Pharmacology II

Question 1

4 Classes of Systemic Fungal Infection

Answer 1

Polyene
Azoles
Echinocandins
Pyrimidine Analogs

Question 2

What are the two types of anti-fungal drugs?

Answer 2

Superficial mycoses

Systemic Mycoses

Question 3

What are the two types of Anti-fungal systemic mycoses drugs?

Answer 3

Opportunistic

Non-opportunisitc

Question 4

Which fungal organisms cause opportunistic infections

Answer 4

Candida
Aspergillus
Cryptococcus neoformans
Mucor

Question 5

What class of anti-fungal drug is Amphotericin B and Nystatin?

Answer 5

Polyene antibiotics

Question 6

Which class of anti-fungal disrupts fungal cell wall by inhibiting beta-1,3-D-glucan?

Answer 6

Echinocandins

Question 7

What are examples of Azole antibiotics?

Answer 7

Fluconazole
Itraconazole
Ketoconazole
Posaconazole
Voriconazole

Question 8

Which classes of anti-fungal antibiotics disrupt fungal cell membrane by binding/inhibiting ergosterol?

Answer 8

Polyenes

Azoles

Question 9

What is ergosterol?

Answer 9

REQUIRED sterol in fungal cell membrane

Question 10

Examples of Echinocandins

Answer 10

Caspofungin
Anidulafungin
Micafungin

Question 11

Pyrimidine Analog mechanism of action

Answer 11

activated by cytosine deaminase intracellularly

incorporates into DNA chain –? termination and inhibition of DNA/RNA synthesis

Question 12

Example of an Pyrimidine Analog

Answer 12

Flucytosine

Question 13

What is the D.O.C. for systemic infections

Answer 13

Amphotericin B

Question 14

What are the adverse effects of Amphotericin B?

Answer 14

Highly toxic!
Renal damage in >80% patients
Hypersensitivity

Question 15

When is Amphotericin B used

Answer 15

Only treat life-threatening infections in immunocompromised patients

Question 16

How is Amphotericin B given?

Answer 16

IV

Question 17

What is the mechanism of Amphotericin B (Polyene)?

Answer 17

1. Binds to ergosterol on cell membrane to increase membrane permeability
2. fungal leakage of ions –> reduced viability

Question 18

What class of anti-fungals does not affect mammalian cells?

Answer 18

Pyrimidine Analog (Flucytosine)

Question 19

Why is Amphotericin B toxic to mammalian cells?

Answer 19

Mammalian membranes also have sterols (targeted by drug)

Question 20

Is Amphotericin B broad or narrow spectrum?

Answer 20

Broad (Opportunistic and non-)

Question 21

What is the likelihood of resistance from Amphotericin B?

Answer 21

extremely rare

Question 22

Examples non-opportunistic fungal organisms?

Answer 22

Sporothrix schenckii
Blastomyces dermatitidis
Histoplasma capsulatum
Coccidoides immitis

Question 23

What does Flucytosine treat?

Answer 23

serious infections by Candida and Cryptococcus neoformans

Question 24

What is the likelihood of resistance to Flucytosine?

Answer 24

common

Question 25

What is Flucytosine always used in combination with?

Answer 25

Amphotericin B

Question 26

Why does Flucytosine not affect mammalian cells?

Answer 26

no cytosine deaminase (how drug is activated)

Question 27

Flucytosine (Pyrimidine analog) mechanism of action

Answer 27

incorporation in DNA chain to terminate DNA/RNA synthesis

Question 28

Is Flucytosine broad or narrow spectrum?

Answer 28

narrow

Question 29

What are the adverse effects of Flucytosine

Answer 29

bone marrow depression | mild hepatotoxicity

Question 30

What is a safer alternative to Amphotericin B?

Answer 30

Azoles (given PO)

Question 31

What is the adverse effect of Azoles?

Answer 31

increase serum level of many drugs | inhibit hepatic p450

Question 32

What two anti-fungal drug classes have the same drug mechanism?

Answer 32

Polyenes | Azoles

Question 33

What infections do Azoles treat?

Answer 33

``` Systemic infections Superficial infections (Candidas and Dermatophytes) ```

Question 34

What is used to treat Candidas and Dermatophytes

Answer 34

Azoles

Question 35

What does Echinocandins treat

Answer 35

Aspergillus | Candida

Question 36

Echinocandin mechanism of action

Answer 36

inhibit 1,3-D-glucan to disrupt cell wall

Question 37

What organisms causes superficial mycoses

Answer 37

Candida | Dermatophytes

Question 38

What organism causes tinea infections

Answer 38

Dermatophytes

Question 39

What is the most common Candida infection

Answer 39

Candida albicans

Question 40

What do you use to treat Thrush (oral Candida)

Answer 40

nystatin clotrimazole miconazole

Question 41

What is Griseofulvin effective (only) against

Answer 41

dermatophytes (superficial)

Question 42

What is Griseofulvin mechanism of action

Answer 42

inhibit fungal mitosis

Question 43

What is the D.O.C for intestinal Candida

Answer 43

Nystatin

Question 44

What are examples of Allylamines

Answer 44

Naftifine Terbinafine Butenafine

Question 45

What infection is Allylamine used against

Answer 45

dermatophyte

Question 46

What is the differences between HIV-1 and HIV-2?

Answer 46

HIV-1: worldwide | HIV-2: mainly Africa

Question 47

What cell does HIV- attack

Answer 47

CD4 T-cells