Pharmacology of Antifungals

Question 1

A patient is diagnosed with onychomycosis. What antifungal is indicated for treatment?

Answer 1

Terbinafine

Question 2

What ADRs are associated with Voriconazole?

Answer 2

Vision disturbances, hallucinations, phototoxicity, squamous cell carcinoma

Question 3

What antifungal targets microtubules to inhibit mitosis?

Answer 3

Griseofulvin - also binds to keratin to prevent new infections

Question 4

What ADR is associated with Fluconzole?

Answer 4

QT prolongation

Question 5

What are the clinical indications for Grisefulvin?

Answer 5

Tinea capitis

Question 6

What are the PK of Grisefulvin?

Answer 6

PO administration, metabolized by the liver

Question 7

What is the MOA of Terbinaafine?

Answer 7

Inhibits the squalene epoxidase, which is toxic to fungi.

Question 8

What is the primary administration for Ketoconazole?

Answer 8

Topical use for tinea infections and dermatophytosis

Question 9

What are the indications for Itraconazole?

Answer 9

Dimorphic fungi, histoplasmosis, resistant fungi

Question 10

What are the indications for Posaconazole?

Answer 10

mucormycosis, esophageal candidiasis with resistance to other azoles, prophylaxis for invasive fungi

Question 11

What are the common Polyenes?

Answer 11

Nystatin, Amphotericin B

Question 12

Terbinafine is generally prescribed PO, but can be used as a topical cream to treat what diseases?

Answer 12

Tinea corporis, tinea pedis

Question 13

Myelosuppression and sterility are associated with what antifungal?

Answer 13

Flucytosine

Question 14

What adverse reaction is associated with Nystatin?

Answer 14

GI Disturbance

Question 15

What antifungal drug classes target ergosterol in the fungal cell membrane?

Answer 15

Allylamines, Polyenes, Azoles

Question 16

What ADRs are associated with Grisefulvin?

Answer 16

Disulfiram-like reaction with alcohol use

Question 17

Fluconazole is known to interact with what drug?

Answer 17

Warfarin - causes increased bioavailability

Question 18

A patient is diagnosed with refractory aspergillosis. What antifungal is indicated for treatment?

Answer 18

Capsofungin

Question 19

What is the preferred therapy for candidia albicans?

Answer 19

Fluconazole

Question 20

How is Amphotericin B excreted?

Answer 20

By the kidneys in urine

Question 21

What is the MOA for Echinocandins?

Answer 21

Inhibits the glucan synthase to disrupt the fungal cell wall

Question 22

What ADR is associated with Micafungin?

Answer 22

Histamine release

Question 23

True/False. Nystatin via IV is indicated for the treatment of oral thrush.

Answer 23

False. Nystatin is the DOC for oral thrush, but should never be administered via IV. It is too toxic

Question 24

What is the MOA of Flucytosine?

Answer 24

A thymine analog that is integrated into fungal DNA and inhibits synthesis

Question 25

What antifungals belong to the Echinocandin class?

Answer 25

Capsofungin, Micafungin, Anidulafungin

Question 26

What antifungal is used as a stepdown from Amphotericin B treatment?

Answer 26

Posaconazole

Question 27

What is the MOA of Azoles?

Answer 27

Inhibits ergosterol synthesis by blocking demethylation

Question 28

Azoles are known to interact with what drugs?

Answer 28

Human liver enzymes

Question 29

What is Naftifine?

Answer 29

A triple-action topical cream that is anti-bacterial, anti-fungal, and anti-inflammatory

Question 30

When is Voriconazole indicated?

Answer 30

Fluconazole-resistant species, yeast, mold

Question 31

When is Flucytosine indicated?

Answer 31

Serious fungal infections in combination with Amphotericin B

Question 32

Nystatin is the drug of choice to treat what pathologies?

Answer 32

Oral thursh & diaper rash

Question 33

What ADRs are associated with Amphotericin B?

Answer 33

Nephrotoxicity, anemia, infusion reactions

Question 34

What drugs should not be combined with Itraconazole?

Answer 34

Statins

Question 35

All Azoles are metabolized by the liver with one exception. What is the exception?

Answer 35

Fluconazole - metabolized by the kidneys and excreted in urine

Question 36

What antifungal is used to treat critically ill neutropenic patients?

Answer 36

Micafungin

Question 37

When is Amphotericin B indicated?

Answer 37

Serious life-threatening systemic fungal infections

Question 38

What ADRs are associated with Ketoconazole?

Answer 38

Hepatotoxicity, QT prolongation

Question 39

What is the MOA of Nystatin & Amphotericin B?

Answer 39

Forms micropores by binding to ergosterol that leads to cell lysis and death

Question 40

How is Flucytosine excreted?

Answer 40

By kidney in urine

Question 41

What antifungal is used as a prophalyxis for immunocompromised patients?

Answer 41

Fluconazole

Question 42

What ADR is associated with Itraconazole?

Answer 42

Nausea

Question 43

What ADRs are associated with Isavuconazole?

Answer 43

Constipation, hyperkalemia

Question 44

What antifungals are most commonly used for superficial mycoses, such as athlete's foot?

Answer 44

Miconazole & Clotrimazole