Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

pharm 2 mod 4: fungals/microbials > antifungals > Flashcards

antifungals Flashcards

(90 cards)

Start Studying
1
Q

what type of fungal infections are life threatening

A

systemic infections

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what populations are often affected by fungal infections

A

immunosuppressed
chronic immune suppression
undergoing chemotherapy
HIV/AIDS
etc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what are the superficial fungal infections

A

pityriasis versicolor
tinea nigra

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what are cutaneous fungal infections

A

dermatophytosis (skin, hair and nails) (tineas)
candidiasis of skin (breast, armpits, inguinal folds)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what are subcutaneous fungal infections

A

sporotrichosis (rose-gardeners)
chromomycosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what are systemic fungal infections

A

coccidioidomycosis
histoplasmosis
blastomycosis
cryptococcosis
systemic candidiasis
aspergillosis
zygomycetes (mucorales)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what are the different categories of antifungal drugs

A

Polyenes
Zadoles
Echinocandins
allylamines
other

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what are the polyene antifungal medications

A

amphotericin B
Nystatin (potent)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what are the Zoles antifungal medications

A

clotrimazole
ketoconazole
fluconazole
itraconazole
posaconazole
posaconazole
voriconazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what are echinocandin medications

A

caspofungin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what are allylamines

A

terbinafine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what are the other antifungal drugs

A

flucytosine
griseofulvin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what is the MOA for amphotericin B

A

lipophilic rod-like molecule disrupts fungal cell wall synthesis by binding to sterols, primarily ergosterol, leading to formation of pores in the cell membrane. K+ leaks out of cell resulting in cell death.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what is amphotericin B produced by

A

streptomyces nodosus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

when is amphotericin B used

A

treatment of severe invasive fungal infection
widest spectrum of activity of all antifungals
rapid onset
resistance is rare

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what are the pharmacokinetics of amphotericin B

A

metabolism poorly understood
poor PO absorption. Used IV - wide tissue distribution
little CSF penetration; intrathecal sometimes used
low TI
Nephrotoxicity - azotemia due to dose-dependent decrease in GFR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what are the AE of amphotericin B

A

infusion related reactions:
fever and rigors
decreased incidence following multiple doses
pre-medicate with Tylenol or Benadryl recommended
may treat rigors with low-dose meperidine
Nausea/vomiting, anemia, phlebitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is flucytosine

A

5-FC
synthetic pyrimidine analog (false nucleotide)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what is the MOA for Flucytosine

A

inhibits thymidylate synthase and incorporates into fungal RNA disrupting nucleic acid and protein synthesis
NOT used as monotherapy; resistance too high

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what is the spectrim of activity for flucytosine

A

used in combo with ampotericin B (synergistic) for tx of systemic mycoses and meningitis caused by cryptococcus and candida spp.
used in combo with itraconazole for treatment of chromoblastomycosis infections

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What needs to be monitored when using amphotericin B

A

K+, Mg++; replete aggressively in the presence of decreased GFR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the pharmacokinetics of Flucytosine

A

good PO absorption, penetrates CSF
dose adjustment required in renal impairment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what are the AE of flucytosine

A

reversible neutropenia, thrombocytopenia
dose-related bone marrow suppression
reversible hepatic dysfunction
more common: GI upset, N/V, diarrhea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are the two groups of azoles

