Antifungal Drugs Flashcards Preview

Pharm Midterm 2 > Antifungal Drugs > Flashcards

Flashcards in Antifungal Drugs Deck (55):
1

What are the antifungals

Amphoteracin B
Flucytosine
Ketoconazole
Miconazole
Clotrimazole
Fluconazole
Itraconazole
Voriconazole
Posaconazole
Caspofungin
Griseofulvin
Terbinafine
Nystatin

2

What is Amphoteracin B

Polyene ABX

3

How does Amphoteracin work

Binds ergosterol
Pores in cell membrane

4

What does Amphoteracin B work on

Yeast and Molds

5

When do you give Amphoteracin B

Life-threatening infections
Initial therapy to reduce viral load
Continue on azole

6

What is the preferred antifungal for deep fungal infection during pregnancy

Amphoteracin B

7

Amphoteracin B administration

IV
Intrathecal if meningeal disease

8

Amphoteracin B AE

Renal toxicity
Anemia - Decreased EPO
Seizures in intrathecal
Fever, chills, muscle spasms, HA, hypotension

9

How do you reduce nehphrotoxicity with Amphoteracin B

Lipid colloid

10

How does Flucytosine work

Enters cell via cytosine permease
Converted to 5-FU then 5-FdUMP/5-FUMP
Inhibits Thymidylate Synthase
Incorporates into protein
DNA and Protein synthesis inhibition

11

What is Flucytosine used for

Candida
Cryptococcal

12

How does Flucytosine cause BM toxicity

Formation of 5-FU from gut flora

13

Synergistic with Flucytosine

Amphoteracin B

14

Imidazoles

Ketoconazole
Miconazole
Clotrimazole

15

How do the azoles work

Inhibit 14-alpha sterol demethylase
Blocking conversion of lanosterol to ergosterol
Membrane disruption

16

What are the triazoles

Fluconazole
Itraconazole
Voriconazole
Posaconazole

17

Which azoles are less specific for fungal CYP

Imidazoles

18

DOC candida and most coccidioides

Fluconazole

19

Inhibitor of 3A4

Azoles
Fluco - moderate but strong 2C9
Voriconazole - also 2C9, 2C19

20

What do imidazoles potentiate the toxicity of

Warfarin
Cyclosporine

21

Since it has a narrow spectrum what should imidazoles be used for

Superficial mycoses

22

Why can PPIs and H2 blockers interfere with Ketoconazole absorption

Best absorbed at low pH

23

Imidazole AE

Gynecomastia
Menstrual irregularities
Decreased plasma cortisol (inhibition of adrenal steroid synthesis)

24

Which imidazoles are available as topical OTC

Clotrimazole
Miconazole

25

Maintenance therapy or prophylaxis for cryptococcal meningitis

Fluconazole (after Amphoteracin B initial)

26

Which azoles can penetrate CSF

Fluconazole

27

What is the only azole that has renal excretion

Fluconazole

28

What can Fluconazole increase the plasma levels of

Phenytoin
Zidovudine
Warfarin

29

What is Fluconazole not good for

Aspergillus and other filamentous fungi

30

What is the absorption of Itraconazole reduced by

H2 blockers and PPIs

31

What is Itra/Vori/Posaconazole given for

Aspergillus
Blastomycoses
Sporothrix
Histoplasma
Dermatophytosis
Onychomycosis

32

When can Itraconazole cause fatal arrhythmias

When given with Cisapride or Quinidine

33

DOC invasive aspergillosis

Voriconazole

34

Voriconazole AE

Transient visual disturbance

35

Good for Mucor

Posaconazole

36

How does Caspofungin act

Inhibits beta (1.3) glucan synthesis in cell wall

37

What does Caspofungin act on

Candida
Aspergillus

38

What is Caspofungin ineffective against

C. neoformans

39

Structure of Caspofungin

Large cyclic peptide linked to long chain FA

40

How does Griseofulvin work

Disrupt mitotic spindle

41

What is Griseofulvin for

Dermatophysis (skin, hair, nails)

42

How do you improve Griseofulvin absorption

Give with fatty food

43

Induces P450

Griseofulvin

44

Action of Terbinafine

Inhibitis Squalene Epoxidase
No ergosterol and toxic levels of squalene

45

Most effective against Onychomycosis

Terbinafine

46

Is an Allylamine

Terbinafine

47

Accumulates in keratin

Terbinafine

48

No effect on P450

Terbinafine

49

Terbinafine AE

GI upset
Rash, HA, taste disturbance

50

Topical cream use of Terbinafine

Tinea cruris, corporis

51

What is Nystatin

Polyene macrolide

52

What is Nystatin similar to

Amphoteracin B (structure and action)

53

What is the only use of Nystatin

Candidiasis
Cutaneous oral/vaginal administration

54

Why isn't Nystatin given IV

Too toxic

55

What else can you give for cutaneous candidiasis

Topical Amphoteracin B