Anti-Fungal Agents

Question 1

Which Anti-Fungal drugs have good oral bioavailability?

Answer 1

1) Triazoles (Flucanazole & Voriconazole)
2) 5-Flucytosine
3) Echinocandins

Question 2

Use of 5-Flucytosine?

Answer 2

Combination (+) Amphotericin B:

1) Candidiasis
2) Cryptococcosis (Meningitis & Pul Infections)

Question 3

ADE of 5-Flucytosine

Answer 3

1) GI effects
2) Hepatotoxicity
3) Bone marrow supression

Question 4

Use of Echinocandins

Answer 4

1) 1st line for invasive candidiasis

2) 2nd line for invasive asperigillosis

Question 5

Which agents can be used for Asperigillosis?

Answer 5

1) Amphotericin B

2) Itraconazole (Intolerant to AB)

Question 6

Which agents can be used for Invasive Asperigillosis?

Answer 6

1) Voriconazole (1st line)

2) Echinocandins

Question 7

Which agents can be used for Invasive Candidiasis?

Answer 7

Echinocandins (1st line)

Question 8

Which agent should not be given IV?

Answer 8

Nystatin (systemic toxicity)

Question 9

Which drug should not be taken with antacids?

Answer 9

Itraconazole (low pH for better absorption)

Question 10

Which agents can be used for Onychromycoses?

Answer 10

Itraconazole, Terbinafine

Question 11

What is oral Terbinafine used for?

Answer 11

1) Onychromycoses (nail)

2) Tinea capitis (scalp)

Question 12

What is Miconazole used for?

Answer 12

1) Tinea pedis
2) Tinea cruris
3) Tinea versicolor
4) Vulvovaginal candidiasis

Question 13

What is Nystatin used for?

Answer 13

Commonly used for candida & oral cutaneous infections:

1) Oropharyngeal candidiasis (oral)
2) Vulvovaginal candidiasis (intra-vaginally)
3) Cutaneous candidiasis (topical)
4) GIT fungal infections

Question 14

What is topical Terbinafine used for?

Answer 14

1) Tinea pedis
2) Tinea cruris
3) Tinea corporis (ringworm)

Question 15

Safe for pregnancy

Answer 15

Amphotericin B

Terbinafine - Vaginal (A), Oral (B)

Question 16

ADE of imidazoles

Answer 16

1) Contact dermatitis
2) Vulvular irritation
3) Edema
4) GIT (Oral)

Question 17

ADE of terbinafine

Answer 17

GIT, Headache, Rash, Elevated liver enzymes

Question 18

Administration of Amphotericin B

Answer 18

Topical or Slow IV

Question 19

Which Anti-fungal agents can be given orally?

Answer 19

1) 5-Flucytosine???
2) Triazoles
3) Imidazoles (lozenges)
4) Nystatin
5) Terbinafine

Question 20

Which agents can be used for Candidiasis?

Answer 20

1) Amphotericin B
2) 5-Flucytosine
3) Voriconazole

Question 21

Which agents can be used for Cryptococcus meningitis?

Answer 21

5-Flucytosine & Fluconazole

Question 22

Use of Itraconazole?

Answer 22

1) Blastomycosis & Aspergillus (Intolerant to AB)
2) Onychomycosis (nail)
3) Esophageal oropharyngeal candidiasis (oral sol)

Question 23

Name the polyenes & their MOA

Answer 23

Amphotericin B & Nystatin

MOA: Binds to ergosterol, form pores in c.m & causing leakage

Question 24

Coverage & use of Amphotericin B

Answer 24

Broad-spectrum Fungistatic & Fungicidal

1) Candidiasis
2) Crytococcus neoformans
3) Asperigillosis
4) Histoplasmosis

Question 25

ADE of Amphotericin B

Answer 25

- Fever/Chills (Infusion-related) - Nephro & Ototoxicity - Bone marrow suppression - Thrombophlebitis - Hypotension

Question 26

MOA of 5-Flucytosine

Answer 26

Inhibits protein synthesis: | Converted to 5-FTU by cytosine deaminase -> FUTP -> Incorporated into fungal RNA instead of uridylic acid

Question 27

Use of Fluconazole

Answer 27

1) Single-dose oral for vulvovaginal candidiasis | 2) Cryptococcal meningitis

Question 28

Use of Voriconazole

Answer 28

1) Invasive asperigillosis (1st line) | 2) Candida

Question 29

MOA of Echinocandins

Answer 29

Inhibits activity of glucan synthase complex | -> Loss of structural integrity

Question 30

Adverse Side Effects of Triazoles

Answer 30

GIT Hepatotoxicity QT Prolongation

Question 31

MOA of Triazoles

Answer 31

Inhibits C-14 a-demthylase -> Blocks demthylation of lanosterol to ergosterol

Question 32

Use of Clotrimazole

Answer 32

1) Dermatophyte infections | 2) Vulvovaginal candidiasis

Question 33

Adverse Drug Effects of Imidazoles

Answer 33

- Contact dermatitis - Vulvular irritation - Edema - GIT (oral)

Question 34

Contraindications for Terbinafine

Answer 34

Nursing mothers & renal impairment