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Pharmacology Block 3 > Antifungals > Flashcards

Antifungals Flashcards

1
Q

What are the risk factors for acquiring fungal infections?

A
  • broad spectrum antibiotics
  • indwelling catheters
  • immunocompromised
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2
Q

What is the most common fungal target for drug therapy?

A

Ergosterol

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3
Q

What is the only broad spectrum antifungal used for serious systemic infections?

A

Amphotericin B

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4
Q

What is the unique mechanism for Amphotericin B and how’s administered?

A

Very Lipophilic and binds ergosterol in the membrane of the fungi causing membrane leakage and death. IV dose only.

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5
Q

What type of toxicity does Amphotericin B have and what are the effects?

A

Total Cumulative Dose Toxicity.

Symptoms - Renal Damage, can cause potassium imbalance.

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6
Q

What antifungal is used with Amphotericin B for serious Candida and Cryptococcus infections?

A

Flucytosine

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7
Q

What is the unique enzyme that Candida and Cryptococcus express that Flucytosine takes advantage of?

A

Fungal Cytosine Deaminase

Converts Flucytosine to 5-FU, which inhibits fungal DNA replication

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8
Q

How does the synergy between Flucytosine and Amphotericin B work?

A

Administering Flucytosine with Amphotericin B allows the Amphotericin B dose to be lower with same effects, thus less side effects.

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9
Q

What are common side effects of Flucytosine? What patients should you not use it with?

A

Leukopenia and Thrombocytopenia
Heptatoxicty
–Should not use with renal insufficiency or bone marrow suppression patients–

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10
Q

What is the common mechanism of Triazoles and Imidizoles?

A

Inhibits 14-alpha-sterol demethylase preventing ergosterol synthesis, which is a fungal P450.

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11
Q

What antifungal would be used to treat cryptococcus meningitis?

A

Fluconazole

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12
Q

What triazoles would be used to treat urinary candida?

A

Fluconazole (Diflucan) - penetrates CNS and urinary tract tissues.

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13
Q

What antifungal would be used to treat Blastomyces, Histoplasma, and oral Candida?

A

Itraconazole

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14
Q

What azole would be used to treat invasive Aspergillus and common strains of Candida?

A

Voriconazole

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15
Q

What are the limitations of Itraconazole and Voriconazole?

A

They cannot penetrate CNS or urinary tract.

Only Fluconazole can be used for Candida UTIs and CNS infections. Secreted in urine unchanged.

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16
Q

What are general side effects of azoles?

A

Heptatoxicity

Many drug interactions

17
Q

What azole inhibits CYP3A?

A

Itraconazole

18
Q

Which azole can cause visual disturbances and photosensitive rash?

A

Voriconazole

19
Q

What drug is used for invasive Aspergillus and difficult Candida?

A

Caspofungin

20
Q

How does Caspofungin work?

A

Noncompetitively inhibits Beta-(1,3)-D-glucan preventing cell wall synthesis

21
Q

When would you use Caspofungin?

A

Invasive Aspergillus and Candida

–or if patients on intolerant to other drugs, or reached their maximal dose. –

22
Q

What antifungal is used to treat urinary tract and mucous membrane Candida?

A

Fluconazole

23
Q

What is another antifungal that has the same mechanism as Fluconazole and can be used as suppositories?

A

Miconazole

24
Q

What antifungals are typically used as topical application for Candida?

A

Clotrimazole and Nystatin

25
Q

What kind of Candida does Nystatin work well for?

A

Azole-Resistant strains of Candida

26
Q

What antifungal is only used as ophthalmic drops?

A

Natamycin, mechanism similar to Amphotericin B.

27
Q

What are common topical medications for dermatophytic infections?

A

Miconazole
Clotrimazole
Terbinafine
Tolnaftate

28
Q

What antifungal is used topically on nails to prevent fungus from growing?

A

Ciclopirox

29
Q

Which antifungal causes a toxic build up of squalene in fungi?

A

Terbinafine

30
Q

What can a patient take orally for a nail infection?

A

Terbinafine and Itraconazole (Many drug interactions)

31
Q

What antifungal would be used for tinea capitis in children?

A

Griseofulvin

32
Q

What antifungal has cross-reactivity with penicillins?

A

Griseofulvin, also induces cytochromes

33
Q

How does Griseofulvin interfere with fungal growth?

A

Interferes with microtubule spindles

Pharmacology Block 3 (19 decks)

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