Antifungals

Question 1

DOC for superficial mycoses

Answer 1

topical Clotrimazole (Lotrimin)

Question 2

Amphotericin B class

Answer 2

polyenes

antifungal

Question 3

Amphotericin B MOA

Answer 3

Binds to ergosterol in fungal cell membrane forming pores; increased permeability –> cell death

Question 4

Gold standard antifungal tx

Answer 4

Amphotericin B (IV)

**broadest spectrum of activity - works against all clinically significant yeasts (candid, histoplasma, aspergillus)

Question 5

Amphotericin B toxicities

Answer 5

“shake and bake”

• infusion-related
• cumulative toxicity (renal damage)

(can pre-medicate with antihistamines, antipyretic, corticosteroids)

Question 6

Azole Antifungals MOA

Answer 6

• inhibit cytochrome P450
• block formation of ergosterol
• slow-killing, considered “static” drugs

Question 7

What is the MC imidazole drug (azole antifungal)?

Answer 7

Clotrimazole (topical only)

Question 8

What is the MC triazole drug (azole antifungal)?

Answer 8

Fluconazole

Question 9

Azole Antifungal ADRs

Answer 9

1) GI upset

2) Hepatitis (LC)

Question 10

Azole Antifungal interactions

Answer 10

1) Drug interactions through the cytochrome P450 system of enzymes
2) increase levels of warfarin

Question 11

What is the MC used systemic antifungal?

Answer 11

Fluconazole

Question 12

Fluconazole is extremely active against ________

Answer 12

C. albicans

Question 13

Echinocandins MOA

Answer 13

cause disruption of the fungal cell wall causing cell death

Question 14

Echinocandins includes which drugs

Answer 14

Caspofungin
Micafungin
Anidulafungin

Question 15

Echinocandins spectrum

Answer 15

Candida, Aspergillus, Pneumocystis

these drugs are IV only

Question 16

Echinocandins s/e

Answer 16

mild GI and flushing

Question 17

What is/are the DOC for superficial mycoses

Answer 17

1 topical Clostrimazole (Lotrimin)

other commonly used are: topical Nystatin (Mycostatin) and oral Terbinafine (Lamisil)

Question 18

T/F: topical administration is not successful for nails and hair

Answer 18

TRUE

must take oral Rx

Question 19

Clotrimazole (Lotrimin) Class

Answer 19

Antifungal (Azole)

Question 20

Clotrimazole (Lotrimin) indication

Answer 20

superficial mycoses - tinea, yeast vaginitis, oral thrush

Question 21

Clotrimazole (Lotrimin) MOA

Answer 21

binds to ergosterol molecules on fungal cell membrane and causes membrane leakage during cell division

Question 22

Nystatin (Mycostatin) indication

Answer 22

superficial mycoses - tinea; oral, esophageal and vaginal Candida

Question 23

Nystatin (Mycostatin) MOA

Answer 23

binds ergosterol molecules on fungal cell membrane resulting in loss of membrane integrity and death of fungal cell

Question 24

________ is often used as prophylaxis in pt. who are at risk for fungal infx, such as AIDS pt with a low CD4 count and pt. receiving chemotherapy

Answer 24

Nystatin

Question 25

Terbinafine class

Answer 25

antifungal (synthetic allylamine)

Question 26

Terbinafine MOA

Answer 26

interferes with ergosterol biosynthesis

Question 27

Terbinafine indications

Answer 27

used primarily for dermatophyte (nail/skin) infx

Question 28

Terbinafine is given continuously for _______ to treat fingernail infx and _______ to treat toenail infx

Answer 28

6 weeks

12 weeks

Question 29

Terbinafine s/e

Answer 29

MC = abdominal discomfort, diarrhea, nausea, HA

LC = elevated liver enzymes, hepatitis, liver damage, liver failure