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pharmacology unit 6 > antifungals > Flashcards

antifungals Flashcards

1
Q

two examples of yeast

A

candida and cryptococcus

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2
Q

examples of molds

A

aspergillus, fusarium, mucorales

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3
Q

endemic mycoses?

A

histoplasma, coccidioides, blastomyces. pneumocystis jirovecii

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4
Q

examples of triazoles

A

fluconazole, itraconazole, voriconazole, posaconazole

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5
Q

examples of the polyenes

A

amphotericin B, nystatin

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6
Q

examples of the echinocandins

A

caspofungin, micafungin, anidulafungin

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7
Q

what is the mechanism of the triazole

A

impedes ergosterol synthesis through direct inhibition of cytochrome p450 dependent 14-alpha-sterol-demethylse. this causes a deficiency of ergosterol in the membrane of the fungal cells and inhibits growth. there is collection of toxic sterols in the membrane as well

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8
Q

what is the most potent of the triazoles?

A

posaconazole works on almost everything

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9
Q

what are itraconazole and voriconazole useful against

A

aspergillus (broad), candida, cryptococcus, endemic mycoses

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10
Q

what is fluconazole used for

A

some candida, cryptococcus and endemic mycoses

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11
Q

name the triazoles from most effective to least

A

posaconazole, voriconazole, itraconazole, fluconazole

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12
Q

what are the SE of the triazole

A

relatively safe. liver enzyme abnorms, GI SE. voriconazole can cause visual disturbances

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13
Q

what does voriconazole cause as a unique side effect

A

visual disturbances.

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14
Q

do triazoles cause drug interactions? how?

A

yes. they are potential inhibitors of the CYP450. agents within the class differ in their ability to do this

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15
Q

what has the least drug interactions of the triazoles

A

fluconazole

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16
Q

how to treat susceptible candidiasis

A

fluconazole

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17
Q

how to treat severe thrush/esophageal candidiasis

A

fluconazole

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18
Q

how to prophylax for cryptococcal meningitis

A

fluconazole

19
Q

what is used as secondary treatment or the prophylaxis of histoplasmosis

A

itraconazole

20
Q

what treatment for invasive aspergillus

A

voriconazole

21
Q

what to prophylax for aspergillus/candidiasis in immunocompromised patients

A

posaconazole

22
Q

what common drug interaction occurs with itraconazole

A

diltiazem CCB. might have to lower the dose.

23
Q

what is another common drug interaction for itraconazole

A

ritonavir inhibits the metabolism of itraconazole significantly

24
Q

what class is amphotericin B

A

polyene macrolide.

25
Q

what is the mechanism of amphotericin

A

inhibition of ergosterol -generates pores in the fungal membrane.

26
Q

what is amphotericin B active against

A

candida, aspergillus, zygomyces, histoplasma, cryptococcus

27
Q

what is negative about amphotericin

A

there is a large SE profile. many patients unable to tolerate.

28
Q

what is the most important SE of amphotericin

A

nephrotoxicity. must watch the Cr.

29
Q

what are the acute infusion related SE of amphotericin

A

fever, chills, rigor. needs premedication

30
Q

what do we premedicate with for amphotericin treatment

A

diphenhydramine, APAP, meperidine

31
Q

what are the electrolyte abnormalities for amphotericin B

A

hypokalemia, hypomag

32
Q

what is the solution to the side effects of amphotericin

A

lipid formulations give better tolerability and are more renal protective with less infusion related SE> they allow to push higher doses in a safer manner.

33
Q

downfall to amphotericin B lipid formulation

A

expensive and still toxic

34
Q

what three agents are in the class echinocandins

A

caspofungin, micofungin, anidulafungin

35
Q

what are the echinocandins used to treat

A

candida, refractory aspergillus, esophageal candida, empirical antifungal for neutropenic patients.

36
Q

what is the unique machanism of action for caspofungin

A

inhibits the enzyme beta-1,3 D glucan synthase. a component of the cell wall not found in mammalian species. it is useful aspergillus and candida sps

37
Q

what are the positives for echinocandins

A

very few side effects, hapatically eliminated (liver toxic possible), few interactions, excellent activity against candida including the azole resistant. it also has good activity against molds.

38
Q

flucytosine is chemically related to what?

A

5 fluorouracil

39
Q

what is the mechanism of action for flucytosine

A

pyrimidine analog that inhibits DNA and RNA synthesis. only available as an oral formulation

40
Q

what is the spectrum of activity for flucytosine

A

narrow. used clinically only with other antifungals particularly with amphotericin B.

41
Q

what is flucytosine active against

A

cryptococcus and candida

42
Q

why is flucytosine not used as monotherapy

A

because resistance forms quickly

43
Q

what is flucytosine and amphotericin B commonly used against

A

cryptococcus meningitis

44
Q

what are the adverse of flucytosine

A

bone marrow toxicity, leukopenia, anemia, thrombocytopenia. liver dysfunction possible, GI intolerances. these are concentration dependent.

pharmacology unit 6 (45 decks)

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