antifungal therpay

Question 1

amphotericin B mechaims

Answer 1

binds ergosterol (unique to fungi); forms membrane pores that allows leakage of electrolytes (esp K+); leading to funal cell lysis

Question 2

use of amphotericin B

Answer 2

serious , systemic mycoses
Cryptococcus (amphotericin B w/wo flucytosine for cryptococcal meningits)
Blastomyces, coccidiodes, histoplasma, canddia, mucor
intrathecally for fungal meningits
supplement K+ and Mg2+ bc of altered renal tubule permeability

Question 3

SE of amphotericin B

Answer 3

fevers / chills , hypotension, neprhotoxcity (decrease GFR, toxic effects on tubular eptihelium), arrhtymias, anemia, IV thrombophelbitis
hydration decrease neprhotoxicity
liposomal amphotericin decrese toxiicty

Question 4

anemia in amphotericiin B due to

Answer 4

suppression of renal EPO synthesis

Question 5

SE of amphotericin B to electorylyest

Answer 5

hypomagensiumeia, hypokalmeia

Question 6

mechainms of nystatin

Answer 6

same as amphtoericin b;

topical use only as too toxic for systemic use

Question 7

use of nystatin

Answer 7

swish and swallow for oral candidais (thrush); topical for diaper rash or vaginal candiasisis

Question 8

flucytosine mechanism

Answer 8

inhibits dna and rna biosyntehsis by conversion to 5 fluorouracil by cytosine deaminase

Question 9

use of flucytosine

Answer 9

systemic fugnal infectsion (esp meniginits caused by cryptococcus) in combo w amphotericin B

Question 10

SE of flucytosine b

Answer 10

bone marrow suppression

Question 11

azoles

Answer 11

clotrimazole, fluconazole, itraconazole, ketoconazlole, miconazole, voriconazole, isavuconazole

Question 12

mechanism of azoles

Answer 12

inhibit fungal sterol (ergosterol ) synthesis by inhibiting cytochrome p450 enzyme (14ademethylase) that converts lanosteorl to ergosterol

Question 13

use of azoles

Answer 13

local and less serious systemic mycoses;

flucaconazole for chronic suppression of cryptococcal meningits in AIDS patietns and candidal infectsion of all types

Question 14

which azole for blastomyces, coccidiodes, histoplasmoa

Answer 14

itraconazole

Question 15

which for topical funal infections

Answer 15

clotrimazole; micoconazole

Question 16

whic azole for aspergillus and some candida

Answer 16

voriconazole

Question 17

which azole for serious asperigllus and mucorales infectiosn

Answer 17

isavucoconazole

Question 18

SE of azoles

Answer 18

testosterone syntehsis inhibition (gynecomastia, esp with ketoconazole, liver dysfunction (inbhitis cytocohrome p450``

Question 19

terbinafine mechanism

Answer 19

inhibits fugnal enzyme squalene epoxidase (thus inhibits ysntehsis of ergosterol

Question 20

use of terbinafine

Answer 20

dermatophytoes (esp onychomycosis 0 infection of finger or toe nails)

Question 21

se of terbinafine

Answer 21

Gi upset headaches hepatotocity, taste distrubance

Question 22

echinocandins

Answer 22

anidulafungin, caspofungin, micafungin

Question 23

mehcanism of echinocandins

Answer 23

inhibit cell wall syntehsis by inhibitng syntehssi of B glucan (1, 3 B D glucan)

Question 24

use of ehcinocandins

Answer 24

invasive aspergillosis, candida

Question 25

SE of enchinocandins

Answer 25

Gi upset, flushing (by histamine release)

Question 26

griseofulvin mechansim

Answer 26

inteferes w microtubule function; disrupts mitosis; depostis in keratin containin tissues (nails) ; p450 inducer

Question 27

use of griseofulvin

Answer 27

oral treatment of supericial infections; inhibits growth of dermatophytes (tinea, ringworm)

Question 28

se of griseofulvin

Answer 28

teratogenic, carcinogenic, confusion, headaches, disulfiram like reaction; increase cytcohome p450 and warfarin metabolism

Question 29

antiprotozona therpay

Answer 29

t

Question 30

pyrimethamine used for

Answer 30

toxoplasmosis and malaria inhibits parasitic DHFR

Question 31

suramin and melarssoprol use

Answer 31

trypansoma brucei

Question 32

nifurtimox use

Answer 32

T. cruzi

Question 33

sodium stibogluconate use

Answer 33

leishmaniasis

Question 34

anti mite/louse therpay treats

Answer 34

sarcopetes scabeie, | lice (pediculus, phtrius)

Question 35

Treat PML (Pesty Mites and LIce) with PML bc they NAG you

Answer 35

``` Treat PML (Pesty Mites and LIce) with PML bc they NAG you ' Pesty Mites Lice Permethrin Malthion, lindane Na, Ache, Gaba ```

Question 36

permethrin mechainsm

Answer 36

neuronal membrane depolarizioant via Na+ channels

Question 37

malathion mechainsm

Answer 37

ache inhibtor

Question 38

lindane mechanism

Answer 38

blocks Gaba channles - neurotoxicity

Question 39

chloroquine mechanism

Answer 39

blocks detoxification of heme into hemozoin. heme accumualtes and is toxic to plasmodia

Question 40

use of chloroquine

Answer 40

treamtent of plasmodial species other than p. falciparium (frequency of resistance in P. falciparum is too high)

Question 41

african species are chlorioqine resisatn so use

Answer 41

atovaquone - proguanil or artemisisns

Question 42

Resistance to chloroquine

Answer 42

membrane pump that decrease intracellular concentration of drug treat p . falciparum w artemether/lumefantrine or atovaquone/proguanil

Question 43

for life threatemning malaria use

Answer 43

quinidien in US (quinine lesewhere) or artesunate

Question 44

se of chloroquine

Answer 44

retinopathy, pruirtus (esp in dark skinned indivudlas)

Question 45

antihelminthic therpay

Answer 45

``` mebendazole (microtubule inhibitor) pyrantel pamoate ivermectin diethylcarbamazine praziquantel ```