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

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Flashcards in 08.20 - Tx of Fungal Lung Infection (Sweatman) - Questions Deck (67):
1

General MOA of Fluorocytosine

Nucleic Acid Synthesis inhibitor

1

Most common topical azoles

Clotrimazole, Miconazole

2

Griseofulvin is used to treat

Dermatophytosis

3

Summary of Ketoconazole

Discouraged - Hepatic, Renal, CYP

3

GI Toxicity

Itraconazole, Posaconazole, 5-FC

4

Photopsia Toxicity

Voriconazole

4

General MOA of Griseofulvin

Mitotic Spindle inhibitor

5

Important enzyme that azoles work through?

CYP450

5

Neither Amph B nor Flucytosine undergoes ___ metabolism

Hepatic

6

Most azoles are eliminated via the __ route, except ___

Hepatic, Fluconazole.

7

Clinical use of Caspofungin

IV - Aspergillus, Candida

8

General MOA of Amphotericin B

Punches hole through cell membrane (binds to ergosterol)

8

Other drug classes beside azoles with concerns over hepatic metabolism

None, maybe Griseofulvin

8

Which azoles have higest side effect incidence?

Itraconazole, Posaconazole

8

Pro-arrhythmogenic Azoles

Fluconazole, Posaconazole, Voriconazole

9

Adverse Effects of Amph B

Infusion-related rxns; Renal Toxicity (anemia)

9

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

Hepatic

10

2 adverse toxicities of Ketaconazole

Hepatic, Adrenal

10

Fungal infection causing caseating granuloma

Histo

11

Summary of Posaconazole

Oral, CYP interactions, Mucormycoses

12

Infusion-related rxns; Renal Toxicity (anemia)

Amph B

13

Most significant aspect of Griseofulvin

Drug-drug interactions

14

How is Amph B administered

IV

15

Terbinafine Summary

No CYP, Well tolerated

17

80% of patients receiving oral Amph B experience

Renal Damage

18

Most common use for Nystatin

Topical only - Candidiasis

19

Infusion reactions

Amph B, Echinocandins

21

First line therapy for most fungal species involves

Azole or Amphotericin B

23

For which condition is Itraconazole the only first line suggested

Mild Blasto

24

Tx for Mild Cocci? Severe?

Voriconazole; Amph B + Itra

25

Fungal spheres containing endospores found in granulomas

Cocci

26

Adverse Effects of Caspofungin

Tolerated well (GI maybe)

27

2 Azoles to avoid in pregnancy

Fluconazole, Voriconazole

28

For which condition is Amphotericin B the only first line suggestion

Mucormycosis

30

When should Ketoconazole be used

Only as necessary alternative for endemic mycoses

31

General MOA of Caspofungin

Inhibitor of Beta-1-3-Glucan

33

Inhibitor of Beta-1-3-Glucan

General MOA of Caspofungin

35

Comparable drug to Amph B

Nystatin

36

Mild vs Severe Blasto

Add Amphotericin B to Itraconazole for Severe

37

Summary of Fluconazole

Good availability - oral and CSF; Best tolerance

38

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

GI - Itraconazole, Posaconazole

38

Ketaconazole is the only azole that causes ___

Adrenal insufficiency

38

Tx for Basto

Fluconazole or Amph B if severe

39

Summary of Itraconazole

Poor penetration of CSF; New formulations overcome poor oral bioavailability

39

Mech of Resistance for Caspofungin

Altered Glucan Synthetase

40

Azole with highest CYP interaction

Voriconazole

41

Neurologic, Cutaneous, and Visual Adverse Effects

Voriconazole

43

Only azole with activity against mucormycosis

Posaconazole

45

3 notable adverse effects of voriconazole

Photosensitivity Dermatitis, Visual Disturbances, Hallucinations

46

IV - Aspergillus, Candida

Clinical use of Caspofungin

47

Summary of Voriconazole

Good oral; CYP3A4 inhibitor

48

Tx for Mild Histo? Severe?

Voriconazole; Amph B + Itra

49

Tx for CNS Crypto

Amph B + Flucytosine

50

Blocks conversion of squalene to squalene epoxide

Terbinafine

52

Which azoles penetrate CSF well

Fluconazole, Voriconazole

54

Azoles that poorly penetrate into CSF

Ketoconazole, Itraconazole

55

Indication for Flucytosine

Cryptococcus

56

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

Azoles def, Griseolfulvin maybe

57

General MOA for Echocandins

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

59

Rash Toxicity

All antifungals

61

General MOA of Terbinafine

Ergosterol synthesis inhibitor (Squalene to Squalene Epoxide)

62

Amph B Summary

Poor solubility, Nephrotoxic

63

CNS Toxicity

Voriconazole

64

Toxicity of Flucytosine

Obvious: Anemia, Leukopenia, Thrombocytopenia

65

Administration of Nystatin

Topical only - Candidiasis

66

1st line tx for Aspergillus

Voriconazole

67

Renal Toxicity

Amph B