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Antifungal Flashcards

Exam 3 (67 cards)

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1
Q

What drugs are Azoles?

A

Antifungal:
Ketoconazole
Fluconazole

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2
Q

What drugs are non-Azoles?

A

Antifungal:
Terbinafine
Amphotericin B
Nystatin

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3
Q

Ketoconazole- MOA?

A

Mycotic cell membrane modifier -> decreases cell wall integrity -> cell death

Inhibits biosynthesis of ergosterol (key component of cell wall) -> decreased cell membrane -> cell death

(CYP inhibitor)

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4
Q

Fluconazole- MOA?

A

Mycotic cell membrane modifier -> decreases cell wall integrity -> cell death

Inhibits biosynthesis of ergosterol (key component of cell wall) -> decreased cell membrane -> cell death

(CYP inhibitor)

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5
Q

Azoles- side effects?

A

Increased LFTs
QT prolongation
CYP inhibitor -> accumulation
Increased effects of warfarin - monitor for bleeding

Hepatic- ketoconazole (hepatotoxicity w/ PO)
Renal dosing- Fluconazole

N/V/D

(Ketoconazole & Fluconazole)

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6
Q

Which azole required renal dose adjustment?

A

Fluconazole

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7
Q

Ketoconazole- formulation?

A

Topical- most common
Oral (hepatotoxicity- last line)

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8
Q

Fluconazole- formulation?

A

PO, IV

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9
Q

Amphotericin- MOA?

A

Binds to ergosterol -> forms pore -> altered cell membrane permeability -> cell death

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10
Q

Azoles- indication?

A

Systemic fungal infections
Fungal/bacterial/skin infections

(Ketoconazole & Fluconazole)

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11
Q

Amphotericin B- indications?

A

Broad spectrum
First line for Invasive infections;
yeast, molds, fungi

Bloodstream infection (alt. choice)
Invasive infection (alt. choice)

Meningitis (AmB w/ flucytosine)

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12
Q

Amphotericin B- formulation?

A

IV

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13
Q

Amphotericin B- side effects?

A

Nephrotoxic
Increased LFTs
Infusion reactions/histamine release

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14
Q

Nystatin- MOA?

A

Alters fungal cell wall permeability -> cell death

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15
Q

Nystatin- indication?

A

Oral thrush (alt. choice)
Cutaneous infection

(not for systemic)

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16
Q

Nystatin- formulation?

A

Swish/swallow
PO
Topical: cream, ointment powder

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17
Q

What drugs are antifungal?

A

Ketoconazole (PO
Fluconazole (PO

Terbinafine (PO
Amphotericin B
Nystatin

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18
Q

Terbinafine- MOA?

A

Inhibits sterol biosynthesis -> cell death

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19
Q

Terbinafine- indications?

A

Nail bed infections (onychomycosis)

Tinea pedis
Tinea cruris
Tinea corporis (ringworm)

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20
Q

Terbinafine- formulations?

A

Topical
PO- hepatotoxicity

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21
Q

Fluconazole- side effects?

A

Abdominal discomfort
Increased LFTs
Rash, photosensitivity
Prolonged QT
Cardiomyopathy

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22
Q

Fluconazole- indications?

A

Oral thrush- candida albicans
Esophageal infections- candida albicans

Alternative choice for Nail bed infections- dermatophytes

Yeasts
Fungi

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23
Q

How would you treat Tinea Pedis?
Tinea corporis?
Tinea Cruris?

A

Tinea pedis- athletes foot: topical antifungal creams- terbinafine, ketoconazole
PO (fluconazole, terbinafine) if immunocompromised or failed topical antifungal

Tinea corporis- ringworm: Tinea pedis- athletes foot: topical antifungal creams- terbinafine, ketoconazole
PO (fluconazole, terbinafine) if immunocompromised or failed topical antifungal

Tinea Cruris- jock itch: Tinea pedis- athletes foot: topical antifungal creams- terbinafine, ketoconazole
PO (fluconazole, terbinafine) if immunocompromised or failed topical antifungal

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24
Q

Uncomplicated vulvovaginal candidiasis- treatment?

