antifungal drugs

Question 1

fungal infections are also known as

Answer 1

mycoses

Question 2

infections of integumentary system

Answer 2

cutaneous
subcutaneous
superficial

Question 3

fungi that causes integumentary infections are known as

Answer 3

dermatophytes

Question 4

yeasts

Answer 4

• single cell fungi
• reproduce by budding
• can be used for baking bread and brewing alcohol

Question 5

moulds

Answer 5

• multicellular
• long branching filaments called hyphae

Question 6

4 general types of mycotic infections

Answer 6

• cutaneous
• subcutaneous
• superficial
• systemic (life threatening, usually in immunocompromised host)

Question 7

candida albicans

Answer 7

• may follow antibiotic therapy, antineoplastics or immunosuppressants
• may result in overgrowth and systemic infections
• common in newborn infants and immunocompromised pts

Question 8

candida albicans growth in mouth

Answer 8

thrush or oral candidiasis

Question 9

vaginal candidiasis

Answer 9

• yeast infection
• pregnant women, women with diabetes, women taking oral contraceptives

Question 10

aspergillosis infection affects the

Answer 10

lungs

Question 11

meds used to treat systemic fungal infections

Answer 11

• terbinafine and voriconazole

Question 12

triazoles

Answer 12

fluconazole, voriconazole

Question 13

echinocandins

Answer 13

caspofungin

Question 14

imidazoles

Answer 14

ketoconazole (common topical)

Question 15

polyenes

Answer 15

amphotericin B, nystatin

Question 16

polyenes (amphotericin B and nystatin) moa

Answer 16

• binds to steroles in cell membrane lining
• results in fungal cell death
• dont bind to human cell membranes or kill human cells

Question 17

how to take nystatin

Answer 17

-swish and swallow and dont eat after for 30 mins

Question 18

imidazoles and triazoles (ketoconazole, fluconazole and voriconazole )

Answer 18

• inhibits fungal cell cytochrome P450 enzymes resulting in cell membrane leaking
• result is altered cellular metabolism and fungal cell death

Question 19

echinocandins (caspofungin) moa

Answer 19

• prevents synthesis of glucans (part of cell wall)
• results in fungal cell death
• adverse effect: hypotension

Question 20

drug of choice for severe systemic fungal infections

Answer 20

amphotericin B

Question 21

which drug is used to treat onychomycosis (fungal infection of fingernails and toenails)

Answer 21

terbinafine (Lamisil)

Question 22

fluconazole passes through the ____

Answer 22

-cerebrospinal fluid and inhibits growth of crytococcal fungi

Question 23

which drug is effective in the treatment of cryptococcal meningitis

Answer 23

fluconazole

Question 24

antifungal contraindications

Answer 24

• allergy, liver failure, kidney failure and porphyria (for griseofulvin)
• itraconazole= cardiac issues
• voriconazole= preg

Question 25

itraconazole contraindications

Answer 25

contraindicated in treatment of onychomycoses in pts with severe cardiac problems

Question 26

voriconazole can cause

Answer 26

fetal harm in pregnant women

Question 27

amphotericin B adverse effects

Answer 27

- cardiac dysrhythmias - neurotoxicity ( tinnitus, visual disturbances, paresthesias, convulsions) - kidney toxicity ( potassium loss, hypomagnesemia) -pulmonary infiltrates - fever, chills, headache, nausea, occasional hypotension, GI upset, anemia

Question 28

amphotericin B contraindications

Answer 28

bone marrow suppression and kidney impairment

Question 29

amphotericin B adverse effects prevention

Answer 29

- premedications (antiemetics, antihistamines, antipyretics, corticosteroids) - minimize infusion related reactions - reactions can be reduced by using longer than average drug infusion times (2-6 hrs)

Question 30

fluconazole adverse effects

Answer 30

- nausea, vomiting, diarrhea, stomach pain - increased liver enzymes

Question 31

use fluconazole with caution in

Answer 31

pts with kidney or liver dysfunction

Question 32

nystatin (topical) adverse effects

Answer 32

nausea, vomiting, diarrhea, anorexia, rash, urticaria

Question 33

antifungal interactions

Answer 33

- co administration of 2 drugs metabolized by the P450 enzyme may result in competition for this enzyme resulting in higher levels of one of these drugs

Question 34

what to obtain from pt before antifungal administration

Answer 34

vitals, complete blood count, liver and renal function studies, electrocardiogram

Question 35

how often to monitor vitals when receiving IV infusions (amphotericin B)

Answer 35

every 15-30 mins

Question 36

amphotericin B preferred route

Answer 36

IV infusion pumps and the most distal veins

Question 37

voriconazole is given

Answer 37

1 hr before or after meals