Pharm 35 Fungal Infections

Question 1

Flucytosine Mechanism

Answer 1

converted to 5-FdUMP, which inhibits thymidylate synthase and interferes with DNA synthesis. Syngergy with amph B against aspergillus

Question 2

Flucytosine Use

Answer 2

Candidiasis, Cryptococcosis, Chromomycosis

Question 3

Flucytosine Side Effects

Answer 3

Bone marrow suppression, cardiotoxicity, GI disturbance, hepatic, dysfunction

Question 4

Flucytosine Contraindications

Answer 4

Pregnancy

Question 5

Griseofulvin Mechanism

Answer 5

Binds to tubulin and a microtubule-associated protein, disrupting assembly of mitotic spindle

Question 6

Griseofulvin Use

Answer 6

Fungal infection of the skin, hair, or nail due to trichophyton, microsporum or epidermophyton

Question 7

Griseofulvin Side Effects

Answer 7

Hepatotoxicity, albuminuria, leukopenia, neutropenia, monocytosis, serum sickness, angioedema, toxic epidermal necrolysis, headache, lethargy, vertigo, blurred vision, increased fecal protoporphyrin levels

Question 8

Griseofulvin Contraindications

Answer 8

Pregnancy, porphyria and hepatic failure

Question 9

Allylamines: Terbinafine, Naftifine, butenafine Mechanism

Answer 9

Inhibit conversion of squalene to lanosterol by inhibiting squalene epoxidase

Question 10

Allylamines

Answer 10

Terbinafine, Naftifine (cream or gel), butenafine

Question 11

Allylamines: Terbinafine, Naftifine, butenafine use

Answer 11

Onychomycosis (Nail fungus), Tinea corporis (Ringworm), tinea cruris (Fungus in groin, Jock Itch, Crotch Rot), tinea pedis (Athlete’s Foot), tinea capitis (Ringworm of the scalp)

Question 12

Allylamines: Terbinafine, Naftifine, butenafine Side Effects

Answer 12

hepatotoxicity, stevens-johnson syndrome, neutropenia, exacerbation of psoriasis or subacute cutaneous lupus erythematosus, gi disturbance, burning sensation and local irritation of skin

Question 13

Allylamines: Terbinafine, Naftifine, butenafine Contraindications

Answer 13

Hypersensitivity

Question 14

Imidazole antifungals Mechanism

Answer 14

Inhibit ultimate conversion of lanosterol to ergosterol by inhibiting 14a-sterol demethylase; decrease in egosterol and accumulation of 14alpha-methyl sterols disrupt the tightly packed chains of phospholipids in the fungal membrane.

Question 15

Imidazoles

Answer 15

Ketoconazole, Butoconazole, Clotrimazole

Question 16

Imidazole antifungals Use

Answer 16

Coccidioides immitis, cryptococcus neoformans, candida species, histoplasma capsulatum, blastomyces dermatitids, dermatophytes, superficial fungal infections of stratum corneum, squamous mucosa, and cornea

Question 17

Imidazole antifungals Side Effects

Answer 17

• GI disturb, hepatic dysfunction, gynecomastia, decreased libido, menstrual irregularities: Ketoconazole.
• pruritus and burning (All but Ketoconazole)

Question 18

Imidazole antifungals Contraindications

Answer 18

Concurrent admin of ampho B or oral triazolam, hypersensitivity

Question 19

Triazole antifungals Mechanism

Answer 19

Inhibit ultimate conversion of lanosterol to ergosterol by inhibiting 14a-sterol demethylase; decrease in egosterol and accumulation of 14alpha-methyl sterols disrupt the tightly packed chains of phospholipids in the fungal membrane.

Question 20

Triazole antifungals Use

Answer 20

Aspergillosis, blastomycosis, candidiasis, histoplasmosis, onychomycosis, cryptococcal meningitis, vulvovaginal candidiasis

Question 21

Triazoles

Answer 21

Fluconazole, Itraconazole, Posaconazole.

Question 22

Triazole antifungals Side Effects

Answer 22

Heptatic toxicity, stevens-johnson syndrome, gi disturb, rash, hypokalemia, hypertension, edema, headache

Question 23

Triazole antifungals Contraindications

Answer 23

Coadmin with dofetilide, oral midazolam, pimozide, levacetylmethadol, quinidine, lovastatin, simvastatin, or triazolam, pregnancy, hypersensitivity

Question 24

Amphoterecin B Mechanism

Answer 24

Binds to ergosterol and form pores that alter fungal membrane permeability and stability. Polyene. Combo with with flucytosine for cryptococcal meningitis

Question 25

Amphoterecin B Use

Answer 25

Potentially life-threatening aspergillosis, cryptococcosis, blastomycosis, systemic candidiasis, coccidiodomycosis, histoplasmosis, systemic candidiasis, zygomycosis

Question 26

Amphoterecin B Side Effects

Answer 26

renal toxicity, cytokine storm, anemia, weight loss, gi distrubance

Question 27

Amphoterecin B Contraindications

Answer 27

Hypersensitivity

Question 28

Nystatin Mechanism

Answer 28

Bind to ergosterol and form bores that alter fungal membrane permeability and stability. polyene. Not absorbed systematically

Question 29

Nystatin Use

Answer 29

Mucocutaneous candidiasis

Question 30

Nystatin Side Effects

Answer 30

Rare contact dermatitis

Question 31

Nystatin Contraindications

Answer 31

Hypersensitivity

Question 32

Echinocandins: caspofungin, micafungin, anidulafungin Mechanism

Answer 32

Noncompetitively inhibit synthesis of beta-(1,3)-d-glucans which leads to disruption of cell wall integrity

Question 33

Echinocandins: caspofungin, micafungin, anidulafungin Use

Answer 33

Esophageal candidiasis, candidemia, salvage therapy of aspergillus infections, antifungal prophylaxis for recipients of hematopoietic stem cell transplants

Question 34

Echinocandins: caspofungin, micafungin, anidulafungin Side Effects

Answer 34

pruritus, rash, gi disturb, increased liver enzymes, thrombophlebitis, headache, fever

Question 35

Echinocandins: caspofungin, micafungin, anidulafungin Contraindications

Answer 35

Hypersensitivity

Question 36

Echinocandins

Answer 36

Caspofungin, micafungin, anidulafungin (Fungins are CANDINS that inhibit beta-(1,3)-d-GLUCANS - bad cell walls)