Antifungal and Antiparasitic Therapy Flashcards Preview

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Flashcards in Antifungal and Antiparasitic Therapy Deck (61)
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0

Which 2 agents are considered Polyenes?

1. Amphotericin
2. Nystatin

1

What is the mechanism of action of Amphotericin and Nystatin?

Bind to ergosterol in cell membrane, disrupt cell wall permeability, resulting in cell death.

2

What is the nickname of Amphotericin, and why is this so?

1. "Amphoterrible"
2. It's toxicity (nephro)

3

Amphotericin and Nystatin are:
A) Fungistatic
B) Fungicidal

B

4

What is the spectrum of Amphotericin B IV?

1. Candida
2. Coccidioides
3. Cryptococcus
4. Blastomyces
5. Histoplasma

5

What are the clinical indications for Amphotericin B IV?

1. Aspergillus
2. Cryptococcal meningitis
3. Blastomycosis
4. Coccidiomycosis
5. Not 1st line for Candida

6

Nystatin is primarily used against what type of fungus? It is indicated for 2 conditions involving this pathogen.

1. Candida
2. Oropharyngeal and vaginal candidiasis

7

The Azoles include: (4)

1. Fluconazole
2. Itraconazole
3. Voriconazole
4. Posaconazole

8

What is the MOA of the Azoles?

They inhibit lanosterol C14-demethylase to inhibit ergosterol synthesis

9

Azoles are "BLANK" against Candida, and "BLANK" against Aspergillus

1. Fungistatic
2. Fungicidal

10

Which 2 Azoles have excellent bioavailability?

1. Voriconazole
2. Fluconazole

11

What is one potential downside to the Azoles?

They are potent CYP 3A4 inhibitors

12

What is the spectrum of Fluconazole (IV/PO)

1. Candida
2. Coccidioides
3. Blastomyces
4. Histoplasma

13

What are the clinical indications for Fluconazole?

1. Invasive C. albicans
2. Esophageal candidiasis
3. Severe mucocutaneous candidiasis
4. Oral stepdown for cryptococcal meningitis

14

What is the spectrum of Itraconazole PO?

1. Candida
2. Aspergillus
3. Coccidioides
4. Cryptococcus
5. Blastomyces
6. Histoplasma

15

What are the clinical indications for Itraconazole PO?

1. Oral stepdown for coccidiomycosis
2. Blastomycosis
3. Histoplasmosis
4. Alternative for Candida and Aspergillus (but has poor oral absorption)

16

What is the spectrum of activity for Voriconazole (IV/PO)?

1. Candida
2. Aspergillus
3. Coccidioides
4. Cryptococcus
5. Blastomyces
6. Histoplasma
7. Fusarium
8. Scedosporium

17

What are the clinical indications for Voriconazole (IV/PO)?

1. Aspergillus
2. Fusarium
3. Scedosporium
4. Drug resistant fungal infections

18

What is the spectrum of Posaconazole PO?

1. Candida
2. Aspergillus
3. Coccidioides
4. Cryptococcus
5. Blastomycosis
6. Histoplasma
7. Fusarium
8. Scedosporium
9. Zygomycetes

19

What are the clinical indications for Posaconazole PO?

1. Zygomycetes
2. Fusarium
3. Scedosporium
4. Drug resistant fungal infections (broad spectrum)

20

What 3 agents are considered Echinocandins?

1. Anidulafungin
2. Caspofungin
3. Micafungin

21

What is the MOA of the Echinocandins?

They inhibit the production of B-(1,3)-D-glucan, needed for cell wall synthesis

22

Echinoderms are orally absorbed, T or F?

False. IV only.

23

All Echinocandins presented in class are given IV only? T or F

True.

24

What is the spectrum of the Echinocandins?

1. Candida
2. Aspergillus

25

What are the clinical indications for the Echinocandins?

1. Serious non-albicans Candida infections
2. Active against Aspergillus (studied in salvage therapy)

26

What 4 agents are topical antifungals?

1. Clotrimazole
2. Ciclopirox
3. Tolnaftate
4. Terbinafine

27

What is the spectrum of Clotrimazole cream?

1. Trichophyton
2. Microsporum
3. Epidermophyton
4. Candida
5. Malassezia furfur

28

What are the clinical indications for Clotrimazole cream?

