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Pharmacology > Exam 4 - Antifungal Agents & Laxatives > Flashcards

Exam 4 - Antifungal Agents & Laxatives Flashcards

(71 cards)

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1
Q

Groups of infections that anti-fungal agents treat

A

Drugs for systemic mycoses (infections)
Drugs for superficial mycoses (infections)
(A few drugs are used for both)

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2
Q

Groups of systemic mycoses

A

Opportunistic
Nonopportunistic

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3
Q

What are opportunistic systemic mycoses?

A

Infect an immunocompromised host
Ex: cancer pts, pts in the hospital for a long time

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4
Q

What are nonopportunistic systemic mycoses?

A

Can occur in any host

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5
Q

Types of organisms that are opportunistic mycoses

A

Candidiasis
Aspergillosis
Cryptococcosis
Mycomycosis

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6
Q

Types of organisms that cause nonopportunistic mycoses

A

Sporotrichosis (rose gardner’s disease)
Blastomycosis (decaying wood)
Histoplasmosis (from birds and bats)
Coccidioidomycosis

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7
Q

Classes of antifungal drugs

A

Polyene antibiotics
Azoles
Echinocandins
Pyrimidine analogs

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8
Q

What is Amphotericin B?

A

Broad-spectrum antifungal agent (also used against some Protozoa)

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9
Q

Administration of Amphotericin B

A

Must be given IV (no oral admin)
**Highly toxic. Needs to be infused over 2-4 hours

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10
Q

Uses of Amphotericin B

A

for most systemic fungal infections
(Esp in immunocompromised patients)

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11
Q

Action of Amphotericin B

A

Binds to ergosterol (much more than cholesterol) in fungal cell membrane (Bacterial cell membranes lack sterols)

Increases permeability
Cell leaks intercellular cations (esp potassium)

Can be fungistatic or fungicidal

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12
Q

Adverse effects of Amphotericin B

A

*Infusion reactions
*Nephrotoxicity (need to watch levels)
Hypokalemia
Bone marrow suppression

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13
Q

*Symptoms of Amphotericin B infusion reaction

A

Fever
Chills
Rigors
Nausea
Headache

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14
Q

What causes infusion reactions with Amphotericin B?

A

Release of proinflammatory cytokines
(Less intense with lipid-based Amphotericin B formulations)

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15
Q

When do symptoms of Amphotericin B infusion reactions occur?

A

Begin 1-3 hours after start of infusion and last for about an hour

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16
Q

What is the extent of *nephrotoxicity with Amphotericin B related to?

A

Related to total dose administered over the full course of treatment
If the dose is >4, residual impairment is likely

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17
Q

How to minimize kidney damage when administering Amphotericin B

A

By infusing 1 L of saline on days of treatment

*Avoid concurrent use of other nephrotoxic drugs (Aminoglycosides, cyclosporines)

NSAIDs should be avoided

Monitor serum creatinine every 3-4 days
And reduce dosage if >3.5mg/dL

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18
Q

How to prevent hypokalemia when administering Amphotericin B

A

*Monitor serum levels
(Results from damage to the kidneys)
Potassium supplements may be needed

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19
Q

Hematologic effects caused by Amphotericin B

A

Can cause bone marrow suppression
Anemia (must monitor hematocrit)

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20
Q

What are Azoles?

A

Broad spectrum antifungal drugs
Good alternative to ampho B for most systemic mycoses (have lower toxicity)

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21
Q

Administration of Azoles

A

Can be given orally

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22
Q

Disadvantage of Azoles

A

Inhibit P450 drug-metabolizing enzymes and can increase the levels of many other drugs

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23
Q

Prototype Azole

A

Itraconazole (Sporanox)

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24
Q

Uses of Itraconazole

A

Systemic mycoses (alternative to ampho B)

