membrane~~ fungicidal

Answer 23

Terbinafine

Question 24

Terbinafine;
administration:
Metabolism/excretion:

Answer 24

oral, well absorbed; remains in skin 12 weeks after therapy stopped
metabolites excreted in urine

Question 25

Terbinafine toxicity

Answer 25

inhibits CYP2D6 | diarheaa

Question 26

For stuborn infections of skin, hair, nails, that are beyond the scope of topical therapy

Answer 26

Griseofulvin

Question 27

Recommended therapy for children, esp. for tinea capitis

Answer 27

Griseofulvin

Question 28

Tx length with Griseofulvin

Answer 28

Long-term treatment (6–12 months) esp. for nail infections; clinical relapse will occur if long-term treatment not completed

Question 29

Mech of Griseofulvin | micortubles~ metaphase

Answer 29

slowly deposited into skin, hair, nails; interferes with microtubule function/mitotic spindle/mitosis; arrests fungi in metaphase of mitosis.

Question 30

only for Epidermophyton, Microsporum, Trichophyton (dermatophytic) infections of skin, hair, nails; not justified for skin infections which respond to topical agents

Answer 30

Griseofulvin | microtubles, metaphase

Question 31

Is Griseofluvin Fungistatic or fungicidal?

Answer 31

Both Fungistatic or fungicidal, dependent on fungal metabolic rate

Question 32

Administration of Griseofulvin

Answer 32

Oral with high fat foods | use wth others when tx tenia pedis

Question 33

Toxicities of Griseofulvin

Answer 33

Dont use if porphyria and advanced liver disease; monitoring of hepatic, renal, and hematopoietic systems recommended - Increased metabolism of other drugs (e.g. oral contraceptives, warfarin, others) - caution: penicillin allergies

Question 34

Contraindicated in those with porphyria and advanced liver disease; periodic monitoring of hepatic, renal, and hematopoietic systems recommended - Increased metabolism of other drugs (e.g. oral contraceptives, warfarin, others) - caution: penicillin allergies

Answer 34

Griseofulvin

Question 35

3-month therapy for toenail infections

Answer 35

Itraconazole

Question 36

Itraconazole

Answer 36

Discontinue if signs of liver dysfunction appear Inhibits metabolism of many drugs, Nausea, vomiting, rash, diarrhea, headache, edema