A

imidazole and triazoles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
what are the imidazoles
ketoconazole miconazole clotrimazole
26
what are the traizoles
fluconazole itraconazole voriconazole posaconazole
27
what is the MOA for the imidazole
inhibit C-14 alpha-demethylast (CYP450 enzyme), which block the demethylation on lanosterol to ergosterol thereby disrupting membrane structure
28
which of the imidazoles are too toxic for systemic use and are topical use only
miconazole and clotrimazole
29
what is ketoconazole
imidazole - may be used systemically (but systemic use replaced by newer triazoles)
30
what is the MOA for ketoconazole
inhibit C-14 alpha-demethylase - decrease syntehsis of ergosterol thereby disrupting membrane strucure may be used sysetmically should not be used with amphotericin B
31
what is the spectrim of activity of ketoconazole
candida, histoplasma, blastomyces, coccidioides but NOT aspergillus species
32
what are the pharmacokinetics of ketoconazole
topical and PO formation available requires gastric acid for dissolution and absorption does NOT penetrate CSF endocrine effect: inhibit human gonadal and adrenal steroid homrone synthesis
33
what are the AE of ketoconazole
GI upset hepatitis rare - d/c if raising LFTs gynecomastia, decreased libido, menstrual irregulatiteis drug interactions: CYP450 metabolized drugs
34
when is ketoconazole contraindicated
Pregnancy
35
What is the MOA for triazoles
inhibits synthesis of cellmembrane via fungal CYP 450 inhibition similar to ketoconazole, however, it does not interefere with the mammalian CYP 450 enzymes involvved in synthesis of other steroid hormones - no endocrine side effects
36
what is the spectrim of activity of fluconazole
candida, cyrptococcus neoformans, coccidiomycosis; no activity against aspergillus
37
what is the pharmacokinetics of Fluconazole
PO/IV, not dependent on gastic acid Good CSF penetration dose adjust in renal impairment
38
what are the AE of fluconazole
N/V/rashes, alopecia, hepatitis is rare
39
what are the contraindications for fluconzaole
teratogenic- should not be used in pregnancy
40
what is the spectrum of activity for itraconazole
broad: drug of choice for histoplasmosis, blastomycosis, sporotrichosis
41
what are the pharmacokinetics of itraconazole
good PO availability but requires gastic acid for absoprtion; no IV formulation metabolized in liver no dose-adjustment in renal impairment dose not penetrate CSF well
42
what are the AE of itraconazole
N/V, rash, HA HTN, Hypokalemia, edema rarely hepatitis chronic therpay can cause alopecia potential drug-drug interactions: warfarin, statin, phenytoin contra: teratogenic. black box warning: CHF
43
what is the MOA for caspofungin
echinocandins inhibits B (1,3) - D- Glucan synthase, an enzyme involved in fungal cell wall synthesis
44
what is the spectrum of activity for caspofungin
invasive aspergillus infection (2nd line agent) - vericonazole 1st line agent candidal infections: -c. glabrata candidemia zole-resistance candida esophagus
45
what is capsofungin not active against
zygomycytes and crypotococcus noeformans
46
what are the AE of echinocandins
generally well tolerated histamine reaction with infusion - pretreat with benadryl drug-drug interactions: cyclosporine, tacrolimus, rifampin CNS penetration is poor
47
what is the MOA forNystatin
binds to ergosterol' similar mechanisms of amphotericin B too toxic for systemic use - never used IV
48
what is grieofluvin
Mechanism: inhibits mitosis used for dermatophytic nail infections - accumulates in keratin-containing tissues treatment may be required for 6-12 months
49
what are the drug to drug interactions with grieofulvin
induces CYP450 enzymes; increases rate of metabolism of other drugs including anticaogulants avoid alcohol during therapy
50
what is terbinafine
mechanism: inhibits cell wall synthesis by inhibiting fungal squalene epoxidase - decreases the synthesis of ergosterol
51
where does terbinafine accumulate
skin, nails and fat - drug of choice for onychomycosis and dermatophytic infections
52
what are the SE/AE of terbinafine
contraindicated in nuring mothers - accumulates in breast milk ARDs: hepatotoxicity - LFTs at baseline
53
What is coccidioimycosis
southwest US, aerosolized spores from soil pulmonary disease synovitis hepatospenomegaly meningitis leading to hydrocephalus
54
what are the treatment options for coccidioidomycosis
fluconazole or itraconazole, amphotericin B if severe/dissminated
55
what is Histoplasmosis
ohio, missouri, and mississippi river valeys bird droppings in damp soil, bats pulmonary disease to disseminated disease disseminated form includes GI, cardiac, ocular and CNS effects
56
what is the treatment of choice for histoplasmosis
itraconazole
57
what is blastomycosis
