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Pharm: Antifungals/Antivirals > Antifungals > Flashcards

Antifungals Flashcards

(68 cards)

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1
Q

What are the classes of Antifungals?

A

Polyenes, Azoles, Antimetabolites, Allylamines, Echinocandins

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2
Q

What medications belong in the Polyenes class?

A

Amphotericin, Nystatin

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3
Q

What medications belong in the Azoles class? (a lot)

A

Fluconazole, Itraconazole, Voriconazole, Posaconazole, Isavuconazonium sulfate, Ketoconazole, Efinaconazole (Terconazole, Butoconazole, Clotrimazole, Miconazole nitrate, Triconazole)

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4
Q

Which medications belong to the Allylamine class? What are they most commonly used for?

A

Terbinafine, Nafifine, Butenafine; SKIN

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5
Q

Which medications belong to the Antimetabolite class?

A

Flucystosine

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6
Q

Which medications belong in the Echinocandins class?

A

Caspofungin, Anidulafungin, Micafungin

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7
Q

Why is Amphotericin called Amphoterrible?

A

Because it has so many adverse drug reactions

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8
Q

What is Amphotericin indicated for?

A

progressive, potentially life threatening fungal infections, disseminated candidiasis in immunocompromised patients, meningitis

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9
Q

What is Amphotericin a second line treatment for?

A

aspergillosis and leishmaniasis

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10
Q

What is a benefit of Amphotericin in regards to its spectrum?

A

It is the broadest spectrum of the antifungals

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11
Q

What does Amphotericin bind to in fungal cells that allows it to damage cell membranes?

A

Ergosterol

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12
Q

Is Amphotericin fungicidal, fungistatic, or both? What does that depend on?

A

both; concentration of medication in tissues and susceptibility of organism

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13
Q

What are some warnings or precautions that you should make sure to inform any patient of before prescribing them Amphotericin? What is a warning and precaution that you as a prescriber should pay attention to when writing out this Rx?

A

Pregnancy Category B
Nephrotoxicity (can cause permanent damage)
As a prescriber, beware of confusing Amphotericin B with Amphotericin B Liposomal (Ambisome) in cancer patients/infectious disease.

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14
Q

What can be done to prevent nephrotoxicity when prescribing patients Amphotericin?

A

close monitoring, interrupt therapy, decrease dosage, and increase dosing interval (also hydrate and replenish Na+)

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15
Q

What are some of the many Adverse Drug Reactions of Amphotericin?

A

Infusion reactions, anaphylaxis, leukoencephalopathy, HA, NVD

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16
Q

What can you do to avoid an infusion reaction in patients who are being administered Amphotericin?

A

premedicate and run the dose slowly (fast infusion can cause hypotension, hypokalemia, arrhythmia, and shock)

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17
Q

Amphotericin is excreted (quickly/slowly) by the ____

A

slowly (weeks to months); kidneys

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18
Q

Amphotericin is highly _____-bound

A

protein

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19
Q

Nystatin works by binding to ergosterol in fungal ____ _____

A

cell membranes

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20
Q

Nystatin is fungistatic, fungicidal, or both?

A

both

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21
Q

Nystatin should be prescribed to patients who have extreme ____ ____, oral ___, and ____ candidiasis.

A

diaper rash; candidiasis; vulvovaginal

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22
Q

When being prescribed to patients with extreme diaper rash, Nystatin is commonly combined with ___ to increase its effectiveness, even though the combination of an anti-fungal with a ____ medication is commonly contraindicated.

A

triamcinolone; steroid

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23
Q

Nystatin is a pregnancy category ___ medication.

