Pulm: Drugs used to Treat Fungal Infections

Question 1

Polyene fungal drug

Answer 1

Amphotericin B

Question 2

Azole drugs for Pulm infections

Answer 2

Fluconazole
Itraconazole
Voriconazole

Question 3

Echiocandin Drugs for Pulm Infections

Answer 3

Caspofungin
Micafungin
Andidudlafungin

Question 4

MOA of Amphotericin B

Answer 4

Bind to ergosterol of fungal cells

but also cholesterol in human cells!

Question 5

What organ is amphotericin specifically toxic for?

Answer 5

Nephrotoxic

-BB warning

Question 6

Adverse effects of amphotericin?

Answer 6

CNS-headache, fever, chills
Renal-toxic
GI-dyspepsia, pain, cramping
CV-hypotension
Resp-tachypnea

Question 7

What should you do when first prescribing amphotericin?

Answer 7

Prevent overdose–>cardiopulm arrest
-tell patients to verify name and dosage before administration

Monitor Closely!
-look for N/V, chills, rigors

Question 8

Indications for amphotericin?

Answer 8

Those with life threatening fungal infections, NOT noninvasive forms such as thrush or candidiasis

Question 9

MOA of the azoles?

Answer 9

Interrupt the conversion of lanosterol to ergosterol by binding fungal CYP450

Question 10

What make voriconazole different than the other azoles?

Answer 10

Newer, so they have more activity against strains of Candida resistant to fluconazole

Question 11

Should you give terfenadine with fluconazole?

Answer 11

No, contraindicated

Question 12

What drugs should you not proscribe with fluconazole?

Answer 12

Those that prolong QT interval

-Class Ia and III antiarrythmics, erythromycin, etc

Question 13

Is fluconazole safe in pregnancy?

Answer 13

No, has not been established

Question 14

If a patient has QT prolongation or hypokalemia, is fluconazole appropriate?

Answer 14

Nope

-he has this like 4 times (important?)

Question 15

The azole antifungals inhibit what CYP?

Answer 15

CYP3A4

-therefore increase the concentrations of a variety of drugs (CCBs, immunosuppressants, chemo, macrolides, SSRIs) etc

Question 16

What can be done to increase absorption of Itraconazole?

Answer 16

Take with food and a high acidic beverage (OJ)

-increases absorption

Question 17

When is itraconazole contraindicated?

Answer 17

Pregnancy, Left ventricular dysfunction, and HF (BB warning)

Question 18

What are some adverse effects of intraconazole?

Answer 18

Hepatic damage

-jaundice, dark urine, N/V

Question 19

MOA of voriconazole (slightly different than other azoles?)

Answer 19

Inhibits CYP450 mediated 14 alpha-lanosterol dimethylation

Question 20

If a patient has QT prolongation or hypokalemia, is voriconazole appropriate?

Answer 20

Nope, can also prolong QT

Question 21

What should you monitor before starting and during voriconazole therapy?

Answer 21

Hepatic liver tests

Question 22

Which CYP does Voriconazole have the highest affinity for?

Answer 22

CYP2C19

Question 23

Should you alter dosage of voriconazole in renal impairment?

Answer 23

Oral does NOT need an adjustment, but parenteral does

Question 24

MOA of the echinocandins?

Answer 24

inhibit B(1-3)-D-glucan synthesis, so block the cell wall synthesis

Question 25

Indications for the echinocandins?

Answer 25

IV use of systemic candida infection

Question 26

Which anti-fungal can cause red-man syndrome?

Answer 26

``` The echinocandins (-fungins) -mast cell histamine release ```

Question 27

Which echinocandin has had life threatening hypotension and bradycardia associated with it?

Answer 27

Anidulafungin

Question 28

BB warnings of the echinocandins?

Answer 28

``` Hepatic malignancy (shown in rats) -monitor LFTs!! ```

Question 29

MOA of flucytosine?

Answer 29

Prodrug of 5-fluorodeoxyuridulic acid, which interferes with DNA synthesis

Question 30

What is flucytosine mainly used for now?

Answer 30

Combined with liposomal amphotericin for cryptococcal meningitis can also be used in life threatening candidiasis

Question 31

BB warning for flucystosine?

Answer 31

Renal and Hepatic impairment -monitor closely Also bone marrow toxicity

Question 32

Is flucystosine okay during pregnancy? what about breastfeeding?

Answer 32

No and No