08.20 - Tx of Fungal Lung Infection (Sweatman) - Questions

Question 1

General MOA of Fluorocytosine

Answer 1

Nucleic Acid Synthesis inhibitor

Question 1

Most common topical azoles

Answer 1

Clotrimazole, Miconazole

Question 2

Griseofulvin is used to treat

Answer 2

Dermatophytosis

Question 3

Summary of Ketoconazole

Answer 3

Discouraged - Hepatic, Renal, CYP

Question 3

GI Toxicity

Answer 3

Itraconazole, Posaconazole, 5-FC

Question 4

Photopsia Toxicity

Answer 4

Voriconazole

Question 4

General MOA of Griseofulvin

Answer 4

Mitotic Spindle inhibitor

Question 5

Important enzyme that azoles work through?

Answer 5

CYP450

Question 5

Neither Amph B nor Flucytosine undergoes ___ metabolism

Answer 5

Hepatic

Question 6

Most azoles are eliminated via the __ route, except ___

Answer 6

Hepatic, Fluconazole.

Question 7

Clinical use of Caspofungin

Answer 7

IV - Aspergillus, Candida

Question 8

General MOA of Amphotericin B

Answer 8

Punches hole through cell membrane (binds to ergosterol)

Question 8

Other drug classes beside azoles with concerns over hepatic metabolism

Answer 8

None, maybe Griseofulvin

Question 8

Which azoles have higest side effect incidence?

Answer 8

Itraconazole, Posaconazole

Question 8

Pro-arrhythmogenic Azoles

Answer 8

Fluconazole, Posaconazole, Voriconazole

Question 9

Adverse Effects of Amph B

Answer 9

Infusion-related rxns; Renal Toxicity (anemia)

Question 9

With the excepton of Fluconazone, azoles are eliminated via what route

Answer 9

Hepatic

Question 10

2 adverse toxicities of Ketaconazole

Answer 10

Hepatic, Adrenal

Question 10

Fungal infection causing caseating granuloma

Answer 10

Histo

Question 11

Summary of Posaconazole

Answer 11

Oral, CYP interactions, Mucormycoses

Question 12

Infusion-related rxns; Renal Toxicity (anemia)

Answer 12

Amph B

Question 13

Most significant aspect of Griseofulvin

Answer 13

Drug-drug interactions

Question 14

How is Amph B administered

Answer 14

IV

Question 15

Terbinafine Summary

Answer 15

No CYP, Well tolerated

Question 17

80% of patients receiving oral Amph B experience

Answer 17

Renal Damage

Question 18

Most common use for Nystatin

Answer 18

Topical only - Candidiasis

Question 19

Infusion reactions

Answer 19

Amph B, Echinocandins

Question 21

First line therapy for most fungal species involves

Answer 21

Azole or Amphotericin B

Question 23

For which condition is Itraconazole the only first line suggested

Answer 23

Mild Blasto

Question 24

Tx for Mild Cocci? Severe?

Answer 24

Voriconazole; Amph B + Itra

Question 25

Fungal spheres containing endospores found in granulomas

Answer 25

Cocci

Question 26

Adverse Effects of Caspofungin

Answer 26

Tolerated well (GI maybe)

Question 27

2 Azoles to avoid in pregnancy

Answer 27

Fluconazole, Voriconazole

Question 28

For which condition is Amphotericin B the only first line suggestion

Answer 28

Mucormycosis

Question 30

When should Ketoconazole be used

Answer 30

Only as necessary alternative for endemic mycoses

Question 31

General MOA of Caspofungin

Answer 31

Inhibitor of Beta-1-3-Glucan

Question 33

Inhibitor of Beta-1-3-Glucan

Answer 33

General MOA of Caspofungin

Question 35

Comparable drug to Amph B

Answer 35

Nystatin

Question 36

Mild vs Severe Blasto

Answer 36

Add Amphotericin B to Itraconazole for Severe

Question 37

Summary of Fluconazole

Answer 37

Good availability - oral and CSF; Best tolerance

Question 38

Azoles produce what type of adverse effects? Which members are worst?

Answer 38

GI - Itraconazole, Posaconazole

Question 38

Ketaconazole is the only azole that causes \_\_\_

Answer 38

Adrenal insufficiency

Question 38

Tx for Basto

Answer 38

Fluconazole or Amph B if severe

Question 39

Summary of Itraconazole

Answer 39

Poor penetration of CSF; New formulations overcome poor oral bioavailability

Question 39

Mech of Resistance for Caspofungin

Answer 39

Altered Glucan Synthetase

Question 40

Azole with highest CYP interaction

Answer 40

Voriconazole

Question 41

Neurologic, Cutaneous, and Visual Adverse Effects

Answer 41

Voriconazole

Question 43

Only azole with activity against mucormycosis

Answer 43

Posaconazole

Question 45

3 notable adverse effects of voriconazole

Answer 45

Photosensitivity Dermatitis, Visual Disturbances, Hallucinations

Question 46

IV - Aspergillus, Candida

Answer 46

Clinical use of Caspofungin

Question 47

Summary of Voriconazole

Answer 47

Good oral; CYP3A4 inhibitor

Question 48

Tx for Mild Histo? Severe?

Answer 48

Voriconazole; Amph B + Itra

Question 49

Tx for CNS Crypto

Answer 49

Amph B + Flucytosine

Question 50

Blocks conversion of squalene to squalene epoxide

Answer 50

Terbinafine

Question 52

Which azoles penetrate CSF well

Answer 52

Fluconazole, Voriconazole

Question 54

Azoles that poorly penetrate into CSF

Answer 54

Ketoconazole, Itraconazole

Question 55

Indication for Flucytosine

Answer 55

Cryptococcus

Question 56

Drugs classes with concern about drug-induced effects on hepatic metabolism

Answer 56

Azoles def, Griseolfulvin maybe

Question 57

General MOA for Echocandins

Answer 57

Fungins: Inhibit Beta-1-3-Glucan Synthesis (cell membrane)

Question 59

Rash Toxicity

Answer 59

All antifungals

Question 61

General MOA of Terbinafine

Answer 61

Ergosterol synthesis inhibitor (Squalene to Squalene Epoxide)

Question 62

Amph B Summary

Answer 62

Poor solubility, Nephrotoxic

Question 63

CNS Toxicity

Answer 63

Voriconazole

Question 64

Toxicity of Flucytosine

Answer 64

Obvious: Anemia, Leukopenia, Thrombocytopenia

Question 65

Administration of Nystatin

Answer 65

Topical only - Candidiasis

Question 66

1st line tx for Aspergillus

Answer 66

Voriconazole

Question 67

Renal Toxicity

Answer 67

Amph B