Antifungal

Question 1

• binds to ergosterol

- alters membrane permeability

Answer 1

amphotericin B

Question 2

• inhibits ergosterol synthesis

- membrane becomes leaky

Answer 2

azoles

Question 3

• pyrimidine analog
• converted to 5-FU
• interfere with RNA and DNA sythesis

Answer 3

flucytosine

Question 4

• inhibits synthesis of beta-glucans (cell wall)

- weakens cell wall –> greater osmotic stress

Answer 4

echinocandins

Question 5

interferes with microtubule function –> disrupts mitosis

Answer 5

griseofulvin

Question 6

• inhibitors of enzyme sequalene epoxidase (ergosterol synthesis)
• defective/damaged cell membrane

Answer 6

allylamines

Question 7

Adverse effects of amphotericin B

Answer 7

• infusion related

- nephrotoxicity

Question 8

All azoles have what adverse effect?

Answer 8

interactions with P450

Question 9

Which azole has highest degree of inhibition of P450?

Answer 9

Ketoconazole

Question 10

Which azole has the lowest level of interaction with P450?

Answer 10

Fluconazole

Question 11

Which azole requires acidic environment?

Answer 11

Itraconazole

Question 12

Which azole has drug interactions with Rifampin?

Answer 12

Itraconazole

Question 13

Adverse effects of voriconazole (3)

Answer 13

• transient visual disturbances
• liver enzyme abnormalities
• drug interactions

Question 14

Adverse effects of flucytosine (3)

Answer 14

• BM toxicity
• Hepatoxicity
• GI intolerance

Question 15

Adverse effects of echinocandins

Answer 15

well tolerated

Question 16

Drug of choice for aspergillosis

Answer 16

Voriconazole

Question 17

Drug of choice for mild to moderate blastomycosis

Answer 17

Itraconazole

Question 18

Drug of choice for mod to severe blastromycosis

Answer 18

amphotericin B followed by itraconazole

Question 19

What are the 3 options for vaginal candiasis?

Answer 19

1) intravaginal azole - clotrimazole, miconazole
2) Intravaginal nystatin
3) Fluconazole (oral)

Question 20

What are the 3 options for oropharyngeal candiasis?

Answer 20

1) clotrimazole or miconazole lozenges
2) nystatin oral suspension
3) fluconazole

Question 21

Esophageal candiasis

Answer 21

fluconazole

Question 22

Systemic candiasis

Answer 22

fluconazole or echinocandin

Question 23

Coccidioidomycosis

Answer 23

fluconazole or itraconazole

Question 24

Cryptococcosis

Answer 24

amphotericin B + flucytosine, followed by fluconazole

Question 25

Prophylaxis for cryptococcosis for HIV pts

Answer 25

fluconazole

Question 26

Histoplasmosis

Answer 26

amphotericin B followed by itraconazole

Question 27

Prophylaxis for histoplasmosis for HIV pts

Answer 27

Itraconazole

Question 28

Mucormycosis

Answer 28

amphotericin B

Question 29

Cutaneous sporotrichosis

Answer 29

itraconazole

Question 30

Extracutaneous sporotrichosis

Answer 30

amphotericin B followed by itraconazole

Question 31

Dermatomycosis

Answer 31

Topical azole or topical terbinafine

Question 32

Onychomycosis

Answer 32

Terbinafine (oral) or itraconzaole (oral)

Question 33

Candida | Cryptococcus

Answer 33

Yeast

Question 34

``` Aspergillus Histoplasma Coccidioides Blastomyces Sporothrix Mucormycoses ```

Answer 34

Mold

Question 35

Systemic infections (4)

Answer 35

Histoplasma Blastomyces Coccidioides Sporothrix

Question 36

Opportunistic infections (3)

Answer 36

Candida Aspergillus Cryptococcus

Question 37

Cutaneous/Spontaneous (2)

Answer 37

Sporothrix | Dermatophytes

Question 38

Voriconazole

Answer 38

Aspergillosis

Question 39

Itraconazole (5)

Answer 39

1) mild to mod blastomycosis - mod to severe, follows amphotericin B 2) coccidioidomycosis 3) histoplasmosis - follows amphotericin B - prophylaxis 4) cutaneous sporotrichiosis 5) onchomycosis

Question 40

Fluconazole (3)

Answer 40

1) candidiasis (all forms) 2) coccidioidomycosis 3) cryptococcus - follows amphotericin B - prophylaxis

Question 41

Amphotericin B (5)

Answer 41

1) mod to severe blastomycosis 2) cryptococcosis 3) histoplasmosis 4) mucormycosis 5) extracutaneous sporotrichosis

Question 42

Topical azoles

Answer 42

1) vaginal and oropharyngeal candidiasis | 2) dermatomycosis

Question 43

Echinocandin

Answer 43

systemic candidiasis

Question 44

Nystatin

Answer 44

topical for vaginal, oral suspension for oropharnygeal candidiasis

Question 45

Terbinafine (oral)

Answer 45

oral - onchomycosis | topical - dermatomycosis