Anti-fungals

Question 1

Can you treat a fungal infection with an antibiotic?

Answer 1

No

Question 2

what is the 4th cause of septicemia?

Answer 2

fungal infections (typically in immunosupressed patients)

Question 3

WHat are the three groups of fungi?

Answer 3

Molds
True yeast
yeast-like fungi

Question 4

what is a systemic infection with a mold?

Answer 4

Disseminated aspergillosis

Question 5

what is the most “drying” of a prep? what is the least?

Answer 5

Gel is most (best for hairy areas)

Ointment is least

Question 6

should powders be the only treatment of a fungal infection?

Answer 6

No, should be for additive (prevention)

Question 7

how long are treatments for antifungals?

Answer 7

Weeks to months

Question 8

What are three main antifungals?

Answer 8

Polyene Antibiotics
Imidazole antifungals
Triazole antifungals

Question 9

What are 4 polyene antibiotics?

Answer 9

Amphotericin B
Nystatin
Flucytosine
Griseofulvin

Question 10

What is the MOA of polyene antibiotics?

Answer 10

Bind to ergosterol in fungal cell membranes are form pore –> leak “-cidal”

Question 11

is resistance a problem in antifungals?

Answer 11

Not as much as with antibiotics

Question 12

what forms is amphotericin B available in? what form is less toxic?

Answer 12

IV

Liposomal preps are less toxic

Question 13

What is the route for Nystatin ?

Answer 13

Cream, vaginal troches, suspension to oral mucosa

Question 14

What Polyene would you use for severe systemic fungal infections?

Answer 14

Amphotericin B

Question 15

What is nystatin mainly used to suppress?

Answer 15

Candidiasis on the skin and mouth

Question 16

What are ADRs of amphoB?

Answer 16

hypotension
anemia (reversible)
nephrotoxicity (liposomal lessens this)
thrombophelbitis

Question 17

What are ADRs of nystatin

Answer 17

N/V/D especially if swallowed

Question 18

What is flucytosine used for?

Answer 18

Sytemic candidiasis
Cryptococcus meningitis
in combo w/ AmphoB

Question 19

How is flucytosine administered?

Answer 19

Oral

has bad side effects of N/V

Question 20

What type antifungal is griseofulvin?

Answer 20

“-static_

Question 21

Where does griseofulvin concentrate?

Answer 21

Nails

Question 22

Who can you use griseofulvin for?

Answer 22

Children

Question 23

WHat is the drug of choice for nail fungal infections?

Answer 23

Terbinafine

Question 24

What is a concern with griseofulvin?

Answer 24

P450 inducer (barbiturates, warfarin, oral contraceptives)
increase absorption with high fat meal (more side effects)
potentiates effects of alcohol

Question 25

What is a broad spectrum antifungal that doesn't cover aspergillus?

Answer 25

Ketoconazole | can see -cidial activity with higher doses

Question 26

Are most fungal medications "static" or "cidial"

Answer 26

static

Question 27

What can ketoconazole decrease in terms of steroid levels?

Answer 27

Decreased testosterone and cortisol production

Question 28

how is ketoconzaole administered? What does it require to be dissolved?

Answer 28

PO | gastric acid for dissolution

Question 29

Does ketoconazole enter teh CSF?

Answer 29

NO

Question 30

Is ketoconazole teratogenic?

Answer 30

Yes because of endocrine effects

Question 31

Ketoconzaole is an inhibitor of what?

Answer 31

P450

Question 32

Do ketoconazole or amphoB have more restiatnce?

Answer 32

ketoconazole

Question 33

What are 2 drugs that are only topical but are similar to ketoconazole?

Answer 33

Clotrimazole | Miconazole

Question 34

Topical miconazole is a potent inhibitor of what?

Answer 34

Warfarin metabolism

Question 35

What is a benefit of fluconazole?

Answer 35

Lacks endocrine side effects as seen with ketoconazole | can penetrate CSF

Question 36

What is fluconazole a DOC for?

Answer 36

cryptococcus neoformans candidemia Coccidiodomycosis Mucocutaneous candidasis

Question 37

What is fluconazole a inhibitor of?

Answer 37

CYP3A4 | CYP2C9

Question 38

Can fluconazole be administered to a preggo patient?

Answer 38

No, it is a teratogen

Question 39

What is a benefit of itraconazole

Answer 39

Cover aspergillis | no endocrine side effects

Question 40

What is a concernign side effect of itaconazole?

Answer 40

hypokalemia

Question 41

What is a "bigger gun" that is used for aspergillosis and serious infections?

Answer 41

Voriconazole

Question 42

What is a big ADR of voriconazole?

Answer 42

Visual disturbances

Question 43

What is an antifungal that isn't avaliable as a tablet. Has aspergillis. More sucessful in immunocomprimised patients.

Answer 43

Posaconazole

Question 44

What is a "-cidial" anti fungal that is sipophilic- so it penetrates superficial tissues well. first line agent for nail infections.

Answer 44

Terbinafine (Lamisil)

Question 45

What is the main ADR you should monitor for terbenafine?

Answer 45

LFT's and CBC | has had steven johnson rash

Question 46

What is a second line therapy for those who have failed amphoB or itraconazole? Limited to aspergillus and candida species.

Answer 46

Caspofungin

Question 47

What is used for esophageal candidiasis and prophylaxis for those undergoing stem cell transplant?

Answer 47

Micfungin