A

Intravaginal clotrimazole cream
PO fluconazole

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25
Complicated vulvovaginal candidiasis- treatment?
Topical azoles- ketoconazole Fluconazole PO
26
Thrush- treatment?
Thrush- oropharyngeal candidiasis Mild: Nystatin PO Moderate/severe: Fluconazole PO
27
Esophageal candidiasis- treatement?
Fluconazole (PO or IV)
28
What drugs are antivirals?
Acyclovir (herpes/ HSV) Ganciclovir (herpes) Oseltamivir (Influenza) Paxolovid (COVID) Emtricitabine (HIV) Efavirenz (HIV) Ritonavir (HIV) Bictegravir (HIV) Enfuvitride (HIV)
29
What can herpes cause?
Oropharyngeal disease Genital disease Chicken pox -> shingles CMV EBV Mono
30
Anti-HSV drugs- MOA?
Suppresses synthesis of viral DNA -> inhibits viral replication (Acyclovir & Ganciclovir)
31
Anti-HSV drugs- indication?
Treating symptoms/outbreaks of: HSV VZV HZV Most effective within 72hr of rash (Acyclovir & Ganciclovir)
32
Anti-HSV drugs- side effects?
Nephrotoxicity - AKI Crystal nephropathy w/ IV Acyclovir Neurotoxicity Thrombotic microangiopathy- TTP/HUS (Acyclovir & Ganciclovir)
33
Acyclovir- formulations?
PO IV- risk of crystal nephropathy
34
Acyclovir- indications?
Genital herpes Invasive HSV infections Herpes simplex labialis (cold sores) Varicella zoster (chicken pox) Recurrent herpes zoster (shingles)
35
Genital herpes- treatment?
Acyclovir, PO
36
Herpes simplex labialis- treatment?
Acyclovir, cream/buccal tablet
37
Invasive HSV infection- teatment?
Acyclovir, IV
38
Varicella zoster- treatment?
Acyclovir, PO
39
Herpes zoster- treatment?
(shingles) Acyclovir
40
What drug is anti-influenza?
Oseltamivir
41
Oseltamivir- MOA?
Inhibits release of new viral particles from infected cells -> decreased amount of virus in the body
42
Oseltamivir- indications?
Influenza, treatment/prophylaxis
43
Oseltamivir- fromulation?
PO Capsules, suspensionO
44
Oseltamivir- side effects?
Neuropsychiatric: Confusion, delirium, hallucinations, N/V
45
What drug is anti-COVID?
Paxlovid
46
Paxlovid- indications?
Mild-moderate COVID Symptomatic pts w/ risk of progression to severe disease Initiate within 5 days of COVID symptoms onset
47
Paxlovid- MOA?
Inhibits viral replications "Booster"- Increased plasma concentration of med 1(above action)
48
Paxlovid- side effects?
Renal dose adjustments DDI Increased LFTs / Hepatic adverse effects Dysgeusia- altered taste
49
What is PrEP?
HIV Pre-exposure prophylaxis, for high risk people
50
What drug is used as HIV PrEP?
Emtricitabine
51
Emtricitabine- indications?
At-risk pts: Sex w/ men and women Anal sex w/o condoms Sexual relationship w/ HIV-positive partner Bacterial STI diagnosed Injected non-prescribed drug user
52
What is PEP?
HIV Postexposure prophylaxis After possible HIV exposure, within 72hours Daily for 28days
53
Emtricitabine- side effects?
Renal toxicity Decreased bone density Increased TG Weight gain
54
Emtricitabine- MOA?
Reverse transcriptase inhibition -> inhibits replication of HIV
55
Emtricitabine- side effects?
Lactic acidosis Hepatomegaly
56
Bictegravir- indications?
Treatment of HIV-1
57
Bictegravir- MOA?
Strand transfer inhibitor -> interferes with HIV replication -> decreases viral load
58
Bictegravir- side effects?
Headache Insomnia Diarrhea Weight gain Separate Al/Mg
59
Efavirenz- indications?
Treatment for HIV
60
Efavirenz- MOA?
Reverse transcriptase inhibitor Decreased amount of HIV in blood
61
Efavirenz- side effects?
Severe rash Hepatotoxicity CYP-substrate
62
Ritonavir- indication?
Treatment of HIV-1
63
Ritonavir- MOA?
Protease inhibitor -> inhibits HIV replication
64
Ritonavir- side effects?
Metabolic complications- hyperglycemia, DM exacerbation Hepatotoxicity CYP inhibitor
65
Enfuvirtide- indications?
HIV treatment
66
Enfuvirtide- MOA?
Entry inhibitor -> Inhibits HIV fusion with host cells
67
Enfuvirtide- side effects?
Injection site reactions Pain, erythema, nodules

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