1. Tinea pedis
2. Tinea cruris
3. Tinea corporis
4. Tinea versicolor
5. Cutaneous candidiasis

29

What is the spectrum of Ciclopirox?

1. Trichophyton
2. Microsporum
3. Epidermophyton
4. Candida
5. Malassezia furfur

30

What are the clinical indications for Ciclopirox?

1. Mild onychomycosis
2. Tinea pedis
3. Tinea cruris
4. Tinea corporis
5. Cutaneous candidiasis
6. Tinea versicolor

31

What is the spectrum of Tolnaftate?

1. Trichophyton
2. Microsporum
3. Epidermophyton
4. Malassezia furfur

32

Tolnaftate is not effective against which fungus?

Candida

33

What are the clinical indications for Tolnaftate?

1. Tinea pedis
2. Tinea cruris
3. Tinea corporis
4. Tinea versicolor

34

What is the spectrum of Terbinafine?

1. Dermatophytes (Trichophyton, Microsporum, Epidermophyton)

35

What are the clinical indications for Terbinafine?

PO for Tinea capitis and onychomycosis

Topical: Tinea pedis, Tinea cruris, Tinea corporis, Tinea versicolor

36

These 6 agents are considered Antimalarial

1. Chloroquine
2. Mefloquine
3. Atovaquone/proguanil
4. Artesunate
5. Quinine
6. Primaquine

37

What are the clinical indications for Chloroquine?

1. Malarial prophylaxis
2. Tx for chloroquine susceptible regions

38

What are the clinical indications for Mefloquine?

1. Malaria prophylaxis for Chloroquine resistant regions or chloroquine intolerance.

39

What are the clinical indications for Atovaquone/proguanil?

1. Malarial prophylaxis for chloroquine/mefloquine resistant regions or intolerance of these drugs
2. 1st line for uncomplicated P. falciparum Tx

40

What antibiotic can be used as alternative malaria prophylaxis or adjunctive Tx?

Doxycycline

41

What are the clinical indications for Artesunate IV?

1. Preferred Tx for severe malaria, followed by PO therapy.

42

What are the clinical indications for Quinine IV/PO?

1. IV for 2nd line Tx of severe malaria (+ PO therapy)
2. PO 2nd line for uncomplicated malaria

43

What are the clinical indications for Primaquine?

1. Terminal prophylaxis for P. ovale, P. vivax; primary prophylaxis

44

If you cannot use a 1st line PO med for malaria, what antibiotic can be used for combination malaria Tx?

Clindamycin

45

Why is Mefloquine not used for malarial Tx?

1. At the high doses required for Tx it can cause neuropsychiatric effects

46

What are 2 contraindications for Primaquine?

1. Pregnancy
2. G6PD deficiency

47

What 5 drugs are Antihelminthics?

1. Albendazole
2. Mebendazole
3. Ivermectin
4. Pyrantel pamoate
5. Praziquantel

48

What are the clinical indications for Albendazole PO?

1. Alternative for Strongyloidiasis, roundworm, pinworm, whipworm, hookworm

49

What are the clinical indications for Mebendazole PO?

1. Roundworm, pinworm, whipworm, hookworm

50

What are the clinical indications for Ivermectin PO?

1. Strongyloidiasis
2. Alternative for roundworm or whipworm

51

What are the clinical indications for Pyrantel pamoate PO?

1. Pinworm
2. Hookworm

52

What are the clinical indications for Praziquantel PO?

Intestinal tapeworms

53

Which Antihelminthic agent can cause Mazzoti reaction?

Ivermectin

54

What is the Mazzoti reaction?

Host inflammatory reaction to death of parasites - fever, hives, asthma, GI upset

55

Ivermectin is not effective for?

Hookworm

56

Iodoquinol and Paromomycin are effective against what type of pathogens?

Protozoa

57

What are the clinical indications for Iodoquinol PO?

1. Dientamoeba fragilis
2. Amebiasis
3. Alternative for Blastocystis

58

What are the clinical indications for Paromomycin PO?

1. Alternative agent for Dientamoeba fragilis, amebiasis, giardiasis

59

Which antibiotic has activity against intestinal protozoa?

Metronidazole

60

What are the clinical indications for Permethrin (cream, lotion)?

1. Scabies
2. Lice