Anti-Fungals

Question 1

Fungi are eukaryotes with rigid cell walls containing

Answer 1

Chitin and polysaccharide

Question 2

Antifungals attack this vital fungal membrane component inhibiting synthesis or binding to its pores

Answer 2

Ergosterol

Question 3

Given for serious systemic infections

Answer 3

Amphotericin B (IV)
Itraconazole (PO)

Question 4

Given to less serious fungal infection

Answer 4

Azoles (PO)

Question 5

Given for superficial infections

Answer 5

Griseofulvin PO
Nystatin topical
Azole

Question 6

Naturally occuring
Produced by Streptomyces nodosus

Drug of choice for systemic mycotic infection

Answer 6

Amphotericin B

Question 7

Binds to ergosterol present in cell membrane disrupting membrane function
Allows electrolytes to leak out from cell resulting in cell death

Answer 7

Amphotericin B

Question 8

Effective against Candida, Histoplasma, Cryptococcus, Blastomyces, Aspergillus, Coccidiodes

Answer 8

Amphotericin B

Question 9

Amphotericin B is excreted through

Answer 9

Bile

Question 10

Amphotericin SE

Answer 10

Hypotension
Arrythmia
Neurologic effect
Nephrotoxic
Fever
Hypochromic, normocytic anemia

Question 11

First isolated from a strain of streptomyces noursei
Used for Candida
Administered as an oral agent for treatment of oral candidiasis
Negligibly absorbed from GI tract so adverse effects are rare

Answer 11

Nystatin

Question 12

Allylamine examples

Answer 12

Naftifine

Terbinafine (Lamisil)

Question 13

Benzylamine example

Answer 13

Butenafine (Mentax)

Question 14

Inhibits squalene epoxidase for the synthesis of ergosterol in fungal cell membrane

Accumulation of squalene (a sterol) which is toxic to fungi

Good for nails

SE: headache, GI upset

Answer 14

Terbinafine

Question 15

Also blocks sterol formation via inhibition of squalene 2,3 epoxidase

Antifungal
Anti inflammatory
Antibacterial

Answer 15

Naftifine

Question 16

Inhibits sterol synthesis via squalene epoxidase

Answer 16

Butenafine

Question 17

Obtained from the mold Penicillium griseofulvum

Answer 17

Griseofulvin

Question 18

Interacts with microtubules within fugus to disrupt the mitotic spindle and inhibit mitosis (arrests cell division in metaphase)

Answer 18

Griseofulvin

Question 19

Griseofulvin absorption is increased by

Answer 19

fatty acids

Question 20

Inhibits microtubule function

Answer 20

Griseofulvin

Question 21

Covers Trichophyton
Microsporum
Epidermophyton

Answer 21

Griseofulvin

Question 22

Griseofulvin AE

Answer 22

Teratogenic*
Hepatotoxic
Increases Warfarin metabolism*
Headache
GI irritation

Question 23

Similar to 5 FU

Answer 23

Flucytosine

Question 24

Griseofulvin is an enzyme

Answer 24

inducer

Question 25

Inhibits thymidylate synthetase For subcutaneous chronomycoses Used in combination with Amphotericin B for treatment of systemic mycoses, subcutaneous chronomycoses, and meningitis by Cryptococcus neoformans and Candida* CD4 <100 The combination is

Answer 25

Flucytosine synergistic

Question 26

Flucytosine SE

Answer 26

Reversible bone marrow depression Increased hepatic enzymes Nausea vomiting diarrhea

Question 27

Interacts with C14 A Demethylase to block demethylation of lanosterol to ergosterol, the principal sterol in fungal membrane Alter permeability of fungal cell membrane

Answer 27

Azole

Question 28

Covers Histoplasma, Candida, Cryptococcus, Blastomycosis, Ketoconazole Never give with amphotericin B because they

Answer 28

Ketoconazole will antagonize each other

Question 29

Ketoconazole AE

Answer 29

``` Gynecomastia Decreased libido Impotence Menstrual irregularity Milk alkali syndrome ```

Question 30

It lacks the endocrinologic effects of ketoconazole

Answer 30

Itraconazole

Question 31

DOC for subcutaneous chromomycosis (Blastomycosis) Broad based budding yeast

Answer 31

Itraconazole

Question 32

Itraconazole AE

Answer 32

Hypokalemia GI distress Hypertriglyceridemia

Question 33

Administered orally and intravenously | Has excellent penetrability into the CSF

Answer 33

Fluconazole

Question 34

DOC for Cryptococcal meningitis | cryptococcus neoformans

Answer 34

Fluconazole 6 months

Question 35

Antifungals for superficial infection

Answer 35

``` Griseofulvin Nystatin Miconazole Clotrimazole Econazole ```

Question 36

For subcutaneous and systemic mycoses Similar to ketoconazole

Answer 36

Ketoconazole Miconazole Econazole Clotramizole

Question 37

For superficial mycoses

Answer 37

``` Clotrimazole Miconazole Econazole Griseofulvin Nystatin ```

Question 38

Interferes with cell wall synthesis/permeability via inhibition of B 13 D glucan synthesis Effective against most species of Candida but not Cryptococcus

Answer 38

Echinocandins capsofungin micafungin anidulafungin

Question 39

Effective in invasive Aspergillosis in patients refractory to or intolerant of other antifungals Also effective against Candida

Answer 39

Capsofungin

Question 40

Capsofungin SE

Answer 40

``` Induration Facial swelling Pruritus Headache Fever Infusion site reactions Nausea Vomiting ```

Question 41

Interrupts with active membrane transport of trivalent cations (essential cellular precursor) Anti-inflammatory

Answer 41

Ciclopirox olamine | Loprox, Penlac

Question 42

Reversible and noncompetitive inhibitor of squalene epoxidase Skin infection

Answer 42

Tolnaftate (Tinactin)

Question 43

Fungistatic Zinc component in this drug provides astringent component Unclear MOA

Answer 43

Undecylenic acid (Desenex)

Question 44

Notorius for arythmia

Answer 44

Amphotericin

Question 45

Impairs absorption of ketoconazole

Answer 45

Cimetidine | Antacid

Question 46

Polyene antifungals

Answer 46

Nystatin | Anphotericin B

Question 47

Griseofulvin

Answer 47

Solid: thyroid, hepatic tumors | Hematologic

Question 48

Improves survival of C meningitis

Answer 48

Amphotericin B Flucytosine + Fluconazole

Question 49

Imidazoles

Answer 49

Miconazole Toconazole Clotrimazole

Question 50

Triazole

Answer 50

Itraconazole Fluconazole Ketoconazole

Question 51

Terbinafine SE Blackbox

Answer 51

Tinnitus | Taste disturbance