A

C

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24
Q

Some ADRs of nystatin include

A

Common: NVD, cramps, rash, hypersensitivity and Rare: Stevens Johnson Syndrome, urticaria

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25
Nystatin is excreted unchanged in the ___, so it does not affect the ____ .
feces; kidneys
26
All Azoles are ___ inhibitors, that increase the permeability of the fungal ____ ___, resulting in cell death.
CYP 450; cell membrane
27
Azoles are fungistatic, fungicidal, or both?
both
28
Fluconazole is most commonly indicated for use against:
YEASTS!, candidiasis, and cryptococcal meningitis
29
Fluconazole can be used off label to treat:
cryptococcal PNA
30
Fluconazole's dosage should be adjusted in patients who have ___ issues
renal
31
ADRs of a majority of Azoles include:
QT prolongation and arrythmias
32
Fluconazole has a (long/short) half life
long
33
Itraconazole has a broader spectrum, and in addition to yeasts, can be used to treat ___, such as ____.
mold; histoplasmosis
34
Itraconazole can be used to treat ___ in patients who did not respond well to Fluconazole originally.
oropharyngeal/esophageal candidiasis
35
Itraconazole can be used to treat ___ as a 2nd line option
aspergillosis
36
Itraconazole is a pregnancy category ___
C
37
Voriconazole, like itraconazole, is of broad spectrum, and covers infections due to both ___ and ___
yeasts and molds
38
Voriconazole is the drug of choice (DOC) for treating____
invasive aspergillosis
39
Voriconazole is a pregnancy category ___
D
40
When adminstering Voriconazole IV, we should be concerned for the patient's ____ function
renal
41
_______ is the broadest spectrum -azole and covers yeast and mold
Posaconazole
42
Posaconazole is best for the treatment of aspergillum and candida in patients who are ___
immunocompromised
43
Posaconazole can be used to treat yeast infections in patients where there has been resistance to ____
fluconazole
44
Isavuconazonium sulfate is a ___ that is used for specific ___ infections, such as ___ and ____
prodrug; fungal; aspergillosis and mucormycosis
45
The only thing that we really need to know about ketoconazole is that it is ____
not used anymore due to too many ADRs
46
Efinaconazole is administered (PO/IV/topically/IM)
topically
47
Efinaconazole is indicated for patients who have ___
onychomycosis
48
Beware, if using efinaconazole, a patient may develop ___
an ingrown toenail, and application site irritation
49
How many weeks does it take for efinaconazole to take full effect?
48 freaking weeks
50
Terbinafine, Naftifine, and Butenafine are all ___, and are indicated for the treatment of ___
allylamines; onychomycosis, tinea cruris/pedis/corporis
51
Terbinafine is fungicidal/fungistatic/both
fungicidal
52
What are some ADRs of terbinafine?
diarrhea, abd pain, LFT abnormalities, and dysgeusia | Rare: Stevens Johnson, TEN
53
Terbinafine is ___ soluble and thus distributes well into the ___, ___, and ___
lipid; nails, skin, fat
54
ADRs of Naftitine and Butenafine include
burning, stinging, itching, rash
55
Flucytosine must be _____ due to resistance
used in conjunction with other drugs
56
Flucytosine is an ____ drug that inhibits ___ and ___ synthesis
antimetabolite; fungal protein synthesis and DNA synthesis
57
Flucytosine is indicated for ___ and is sometimes used as a chemotherapy agent
very severe Fingal infections (candida, strep, crytococcus meningitis)
58
Flucytosine is a pregnancy category ___
C
59
Taking flucytosine can cause
NVD, rash, elevated LFTs
60
Echinocandin medications work by ____
weakening fungal cell wall
61
Echinocandins are used to treat ___ infections
severe, invasive fungal infections such as candida and aspergillus
62
ADRs of echinocandins include
NVD, infusion reactions
63
The really super duper thing about Echinocandins that makes Dr. Murfin really excited is that fact that Echinocandins do NOT have ____
P450 interactions (doesn't cause drug interaction problems)
64
Cyclopirox is indicated for use in patients with ___ infections
dermatophyte (tinea, onychomycosis, candida)
65
Ciclopirox is fungicidal/fungistatic/both
fungicidal
66
Ciclopirox is a pregnancy category ___
B :)
67
Tavoborole inhibits_____
fungal protein synthesis
68
Using Tavoborole topically can cause ADRs such as ____
application site exfoliation, erythema, dermatitis, and ingrown toenail

Pharm: Antifungals/Antivirals (15 decks)

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