S52(2) Fungal Drug Review

Question 1

Cell membranes

Answer 1

Azoles
Polyenes
Allylamines

Question 2

Cell wall

Answer 2

Echinocandins

Question 3

Intracellular

Answer 3

Pyrimidine analogs

mitotic inhibitors

Question 4

Azoles

Answer 4

ketoconazole
miconazole
fluconazole
itraconazole
voriconazole

Question 5

Polyenes

Answer 5

amphotericin B

Question 6

Allylamines

Answer 6

Terbenifine

Question 7

Echinocandins

Answer 7

micafungin
caspofungin
anidulafungin

Question 8

Pyrimidine analogs

Answer 8

flucytosine

Question 9

mitotic inhibitors

Answer 9

griseofulvin

Question 10

Peak:MIC
Amphotericin B
Echinocandins

Answer 10

True

Question 11

Time:MIC

Flucytosine

Answer 11

True

Question 12

AUC:MIC

Triazoles

Answer 12

True

Question 13

Fluconazole is the drug of choice for candida albicans if susceptible

Answer 13

True

Question 14

Itraconazole is the Drug Of Choice for Dimorphic molds

Answer 14

True

Question 15

Voriconazole is the Drug Of Choice for Aspergillus

Answer 15

True

Question 16

Posaconazole and Isavuconazole are drugs for mucor

Answer 16

True

Question 17

Amphotericin AE

Answer 17

Riggors - add meperidine PRN
NEPHROTOXIC
Potassium wasting (try and keep close to ULN)
Magnesium wasting
Hepatotoxic

Question 18

Ampotericin monitoring

Answer 18

BMP/ CMP daily
K/Mg daily
LFTs qWeekly (arbitrary)
CBC daily while inpatient
I/Os daily
QTc

Question 19

Itraconazole Clinical Pearls

Answer 19

Capsules taken w/ food, solution taken wo/food,

SUBA formulation is not food dependent, formulations NOT interchangeable, do not administer with antacids, prolongs QTc, Boxed warning for causing or exacerbating heart failure

Question 20

voriconazole Clinical Pearls

Answer 20

IV:PO 1:1, Requires a LD, Nonlinear PK,

unique ADRs: Visual disturbances, visual or auditory hallucinations, skin cancer, Prolongs QTC

Question 21

posaconazole Clinical Pearls

Answer 21

Suspension requires food (ginger ale) for acidic environment (DDI w/ acid suppressants),

tablets require food but not as much, NOT interchangeable, linear but saturable PK, takes a week to reach SS, prolongs QTc

Question 22

isavuconazole Clinical Pearls

Answer 22

IV:PO 1:1, Prodrug, requires a LD, unique ADR: shortens QTc

Question 23

flucytosine
BBW:
Extreme caution in patients with renal dysfunction
Closely monitor hematologic, renal, and hepatic status

Answer 23

True

Question 24

flucytosine
ADR:
Big points: bone marrow suppression, hepatotoxicity

Answer 24

True

Question 25

IV to PO (1:1)

Answer 25

``` Flucytosine (5-FU) Terbinafine Triazoles: - Fluconazole - Voriconazole - Isavuconazole ```

Question 26

Triazoles, Ketoconazole and Clotrimazole are CYP inhibitors

Answer 26

True

Question 27

amphotericin B can cause rigors with infusion

Answer 27

True

Question 28

amphotericin B liposomal formulation has the least nephrotoxicity associated with it

Answer 28

True

Question 29

You often have to aggressively replete K+ and Mg2+ when a patient is on amphotericin B

Answer 29

True

Question 30

amphotericin B is available as both an IV and inhaled formulation

Answer 30

True