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25
Side effects of Itraconazole (Sporanox)
*Cardiosuppression (transient decrease in ventricular ejection fraction) Liver damage GI effects (nausea, vomiting, diarrhea) Can inhibit drug-metabolizing enzymes
26
If a patient is taking Itraconazole (Sporanox) lab work needs to be monitored if they are taking which other drugs?
Digoxin Coumadin Cyclosporin
27
Two groups of superficial mycoses
Caused by two groups of organisms: - Candida species - Dermatophytic infections
28
Where are Candida species found? And where do they usually cause infections?
Usually in mucous membranes and moist skin Chronic infections may involve scalp, skin, and nails
29
Where do dermatophytic infections usually occur?
Usually confined to skin, hair, and nails (More common than candida infections in nails)
30
In general, how are Azoles administered, what are Azoles used for, and what are their suffixes?
Topical or PO Used for superficial mycoses -azole
31
Suffix for allylamines
-afine
32
In general, what are polyene antibiotics used for and what is the suffix?
Candida infections of the skin, mouth, and vagina -statin
33
Mechanism of action for Azoles
Inhibits the synthesis of ergosterol (essential component of the cytoplasmic membrane) This causes increased membrane permeability and leakage of cellular components
34
Administration of Fluconazole (Diflucan)
Oral IV (Dosage is the same for both)
35
Adverse effects of Fluconazole (Diflucan)
N&V Headache Abdominal pain Diarrhea
36
What is another alternative to ampho B for systemic mycoses
Ketoconazole (Nizoral)
37
Uses of Ketoconazole (Nizoral)
Alternative to ampho B for systemic mycoses Less toxic, less effective, slower effects More useful in suppressing chronic infections than in treating severe, acute infections
38
Examples of superficial mycoses
Oral candidiasis (thrush) Vulvovaginal candidiasis
39
Risk factors for superficial mycoses
Pregnancy Diabetes Debilitation HIV Oral contraceptives Systemic glucocorticoids Anticancer agents Systemic antibiotics
40
Fungal infection of the nails
Onychomycosis
41
Treatment for onychomycosis
Oral therapy - Lamisil and Itraconazole (Sporanox) Topical therapy - Ciclopirox (Penlac Nail Lacquer)
42
What is Nystatin (Mycostatin)?
Polyene antibiotic
43
What is Nystatin used for?
Only for candidiasis Drug of choice for intestinal candidiasis Also used for Candida infections in skin, mouth, esophagus, and vagina
44
Administration of Nystatin
Orally Topically
45
Contraindications of laxative use
Pts with abdominal pain, nausea, cramps, or other symptoms of appendicitis, regional enteritis, diverticulitis, and ulcerative colitis Acute surgical abdomen Fecal impaction or bowel obstruction Habitual use Use with caution in pregnancy and lactation
46
Types of laxatives
Bulk-forming Surfactant Stimulant Osmotic
47
Types of bulk-forming laxatives
Methylcellulose (Citrucel) Psyllium (Metamucil)
48
Function of bulk forming laxatives
Function similarly to dietary fiber: swell with water to form a gel to soften and increase fecal mass
49
Uses of bulk forming laxatives
Preferred treatment for temporary treatment of constipation
50
Administration of bulk forming laxatives
Mix in full glass of water May take 1-3 days to work
51
Adverse effects of bulk forming laxatives
Esophageal obstruction
52
Prototype surfactant laxative
Docusate sodium (Colace)
53
Effects of surfactant laxatives on bowel
Stimulate intestinal motility Increase quantities of water and electrolytes in the intestinal lumen
54
Use of surfactant laxatives
Opioid-induced constipation
55
Types of stimulant laxatives
Bisacodyl (Correctol, Dulcolax) Castor oil Senna (Senokot, Ex-Lax)
56
Administration of Bisacodyl (Correctol, Dulcolax)
Tablets Suppositories
57
Administration of castor oil
Sometimes given before surgical procedures Sometimes mixed and given as enema Works in 2-6 hours
58
How to stimulant laxatives work? And how long do they take to work?
Stimulate intestinal motility Results in 6-12 hours
59
What are stimulant laxatives used for?
Opioid induced constipation
60
Types of osmotic laxatives
Laxative salts: Magnesium hydroxide Sodium phosphate Magnesium citrate Magnesium sulfate
61
How do laxative salts work?
Poorly absorbed salts that draw water into the intestinal lumen The fecal mass softens and swells, wall stretches, and peristalsis is stimulated
62
How long does it take for results of osmotic laxatives?
Low doses: 6-12 hours High doses: 2-6 hours
63
Type of laxative used for chronic constipation
Polyethylene glycol (PEG) (Miralax, Glycolax, Peglax)
64
What type of laxative is polyethylene glycol?
Osmotic laxative
65
Most abused type of laxatives
Osmotic laxatives
66
What are high doses of osmotic laxatives used for?
Diagnostics (colonoscopies) Surgery Ingested poisons Anti-helmintic
67
Adverse effects of osmotic laxatives
Dehydration: substantial water loss Renal decline: toxicity Sodium retention: exacerbated heart failure, HTN, edema
68
Which types of laxatives should not be given to patients with kidney issues
Osmotic laxatives Laxatives with salt because they can build up in kidneys
69
3 types of bowel-cleansing products for colonoscopies
Sodium phosphate Polyethylene glycol Combination - sodium picosulfate, magnesium oxide
70
What causes laxative abuse?
Misconception that bowel movements must occur daily
71
Consequences of laxative abuse
Diminished defecatory reflexes, leading to further reliance on laxatives Electrolyte imbalance Dehydration Colitis

Pharmacology (16 decks)

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