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Pharm 4 > Anti-fungals > Flashcards

Anti-fungals Flashcards

1
Q

Name 4 class effects of the Azoles.

A

CYP interactions, QTc prolongation, hepatotoxicity, bone marrow suppresion

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2
Q

Flucanazole (Diflucan) is active against….(3)

A

candida (NOT krusei, glabrata),
cryptococcus
coccidio

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3
Q

Flucanazole can interact with what 3 drugs?

A

warfarin - increase INR
phenytoin - increase drug levels
OCP - decrease effectiveness

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4
Q

What is the oral bioavailability for flucanazole?

A

excellent - 90%

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5
Q

How is flucanazole eliminated?

A

renally

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6
Q

Itraconazole is more/less effective than Flucanazole against fungi, primarily ___________.

A

more

aspergillus

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7
Q

Itraconazole maintains activity against….(5)

A

candida, cryptococcus
Histoplasmosis
Blastomyces
aspergillus

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8
Q

Which azole requires gastric acidity for absorption and thus shouldn’t be taken with PPIs, antacids, H2RBs..

A

Itraconazole

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9
Q

How does administration differ between a solution and capsule of itraconazole?

A

Solution - empty stomach

Capsule - with food, OJ, cola (Mushroom Caps)

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10
Q

Voriconazole is active against …(6)

A

Candida, cryptococcus
histo
blasto
aspergillus….AND….MOLDS

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11
Q

AEs of voriconazole (4)

A

Visual disturbances
hallucinations
rash
photosensitivity

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12
Q

What is 1st line for aspergillus? Why?

A

Voriconazole

It covers it and it has good CNS penetration.

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13
Q

T or F. Voriconazole should be taken with food.

A

False - empty stomach

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14
Q

IV voriconazole has been known to cause damage to what organ?

A

kidneys – related to cyclodextrin accumulation

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15
Q

Most anti-fungals are _________ eliminated.

A

hepatically — they cause hepatotoxicity.

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16
Q

Posaconazole covers the same fungi as ______________.

A

Voriconazole

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17
Q

Name a bad thing about having to take the suspension of posaconazole.

A

It requires a high fat meal for maximal absorption QID.

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18
Q

A patient is diagnosed with a mucor infection. What are your two options?

A

Posaconazole

Amphotercin B

19
Q

Which azole is broad spectrum and low side effects, but is very expensive.

A

Posaconazole

20
Q

T or F. Polyenes have a wide spectrum of activity.

A

T

21
Q

T or F. Amphotericin B is available PO.

A

F - no oral formulation

22
Q

AEs of polyenes/Amphoterricin:

A

Lyte wasting (K, Mg)
Influsion rxns - fever, chills, rigors, hypotension
Acute renal failure
Anemia

23
Q

Does Amphotericin B cause renal or hepatotoxicity.

A

Renal toxicity

24
Q

Which anti-fungal requires pre-medications?

A

Amphotericin - APAP, diphenhydramine, prednisone, meperidine

25
Q

T or F. Amphotericin is good for CNS infections.

A

T

26
Q

Name the 4 types of Ampotericin.

A

Conventional
cholesterol sulfate complex
lipid complex
liposomal

27
Q

Nystatin is another example of a ________ and is employed for _________ use.

A 
Polyene
Topical use (oral/vaginal candidiasis...)
28
Q

Echinocandids are active against what 2 fungi?

A

candida and aspergillus

29
Q

T or F. Echinocandids are administered orally and parentally.

A

F - only parenterally

30
Q

T or F. Echinocandids are known for having various side effects.

A

F - relatively benign SE profile and few drug interactions.

31
Q

T or F. Echinocandids are cheap.

A

F - expensive

32
Q

Name 3 echinocandids and put them in order of most drug interactions to least drug interactions.

A

Caspofungin > Mica > Anidula

33
Q

Fluocytosine has high/low CSF penetration, meaning it should/not be used for meningitis.

A

high

should

34
Q

T or F. You should dose adjust Fluocytosine in those with hepatic failure.

A

F - renal failure

35
Q

T or F. Fluocytosine should not be used with other anti-fungals.

A

F- rarely used as monotherapy because resistance develops quickly

36
Q

Fluocytosine has what AE that is related to its MOA?

A

bone marrow toxicity (it kills our cells)

37
Q

Which anti-fungal is a prodrug? What is the active form?

A

Fluocytosine

Flurouracil - 5FC

38
Q

What may happen when normal flora convert Fluocytosine to 5FC in the gut?

A

GI upset

39
Q

Fluocytosine is often combined with what other anti-fungal to treat what infection?

A

Ampho B

Cryptococcus meningitis

40
Q

A patient has athlete’s foot (dermatophytoses). What is the best Tx? How is it available?

A

Terbinafine (Lamisil)

OTC - PO, gel, cream, lotion

41
Q

A patient with renal or hepatic dysfunction has ring worm. Is it okay to give them Lamasil?

A

No, avoid it if possible.

42
Q

Oral Terbinafine has been known to cause what AE?

A

taste disturbance

43
Q

What two antifungals are renally eliminated?

A

Fluocytozine

Fluconazole

Pharm 4 (5 decks)

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