Antifungals

Question 1

Polyenes

Answer 1

Amphotericin B

Nystatin

Question 2

Polyenes - mechanism

Answer 2

artificial pores in membrane

Question 3

Azoles - mechanism

Answer 3

block ergosterol synthesis

Question 4

azoles - TOX

Answer 4

teratogenic

Question 5

Echinocandins - mechanism

Answer 5

block cell wall synthesis

Question 6

echinocandins - TOX

Answer 6

embryotoxic

Question 7

Amphotericin B - mechinism

Answer 7

binds ergosterol, creates pores in membrane

Question 8

Amphotericin B - administration

Answer 8

IV (no PO) - liposomal formulation, excreted slowly (can accumulate), intrathecal necessary

Question 9

Amphotericin B - TOX

Answer 9

infusion (chills, fever, spasms, HA, vomit, hypotension) - infuse slowly, give Benadryl+Tylenol, sodium
Renal damage (1st rev, 2nd irrev) - <2 gm cumulative

Question 10

Amphotericin B - in pregnancy

Answer 10

B, but preferred

Question 11

Nystatin - administration

Answer 11

NOT PO (creams, loc inf)

Question 12

Azoles (imidazoles) - administration

Answer 12

topical

Question 13

Azoles (Triazoles) - administration

Answer 13

systemic

Question 14

Azoles - special

Answer 14

Pseudallescheria boydii

Question 15

Azoles - mechanism

Answer 15

inhibit fungal cytochrome P450 - decrease synthesis of ergosterol

Question 16

Fluconazole - administration

Answer 16

PO/IV

Question 17

Fluconazole - special

Answer 17

best azole for CSF

Question 18

Fluconazol - disposition

Answer 18

highest bioavailability +TI + water solubility + renal excretion

Question 19

Fluconazol - indication

Answer 19

cryptococcal meningitis, prophylaxis for imm comp

Question 20

Fluconazol - TOX

Answer 20

rash, SJS, nausea, alopecia, teratogenic

Question 21

Fluconazol - drug drug rx

Answer 21

Inhibits CYP2C9 (incr phenytoin/warfarin)

Question 22

Itraconazole - administration

Answer 22

PO

Question 23

Itraconazole - penetration

Answer 23

poor CNS

Question 24

Itraconazole - drug drug rx

Answer 24

PPI/H2 decrease absorption
+Rifampin - decrease bioavailability
inhibits CYP3A4 - (not with statins, midazolam, triazolam)

Question 25

Itraconazole - indications

Answer 25

dimorphic histoplasma, blastomyces, sporothrix, dermatophytes

Question 26

Itraconazole - TOX

Answer 26

CH

Question 27

Voriconazole - administration

Answer 27

PO/IV

Question 28

Voriconazole - special

Answer 28

broadest spectrum

Question 29

Voriconazole - indication

Answer 29

``` invasive aspergillosis (less tox than Ampho B) also candida, dimorphic ```

Question 30

Voriconazole - TOX

Answer 30

visual disturbances in 1st 30 mins (blur, color, bright)

Question 31

Voriconazole - drug drug rx

Answer 31

inhibits CYPs

Question 32

Capsofungin - mechanism

Answer 32

inhibits synthesis of b(1-3)glucan

Question 33

Capsofungin - origin

Answer 33

ehinocandin (candida)

Question 34

Capsofungin - administration

Answer 34

IV! (PO is bad) (water soluble)

Question 35

Capsofungin - indication

Answer 35

aspergillus (resistant) + candida

Question 36

Capsofungin - TOX

Answer 36

GI, flush, hepatic tox (+cyclosporin)

Question 37

Capsofungin - in pregnanacy

Answer 37

NO

Question 38

Griseofulvin - administration

Answer 38

PO (insoluble microcrystals)

Question 39

Griseofulvin - mechanism

Answer 39

mitotic inhibition (fungistatic), stop microtubule assembly, inserts into growing keratin

Question 40

Griseofulvin - indication

Answer 40

dermatophytosis only (fingernails 6-9 months) (toenails 1 year)

Question 41

Griseofulvin - TOX

Answer 41

CNS, serum sick, hepatic tox, GI

Question 42

Griseofulvin - drug drug rx

Answer 42

P450 inducer (decr warfarin/pheno)

Question 43

Terbinafine - administration

Answer 43

PO

Question 44

Terbinafine - mechanism

Answer 44

inhibits squalene epoxidase (increase squalene which is toxi)

Question 45

Terbinafine - indications

Answer 45

dermatophytosis (keratophilic and fungicidal) - 3 months

Question 46

Terbinafine - TOX

Answer 46

NO P450 dxdx, GI +HA, Preg B

Question 47

Flucytosine - mechanicsm

Answer 47

anti-metabolite (cytosine permease takes up, converts to 5FU and block DNA/RNA synthesis)

Question 48

Flucytosine - administration

Answer 48

PO

Question 49

Flucytosine - excretion

Answer 49

Renal unchanged

Question 50

Flucytosine - TOX

Answer 50

``` narrow TI (only in combo) gut flora converts - hematotox ```

Question 51

Flucytosine - indication

Answer 51

+Amphob B for cryptococcus | +Itraconazole for chromoblastomycosis