great lakes region, inhalation of spores pulmonary disease skin lesions: sharply demarcated, grey to violet verrucal lesions, irregular borders lytic bony lesions prostatitis
58
what is the treatment of choice for blastomycosis
itraconazole consider fungal infection in pneumonias not responding to antibiotics
59
what is Aspiergillosis
pulmonary disease most common increased risk if have asthma or COPD cavitary lesions consider chronic form in patients whose respiratory symptoms do not respond to prolonged antibiotic therapy
60
what is the treatment options for aspergillosis
vericonazole, posaconazole (not first lien), capsofungin, amphotericin B
61
what is zygomycetes
rhizopus fungus, aggressive infections nasopharynx of immunocompromised patients
62
what are the treatment options for zygomycetes
prompt surgical debridement posaconazole, amphotericin B
63
what are antiprotozoal durgs
trimethoprim-sulfamethoxazole metronidazole
64
what aare the antihelmintic drugs
albendazole pyrantel pamoate ivermectin praziquantel
65
What is the MOA for metronidazole
activated by anaerobes to metabolites that damage DNA - the nitro group of metronidaazole serves as an electrol acceptor and forms toxic metabolite that disrupt DNA helical structure leading to cell death
66
what are the uses for metronidazole
amebiasis, giardiasis, tricomoniasis (and anaerobic bacterial infections)
67
what is considered a tissue agent and is co-administered with luminal agent, paromomycin
metronidazole -asymptomatic patient may be treated with intraluminal agent alone
68
what are the pharmacokinetics of metronidazole
metabolized in liver- accumulates in aptients with severe hepatic disease; excreted in urine
69
What are the ARDs of metronidazole
GI disturbance (N/V), metallic taste, seizure, neuropathy, disulfiram (antabuse) effect with alcohol
70
what are contraindications for metronidazole
pregnancy, breast feeding, recent us of disulfiram
71
what are alternative therapies for metronidazole
tinidazole, ornidazole, and nitrazoxanide
72
What is the MOA for Bactrim
combination of TMP-SMX provides sequential, and thus synergistic blockade of FOLATE pathway: which leads to inhibition of thymidines synthesis
73
what is bactrim used for
cyclospora and isospora infections
74
what are the ARDS for bactrim
many potention Rash, SJS, kernicterus, hemolysis in G6PD-deficiency patients; may lead to bone marrow suppression and anemia, renal impairement, hepatotoxicity
75
when should bactrim be avoided
patients with renal disease drug-drug interactions with: warfarin, phenytoin, methotrexate contra: newborns (<2months) and pregnancy
76
what is the primary treatment for nematodes (roundworms)
albendazole
77
what is the treatment for cestodes (tapeworms)
praziquantel
78
what is the treatment for trematodes (flukes)
praziquantel
79
what is the MOA for albendazole
binds to microtubules in the intesting and tegmental worm and larvae; impaired glucose uptake - glycogen depletion - degeneration of ER and mitochondria, release of lysosomes, and depletion of ATP/energy causing worm death
80
what are the uses for albendzaole
broadly effective against nematode infections (round worms)
81
what are the ARDS of albendazole
HA, elevated LFTs rare: GI, alopecia very rare: liver failure, myelosuppression, seizure Contra: pregnancy
82
what is the moa pyrantel pamoate (OTC)
causes release of acetylcholine and inhibits cholinesterase; acts as a depolarizing neuromuscualr blocker, spastic PARALYSIS and release of helminths
83
what are the uses for pyrantel pamoate
NOT Preferred - new agents available alternate to albendazole therapy for enterobius vermicularis (pin worms) infection
84
what are the ARDs with pyrantel pamoate
rare HA, dizziness, GI distress
85
what is the MAO for praziquantel
increases cell permeability to Ca2+ in schistosomes - strong contractions and paralysis of worm muscularture which leads to detachement and dislodgement and death
86
what are the uses of praziquantel
cestodes (tapeworms) and trematodes (flukes)
87
what are the ARDS of praziquantel
abdominal pain, dizziness, drowsiness pts with cerebral cysticercosis experience CNS SE HA, seizures - from the death of parasites CYP450
88
what is the MAO for ivermectin
binds and activates glutamate - gated chloride channels (GluCls) in invertebreate nerve and muscle cells; - hyperpolarization and death of helminth - does not cross BBB
89
what is the use of ivermectin
strongyloidiasis and onchocerviasis ("river blindness"); also used topically for head lice
90
what are the ARDS for ivermectan
neurotoxicity (CNS depression, ataxia) froma ctivation of GABA-nergic synapses; some cutanous effects CI: prenancy, meningitis

pharm 2 mod 4: fungals/microbials (3 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions