Anti fungal drugs

Question 1

Later toxicity of Amphotericin B Deoxycholate

Answer 1

Nephrotoxicity

Question 2

what is the MOA of echinocandins?

Answer 2

inhibition of fungal cell wall synthesis

Question 3

Drug of choice for cryptococcal meningitis

Answer 3

Amphotericin B

Question 4

Side effects of ketoconazole?

Answer 4

• Gynexomastia

- decrease libido

Question 5

Tiazole that clearance is altered by genetics

Answer 5

Voriconazole

Question 6

Triazoles and pregnancy?

Answer 6

Avoid All

Question 7

Synergism of nephrotoxicity of Amphotericin B with Trasplant and allograft patients

Answer 7

• Cyclosporin
• Sirolimus
• Tacrolimus

Question 8

Azole of choice for Histo, cocci, and blasto

Answer 8

itraconazole

Question 9

What therapy has been found to be associated with Histoplasmosis

Answer 9

anti-TNFalpha therapy

• infliximab
• Etanercept

Question 10

What enzyme to echinocandins inhibit?

Answer 10

beta-(1,3) glucan synthase

Question 11

mechanism of action of the Azoles

Answer 11

-inhibit Lanosterol to Ergosterol biosynthetic pathway

Question 12

What 2 azoles have good CSF access?

Answer 12

Fluconazole and Voriconazole

Question 13

What azole has strong cyp450 inhibition and therefore interacts with other drugs?

Answer 13

itraconazole and voriconazole

Question 14

What is given with amphotericin B to treat cryptococcal meningitis

Answer 14

5-FC (5-Fluorocytosine anti metabolite)

Question 15

What enzyme is inhibited by Azoles

Answer 15

14-alpha-demethylase (Cytochrome p450)

Question 16

Fluconazole is narrow spectrum in that it only targets what?

No activity against what?

Answer 16

• Candida Albicans
• also Cryptococcous

No activitiy vs Aspergillus

Question 17

What is the third line Azole that comes in pill form

Answer 17

Ketoconazole

Question 18

Drug of choice for mucormycosis

Answer 18

Amphotericin B

Question 19

Toxicity of amphotericin B deoxycholate upon onset of infusion

Answer 19

• chills
• fever
• anemia
• hypotension

Question 20

Therapeutic indications for echinocandins?

Answer 20

serious opportunistic infections such as

• invasive candidiasis, candidemia
• invasive Aspirgillosis

especially if refractory to other therapies

Question 21

mechanism of action for polyenes (amphotericin B)

Answer 21

associates with ergosterol and creates pores

Question 22

What would you give an AIDS patients with oropharyngeal candidiasis who had failed to recover on fluconazole, amphotericin B, and itraconazole

Answer 22

Caspofungin

Question 23

Azoles create a surplus of what?

Answer 23

Lanosterol

Question 24

What does 5-FC do?

uses what fungal enzyme that humans don’t have?

Answer 24

uses cytosine deaminase to ultimately inhibit DNA synthesis by blocking thymidylate synthase and also inhibits proteins synthesis

Question 25

Mechanisms of resistance to Azoles

Answer 25

- mutation or overexpression of lanosterol 14alpha demethylase - efflux - changes in sterol and/or phospholipid composition

Question 26

Azole for cryptococcus

Answer 26

fluconazole

Question 27

Triazoles and liver damage

Answer 27

All can

Question 28

is Caspofungin effective against pathogenic fungal infections such as histo, cocci, and fusarium

Answer 28

NO

Question 29

Synergism of nephrotoxicity of Amphotericin B with gram - and MRSA infections

Answer 29

- aminoglycosides | - vancomycin

Question 30

mechanism of resistance to 5-FC

Answer 30

- mutated cytosine permease | - mutated cytosine deaminase

Question 31

What azoles have good bioavailibility

Answer 31

Fluconazole and voriconazole

Question 32

Synergism of nephrotoxicity of Amphotericin B with HIV patients

Answer 32

- Foscarnet | - Pentamidine

Question 33

Triazole that disturbs vision

Answer 33

Voriconazole

Question 34

There is a way for 5-FC to still work and get into the fungal cells even if there is a mutation in cytosine permease . . explain this

Answer 34

can go through the pores that are created by amphitericin B

Question 35

Describe the effects of Amphotericin B on the kidney

Answer 35

Direct damage to DISTAL TUBULE membrane leading to Na, K, and Mg wasting and the hyponatremia leads decreased GFR and Arteriole constriction

Question 36

drug to use for Candiduria

Answer 36

Fluconazole . . . (renal excretion and high bioavailibility)

Question 37

What azole is cleared renally

Answer 37

fluconazole

Question 38

What is the Broad spectrum Azole

Answer 38

Itraconazole

Question 39

What is the echinocandin fungal drug?

Answer 39

Caspifungin

Question 40

Azole used for Aspergillus

Answer 40

voriconazole