Antifungal agents Flashcards Preview

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Flashcards in Antifungal agents Deck (32)
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1
Q

What are dermatophytes?

A

Fungal infections of the epidermis and integuments (hair and nails)

2
Q

Treatment for dermatophytes?

A

Topical antifungals such as clotrimazole or terbinafine

3
Q

Do onychomycoses require topical or systemic treatment?

A

systemic

4
Q

What systemic antifungals can treat onychomychosis?

A

Itraconazole, terbinafine

5
Q

Treatment for candida infections?

A

Clotrimazole or nystatin topical

Fluconazole PO if no response

6
Q

What are the common systemic fungal infections?

A

Blastomycosis, Coccidioidomycosis, Cryptococcosis, Histoplasmosis

7
Q

General treatment of systemic fungal infections?

A

Amphotericin B infusions

8
Q

Who is at risk for opportunistic infections?

A

Anyone after use of broad spectrum antibiotics
Immunosuppressed patients
Patients with systemic disease

9
Q

What are 3 pathogens of opportunistic infections and first line treatments?

A

Candidiasis - fluconazole
Aspergillosis - amphotericin B
Pneumocystis pneumonia - TMP-SMX

10
Q

Mechanism of action of amphotericin B?

A

Binds ergosterol in fungal membrane, which opens pores and leads to leakage of cell constituents.

11
Q

T/F? Amphotericin B is highly selectively toxic.

A

False - it also binds to cholesterol components in mammalian cells

12
Q

What is the major limiting factor of amphotericin B infusions?

A

Nephrotoxicity.

13
Q

Most common adverse reaction to amphotericin B?

A

Anemia - 75%

14
Q

Mechanism of action of nystatin?

A

Same as amphotericin B.

15
Q

Is nystatin topical or IV?

A

Topical only

16
Q

What are the echinocandins?

A

Micafungin and anidulafungin

17
Q

Mechanism of action of echinocandins?

A

Inhibits essential component (Beta (1,3)-D-glucan) of fungal cell walls

18
Q

Echinocandins more or less toxic than amphotericin B?

A

Less, because mammalian cells do not have that component

19
Q

Uses of echinocandins?

A

Treatment of aspergillosis in patients refractory to amphotericin B or itraconazole.

20
Q

Adverse effects of echinocandins?

A

Histamine mediated symptoms

fever, N/V, headache

21
Q

What are the triazoles and their mechanism of action?

A

Fluconazole, itraconazole

Selective inhibition of fungal cytochrome P450

22
Q

Clinical uses of fluconazole?

A

Vaginal candidiasis if topical treatment fails, oropharyngeal and esophageal candidiasis
Also initial treatment for cryptococcal meningitis

23
Q

Clinical uses for itraconazole?

A

Systemic therapy for dermatophytoses, 2nd line for onychomycosis

24
Q

Excretion of triazoles?

A

Fluconazole - renal

Itraconazole - hepatic

25
Q

Adverse reactions of triazoles?

A

Generally well tolerated

Can cause DDIs due to inhibition of CYP450

26
Q

What are the imidazoles?

A

ketoconazole, clotrimazole, miconazole

27
Q

Mechanism of action for imadazoles?

A

Inhibits P450 dependent enzyme 14 alpha demethylase

28
Q

Clinical uses of imidazoles?

A

Oral and vaginal candidiasis

29
Q

Mechanism of terbinafine?

A

Inhibits squalene oxidase.

30
Q

Terbinafine fungicidal or fungistatic?

A

fungicidal

31
Q

Clinical uses of terbinafine?

A

Onychomycosis

32
Q

Adverse reactions to terbinafine?

A

Inhibition of CYP450 drug metabolism

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