Pharm antifungal Flashcards Preview

ABBEY MSII U6 > Pharm antifungal > Flashcards

Flashcards in Pharm antifungal Deck (31):
1

what are the major categories of pathogenic fungi?

yeast: candida, cryptococcus
mold: aspergillus, fusarium, mucorales
endmic mycoses: histoplasma, coccidioides, blastomyces, pneumocystis jiroveci

2

what are the categories of antifungal agents?

triazoles, polyenes, echinocandins, flucytosine

3

what are the triazole antifungals?

fluconazole, itraconazole, posaconazole, voriconazole

4

triazoles MOA

impede ergosterol synthesis through direct inhibition of the cytochrome P450 dependent enzyme 14-alpha-sterol demethylase (necessary for biosynthetic pathway or ergosterol)
FUNGALSTATIC

5

triazole adverse effects

relatively safe - liver enzyme abnormalities, GI side effects, voriconazole = visual disturbances

6

what is a specific side effect to voriconazole

visual disturbance (Visual Voriconazole)

7

triazole drug interactions? which has lowest?

potential inhibitors of CYP450 - fluconazole has lowest

8

what is fluconazole the treatment of choice for?

susceptible candidiasis; severe thrush/esophageal candidiasis; secondary treatment and prophylaxis of cryptococcal meningitis

9

what is itrazonazole the treatment of choice for?

secondary treatment and prophylaxis of systemic histoplasmosis

10

what is voriconazole the treatment of choice for?

invasive aspergillosis

11

what is posaconazole the treatment of choice for?

Prophylaxis of aspergillosis/immunocompromised patients
P = Prophylaxis Posaconazole

12

amphotericin B MOA

inhibition of ergosterol - generates pores

13

amphotericin B class

polyene macrolide

14

what are the polyene macrolides?

amphotericin B and nystatin

15

amphotericin B clinical use

life-threatening invasive fungal infections - broad spectrum

16

what is amphotericin used with in immunocompromised hosts?

flucytosine

17

amphotericin B side effects

poor tolerability - nephrotoxicity (so common expected); acute infusion related reactions (fever, chills, rigors); electrolyte abnormalities (d/t pores in cell and kidney dysfunction) - hypomagnesemia, hypokalemia

18

what has been done to amphotericin B to give it better tolerability?

lipid formulations - more renal protective and less infusion-related side effects

19

what are the echinocandins?

-fungins
caspofungin, micafungin, anidulafungin

20

disadvantages to echinocandins

expensive and only available IV

21

echinocandins (-fungins) mechanism

cell wall synthesis inhibitor - inhibit synthesis of beta (1,3)-D-glucan

22

echinocandins (-fungins) clinical uses

life-threatening fungal infections unresponsive to older agnets

23

echinocandins (-fungins) side effects

low side effect profile (some liver toxicity possible)

24

flucytosine MOA

pyrimidine analogue that inhibits DNA and RNA synthesis - only oral

25

flucytosine clinical use

ALWAYS used in combination with something else (amphotericin B usually) - only active against cryptococcus and some candida

26

flucytosine side effects

chemotherapy like - bone marrow toxicity (decreased WBC and anemia), liver disfunction possible, GI intolerances

27

what are the allylamines?

tolnaftate and terbinafine

28

tolnaftate and terbinafine (allylamines) MOA

inhibit ergosterol synthesis by inhibiting squalene epoxidase = increase levels of squalene which are toxic to fungi

29

what are the clinical uses of tolnaftate and terbinafine (allylamines)?

TOPICAL dermatophytes

30

tolnaftate and terbinafine (allylamines) side effects

hepatotoxicity - otherwise low side effect profile

31

what is terbinafine also effective against?

onychomycoses