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Pharmacology > Exam 4 - Antifungal Agents & Laxatives > Flashcards

Exam 4 - Antifungal Agents & Laxatives Flashcards

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
Q

Side effects of Itraconazole (Sporanox)

A

*Cardiosuppression (transient decrease in ventricular ejection fraction)
Liver damage
GI effects (nausea, vomiting, diarrhea)
Can inhibit drug-metabolizing enzymes

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26
Q

If a patient is taking Itraconazole (Sporanox) lab work needs to be monitored if they are taking which other drugs?

A

Digoxin
Coumadin
Cyclosporin

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27
Q

Two groups of superficial mycoses

A

Caused by two groups of organisms:
- Candida species
- Dermatophytic infections

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28
Q

Where are Candida species found? And where do they usually cause infections?

A

Usually in mucous membranes and moist skin
Chronic infections may involve scalp, skin, and nails

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29
Q

Where do dermatophytic infections usually occur?

A

Usually confined to skin, hair, and nails
(More common than candida infections in nails)

30
Q

In general, how are Azoles administered, what are Azoles used for, and what are their suffixes?

A

Topical or PO
Used for superficial mycoses
-azole

31
Q

Suffix for allylamines

A

-afine

32
Q

In general, what are polyene antibiotics used for and what is the suffix?

A

Candida infections of the skin, mouth, and vagina
-statin

33
Q

Mechanism of action for Azoles

A

Inhibits the synthesis of ergosterol (essential component of the cytoplasmic membrane)
This causes increased membrane permeability and leakage of cellular components

34
Q

Administration of Fluconazole (Diflucan)

A

Oral
IV
(Dosage is the same for both)

35
Q

Adverse effects of Fluconazole (Diflucan)

A

N&V
Headache
Abdominal pain
Diarrhea

36
Q

What is another alternative to ampho B for systemic mycoses

A

Ketoconazole (Nizoral)

37
Q

Uses of Ketoconazole (Nizoral)

A

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
Q

Examples of superficial mycoses

A

Oral candidiasis (thrush)
Vulvovaginal candidiasis

39
Q

Risk factors for superficial mycoses

A

Pregnancy
Diabetes
Debilitation
HIV
Oral contraceptives
Systemic glucocorticoids
Anticancer agents
Systemic antibiotics

40
Q

Fungal infection of the nails

A

Onychomycosis

41
Q

Treatment for onychomycosis

A

Oral therapy
- Lamisil and Itraconazole (Sporanox)

Topical therapy
- Ciclopirox (Penlac Nail Lacquer)

42
Q

What is Nystatin (Mycostatin)?

A

Polyene antibiotic

43
Q

What is Nystatin used for?

A

Only for candidiasis
Drug of choice for intestinal candidiasis

Also used for Candida infections in skin, mouth, esophagus, and vagina

44
Q

Administration of Nystatin

A

Orally
Topically

45
Q

Contraindications of laxative use

A

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
Q

Types of laxatives

A

Bulk-forming
Surfactant
Stimulant
Osmotic

47
Q

Types of bulk-forming laxatives

A

Methylcellulose (Citrucel)
Psyllium (Metamucil)

48
Q

Function of bulk forming laxatives

A

Function similarly to dietary fiber: swell with water to form a gel to soften and increase fecal mass

49
Q

Uses of bulk forming laxatives

A

Preferred treatment for temporary treatment of constipation

50
Q

Administration of bulk forming laxatives

A

Mix in full glass of water
May take 1-3 days to work

51
Q

Adverse effects of bulk forming laxatives

A

Esophageal obstruction

52
Q

Prototype surfactant laxative

A

Docusate sodium (Colace)

53
Q

Effects of surfactant laxatives on bowel

A

Stimulate intestinal motility
Increase quantities of water and electrolytes in the intestinal lumen

54
Q

Use of surfactant laxatives

A

Opioid-induced constipation

55
Q

Types of stimulant laxatives

A

Bisacodyl (Correctol, Dulcolax)
Castor oil
Senna (Senokot, Ex-Lax)

56
Q

Administration of Bisacodyl (Correctol, Dulcolax)

A

Tablets
Suppositories

57
Q

Administration of castor oil

A

Sometimes given before surgical procedures
Sometimes mixed and given as enema
Works in 2-6 hours

58
Q

How to stimulant laxatives work? And how long do they take to work?

A

Stimulate intestinal motility
Results in 6-12 hours

59
Q

What are stimulant laxatives used for?

A

Opioid induced constipation

60
Q

Types of osmotic laxatives

A

Laxative salts:
Magnesium hydroxide
Sodium phosphate
Magnesium citrate
Magnesium sulfate

61
Q

How do laxative salts work?

A

Poorly absorbed salts that draw water into the intestinal lumen
The fecal mass softens and swells, wall stretches, and peristalsis is stimulated

62
Q

How long does it take for results of osmotic laxatives?

A

Low doses: 6-12 hours
High doses: 2-6 hours

63
Q

Type of laxative used for chronic constipation

A

Polyethylene glycol (PEG)
(Miralax, Glycolax, Peglax)

64
Q

What type of laxative is polyethylene glycol?

A

Osmotic laxative

65
Q

Most abused type of laxatives

A

Osmotic laxatives

66
Q

What are high doses of osmotic laxatives used for?

A

Diagnostics (colonoscopies)
Surgery
Ingested poisons
Anti-helmintic

67
Q

Adverse effects of osmotic laxatives

A

Dehydration: substantial water loss
Renal decline: toxicity
Sodium retention: exacerbated heart failure, HTN, edema

68
Q

Which types of laxatives should not be given to patients with kidney issues

A

Osmotic laxatives
Laxatives with salt because they can build up in kidneys

69
Q

3 types of bowel-cleansing products for colonoscopies

A

Sodium phosphate
Polyethylene glycol
Combination - sodium picosulfate, magnesium oxide

70
Q

What causes laxative abuse?

A

Misconception that bowel movements must occur daily

71
Q

Consequences of laxative abuse

A

Diminished defecatory reflexes, leading to further reliance on laxatives
Electrolyte imbalance
Dehydration
Colitis

Pharmacology (16 decks)

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