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60 Cards in this Set
- Front
- Back
What patients are at risk for fungal infections
|
1.Surgical ICU patients
2.Patients with PROSTHESES 3.Compromised Immune Defenses (HIV) |
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most important biochemical difference between fungi and animal cells is
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STEROL used to maintain plasma membrane structure
MAMMALIAN→ CHOLESTEROL *** FUNGAL → ERGOSTEROL |
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Ideal antifungal properties
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1. Broad spectrum against variety of fungal pathogens
2. Low drug toxicity 3. Multiple routes of administration 4. Excellent penetration into CSF, URINE and BONE |
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FLUCYTOSINE
works on? |
1. Candidiasis
2. Cryptococcus 3. Chromomycosis →Use combo Rx with crypotcoccal meningitis in HIV infected adults |
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FLUCYTOSINE penetrates?
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CNS
EYES URINARY TRACT |
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Flucytosine is given in combo with what
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Given in combo with Amphotericin B which damages fungal cell membrane and allows increase entry of flucytosine(SYNERGISTIC)
|
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adverse effects of flucytosine?
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→BM Suppression
→Leukopenia →Thrombocytopenia →N/V →Diarrhea →Hepatic Dysfunction ***Contraindicated in PREGNANCY**** |
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How does GRISEOFULVIN work
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Inhibits fungal mitosis static
|
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use of GRISEOFULVIN
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1. Skin
2. Hair 3. Nails |
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GRISEOFULVIN not effective with?
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**Not effective against YEAST or Dimorphic Fungi
|
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GRISEOFULVIN SE
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→Induces P450 enzyme, INCREASES WARFARIN
***Contraindicated in Pregnancy*** |
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what are the inhibitors of ergosterol syn pathway(squalene epoxidase)
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terbinafine, naftifine, butenafine
|
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are the inhibitors of ergosterol syn pathway static or cidal
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are the inhibitors of ergosterol syn pathway(
|
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where do Terbinafine (Lamisil, Terbinex)
|
→SKIN
→NAILS →FAT |
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Oral Terbinafine (Lamisil, Terbinex) TX
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1. Onychomycosis
2. Tinea Corporis 3. Tinea Cruris 4. Tinea Pedis 5. Tinea Capitis |
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topical form Terbinafine (Lamisil, Terbinex) TX?
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1. Tinea Pedis
2. Tinea Cruris 3. Tinea Corporis |
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Dont use Terbinafine (Lamisil, Terbinex) with who?
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RF, hep fail, prego- monitor liver enzymes
|
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Naftifine
(Naftin) used for? |
cream for
1. Tinea Corporis 2. Tinea Cruris 3. Tinea Pedis |
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Additional butenafine benefit compared to naftifine?
|
none
|
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INHIBITORS OF 14 a-sterol Demethylase that result in decrease in ergosterol synthesis and accumulation of 14a-sterols
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Imidazoles
Triazoles (Azoles) |
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What are azoles used for
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1. B. Dermatitidis
2. Crytpococcus neoformans 3. H. Capsulatum 4. Coccidioides species 5. P. Brasiliensis 6. Dermatophytes 7. Candida |
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What is resistant to azoles
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1. Zygomycetes
2. Candida Krusei rm) |
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topical ketoconazole TX what?
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dermatophytes and seborrheic dermatitis
|
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What does ketoconazole require for activation? where is there little penetration?
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Requires acidic stomach environment (not with achlorhydria patients)
→Little penetration into CFS and urine |
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What enzyme does ketoconazle inhibit
|
450, steroid hormone syn
|
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What else does ketoconazole inhibit
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androgen synthesis resulting in gynecomastia and impotence
(Use with Prostate Ca and Adrenal Ca) |
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what are other topical antifungals?
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Clotrimazole
Miconazole Econazole Butoconazole Oxiconazole Sertazconazole Sulconazole |
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what do these topical imidazoles TX what dont they TX
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1. Stratum corneum
2. Squamous mucosa 3. Cornea →Ineffective against hair or nail funga infections dont TX systemically |
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What are the TRIAZOLES ( FIT-VP)
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– Itraconazole (Sporanox)
– Fluconazole (Diflucan) – Voriconazole (Vfend) – Terconazole (Terazol) – Posaconazole (Noxafil) |
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What is itraconazole used for
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1. Aspergillosis
2. Blastomycosis 3. Histoplasmosis →Not efficiently transported into CSF, urine or saliva →Has high concentration in MENINGES (Used for meningitis) |
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SE itraconazole
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HEPATOXICITY
Minor: 1. N/V 2. Abdominal Pain 3. Diarrhea 4. Hypokalemia 5. Pedal Edema 6. Hair Loss |
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Primary use of oral Posaconazole?
