Anti-fungals

Question 1

Amp B - Class

Answer 1

Polyene

Question 2

Amp B - MOA

Answer 2

Ergosterol -> pores -> electrolytes leak -> cell membrane

Question 3

Amp B - Spectra

Answer 3

Cryptococcus
Candidiasis
Histoplasmosis
Asperigillus

Question 4

Amp B - Formulation

Answer 4

Formulation:
Na deoxycholate (conventional)
Aritifical lipids (liposomes)

Question 5

Amp B - Liposomes

Answer 5

Reduced renal toxicity
Increased CSF penetration
Costly

Question 6

Amp B - PK

Answer 6

Poor CSF penetration

Renal dysfx - dose adjustment

Question 7

Amp B - SE

Answer 7

Fevers, chills, thrombophlebitis - slow infusion
Nephrotoxicity - CI in renal impairment
Ototoxicity
HypoTN - may require K supplement

Question 8

5-FC - Class

Answer 8

Fluorinated pyrimidine analogue

Question 9

5-FC - MOA

Answer 9

Cytosine permease -> Cytosine deaminase -> 5-FU ->

1) FUTP -> Uridylic acid -> Protein synthesis
2) FdUMP -> Thymidylate synthase -> DNA synthesis

Question 10

5-FC - Fungistatic/cidal?

Answer 10

Fungistatic

Question 11

5-FC - Clinical

Answer 11

ONLY Combi w AmpB for Candidiasis & Cryptococcus ( cannot be used alone)

Question 12

5-FC - PK

Answer 12

Good oral
Penetrate CSF
Renal dysfx - dose adj

Question 13

5-FC - SE

Answer 13

GI
BM suppression
Hepatotoxicity

Question 14

Echinocandins - MOA

Answer 14

Inhibit B-1,3-glucan synthase complex -> Cell wall

Question 15

Echinocandins - PK

Answer 15

Poor oral
No CSF
Renal dysfx - No dose adj needed
Liver dysfx - Dose adj

Question 16

Echinocandins - Clinical

Answer 16

1st line - Invasive candidiasis

2nd line - Invasive aspergilliosis

Question 17

Triazoles - MOA

Answer 17

Inhibit C-14 a-demethylase -> Block conversion from Lanosterol to Ergosterol -> Cell membrane

Question 18

Name the 3 Triazoles

Answer 18

Fluconazole
Itraconazole
Voriconazole

Question 19

Fluconazole (Triazole) - Spectra

Answer 19

Candidiasis
Cryptococcous
Histoplasmosis
Blastomycosis
Vulvovaginal candidiasis - single oral dose
Fungal meningitis

Question 20

Fluconazole (Triazole) - PK

Answer 20

Good oral
Good CSF
Renal dysfx - dose adj
Excreted unchanged in urine = Good for UTI

Question 21

Itraconazole (Triazole) - PK

Answer 21

Good oral
Poor CSF
Low pH better for absorption (Take w/ food & coke)

Question 22

Voriconazole (Triazole) - PK

Answer 22

Good oral

Good CSF

Question 23

Itraconazole (Triazole) - Spectra

Answer 23

Broader than Fluconazole
Blastomycosis
Asperigillosis
Onychomycosis
Oral candidiasis (oral solution)

Question 24

Voriconazole (Triazole) - Spectra

Answer 24

Broad spec
1st line - Invasive asperigillosis
Candida

Question 25

Triazoles - SE/CI

Answer 25

``` N/V Hepatotoxicity QT prolongation Cardiotoxicity (Itraconazole) Neurotoxicity - Visual disturbance (Voriconazole) CI: Pregnancy ```

Question 26

Triazoles - DDI

Answer 26

Inhibit CYP3A4 - Warfarin - Cyclosporine - Oral hypoglycemic agents

Question 27

Clotrimazole (Imidazoles) - Spectra

Answer 27

Dermatophytes Oropharyngeal candidiasis Vulvovaginal candidiasis (Cream)

Question 28

Name the 2 Imidazoles

Answer 28

Clotrimazole | Miconazole

Question 29

Imidazoles - Formulation in vulvovaginal candidiasis

Answer 29

Clotrimazole - cream | Miconazole - Pessary

Question 30

Miconazole (Imidazoles) - Spectra

Answer 30

``` Tinea Vulvovaginal candidiasis (Pessary) ```

Question 31

Nystatin - Class

Answer 31

Polyene

Question 32

Nystatin - MOA

Answer 32

Similar to AmpB

Question 33

Nystatin - Spectra

Answer 33

``` Oropharyngeal candidiasis (mouthwash) Vulvovaginal candidiasis (intravaginal) Cutaneous candidiasis (Topical) GI fungal infections ```

Question 34

Imidazoles - SE

Answer 34

Skin irritation | Edema

Question 35

Nystatin - SE

Answer 35

Skin irritation

Question 36

Terbinafine - MOA

Answer 36

Inhibit squalene epoxidase -> Block conversion of squalene to lanosterol -> Cell membrane

Question 37

Terbinafine - Spectra

Answer 37

Trichophyton Onychomycosis Tinea captitis (Oral)

Question 38

Oral formulations of what 2 antifungals for Tinea captitis?

Answer 38

Itraconazole | Terbinafine

Question 39

Terbinafine - PK

Answer 39

Poor oral Extensive metabolism by CYP Excreted mainly in urine Hence avoid in hepatic & renal dysfx

Question 40

Terbinafine - SE/CI

Answer 40

GI Hepatic failure Exacerbate SLE Avoid in breastfeeding

Question 41

Terbinafine - Pregnancy?

Answer 41

Vaginal > Oral

Question 42

Terbinafine - DDI

Answer 42

with Azoles = Increase serum [Terbinafine] | Incr halflife of SSRI/MAOIs