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Prophylaxis and RX of invasive fungal infections
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Posaconazole SE
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1. N/V
2. Diarrhea 3. Rash 4. Hypokalemia 5. Thrombocytopenia 6. Abnormal LFT’s |
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Posaconazole interacts with what
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Cimetidine
Rifuabutin Phenytoin |
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most widely used triazole
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fluconazloe→Oral and IV
→Near 100% bioavailable **NOT influenced by Gastric acid** |
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fluconazole penetrates?
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1. CSF
2. Sputum 3. Urine 4. Saliva |
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fluconazole excretion?
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Excreted by Kidneys
→Low adverse effect profile |
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Fluconazole is the DOC for?
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1. Histoplasmosis
2. Blastomycosis 3. Sporotrichosis |
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What is fluconazole inaffective against?
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Aspergillosis
|
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Fluconazole increases the levels of what drugs
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1. Amytriptyline
2. Cyclosporine 3. Phenytoin 4. Warfarin |
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fluconazole is decreased with what
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1. Carbamazepine
2. Isoniazid 3. Phenobarbital |
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fluconazole SE?
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N/V, Abdominal pain
→Reversible Alopecia →SJS →Hepatic Failure |
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DOC for aspergillosis? what is it's SE?
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Voriconazole
hepato tox, visual: photophobia, colored lights |
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Terconazole TX
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Used to treat vaginal candidiasis
→Available as vaginal suppository for bedtime insertion |
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other things vorconazole works on
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1. Candida species
2. C. Krusei 3. C. Glabrata 1. Allogeneic bone marrow transplant 2. CNS infections 3. Disseminated infections |
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What are the INHBITORS OF FUNGAL MEMBRANE STABILITY: POLYENES
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→AMPHOTERICIN B
→NYSTATIN |
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How must you give amphotocericin B? what is it used for
|
IV, Binds to ergosterol and disrupts fungal membrane stability
|
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Amphotocerin B imeadiate reaction
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• Cytokine storm (IL-1, TNF-A)
• Causes Fevers, Chills, Rigors, Hypo-Tn • RX: with antipyretics |
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Amphotocerin B hematological TOX
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• Decreased erythropoietin production
• Anemia • Renal and hematologic toxicities |
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Amphotocerin B renal TOX
|
• Due to Vasoconstriction of afferent
Arterioles leading to renal ischemia • Renal tubular acidosis • Lipid formulas are less nephrotoxic • Lipid forms are more expensive |
|
Nyastin used for?
|
Used topically to treat candidiasis involving
1. Skin 2. Vaginal Mucosa 3. Oral Mucosa |
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How do ECHONOCANDINS INHIBITORS OF FUNGAL WALL SYNTHESIS
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Target fungal wall synthesis by noncompetitively inhibiting synthesis of B1,3 D- glucans
(Makes up Chitin) |
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What are the echonocandins
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1. Caspofungin (Cancidas)
2. Micafungin(Mycamine) 3. Anidulafungin (Eraxis) |
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What does Caspofungin (Cancidas) TX
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Primary therapy for
1. Esophageal Candidiasis 2. Candidemia →Salvage Therapy: ASPERGILLOSIS →Empiric Therapy: Febrile Neutropenia →Poorly penetrates CSF |
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Caspofungin (Cancidas) increases
|
Tacrolimus
|
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what increases Caspofungin (Cancidas) levels
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cyclosporin
|
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when may you need to inc caspfungin dose
|
1. Nelfinavir
2. Efavirenz 3. Phenytoin 4. Rifampin 5. Carbamazepine 6. Dexamethasone |
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Micafungin (Mycamine) TX?
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esophageal candidiasis
→ Can be used as an antifungal prophylaxis for recipients of hematopoietic stem cell transplants →Effective against Candidemia and Pulmonary Aspergillosis |
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Anidulafungin
(Eraxis) |
Approved for the treatment of esophageal candidiasis and candidemia
|
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ECHINOCANDINS→ Can be used in combo with
|
1. Amphotericin B
2. Flucytosine 3. Itraconazole 4. Voriconazole |