Antifungals

Front 1

What patients are at risk for fungal infections

Back 1

1.Surgical ICU patients
2.Patients with PROSTHESES
3.Compromised Immune Defenses (HIV)

Front 2

most important biochemical difference between fungi and animal cells is

Back 2

STEROL used to maintain plasma membrane structure

MAMMALIAN→ CHOLESTEROL
*** FUNGAL → ERGOSTEROL

Front 3

Ideal antifungal properties

Back 3

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

Front 4

FLUCYTOSINE
works on?

Back 4

1. Candidiasis
2. Cryptococcus
3. Chromomycosis
→Use combo Rx with crypotcoccal meningitis in HIV infected adults

Front 5

FLUCYTOSINE penetrates?

Back 5

CNS
EYES
URINARY TRACT

Front 6

Flucytosine is given in combo with what

Back 6

Given in combo with Amphotericin B which damages fungal cell membrane and allows increase entry of flucytosine(SYNERGISTIC)

Front 7

adverse effects of flucytosine?

Back 7

→BM Suppression
→Leukopenia
→Thrombocytopenia
→N/V
→Diarrhea
→Hepatic Dysfunction

***Contraindicated in PREGNANCY****

Front 8

How does GRISEOFULVIN work

Back 8

Inhibits fungal mitosis static

Front 9

use of GRISEOFULVIN

Back 9

1. Skin
2. Hair
3. Nails

Front 10

GRISEOFULVIN not effective with?

Back 10

**Not effective against YEAST or Dimorphic Fungi

Front 11

GRISEOFULVIN SE

Back 11

→Induces P450 enzyme, INCREASES WARFARIN

***Contraindicated in Pregnancy***

Front 12

what are the inhibitors of ergosterol syn pathway(squalene epoxidase)

Back 12

terbinafine, naftifine, butenafine

Front 13

are the inhibitors of ergosterol syn pathway static or cidal

Back 13

are the inhibitors of ergosterol syn pathway(

Front 14

where do Terbinafine (Lamisil, Terbinex)

Back 14

→SKIN
→NAILS
→FAT

Front 15

Oral Terbinafine (Lamisil, Terbinex) TX

Back 15

1. Onychomycosis
2. Tinea Corporis
3. Tinea Cruris
4. Tinea Pedis
5. Tinea Capitis

Front 16

topical form Terbinafine (Lamisil, Terbinex) TX?

Back 16

1. Tinea Pedis
2. Tinea Cruris
3. Tinea Corporis

Front 17

Dont use Terbinafine (Lamisil, Terbinex) with who?

Back 17

RF, hep fail, prego- monitor liver enzymes

Front 18

Naftifine
(Naftin) used for?

Back 18

cream for
1. Tinea Corporis
2. Tinea Cruris
3. Tinea Pedis

Front 19

Additional butenafine benefit compared to naftifine?

Back 19

none

Front 20

INHIBITORS OF 14 a-sterol Demethylase that result in decrease in ergosterol synthesis and accumulation of 14a-sterols

Back 20

Imidazoles
Triazoles (Azoles)

Front 21

What are azoles used for

Back 21

1. B. Dermatitidis
2. Crytpococcus neoformans
3. H. Capsulatum
4. Coccidioides species
5. P. Brasiliensis
6. Dermatophytes
7. Candida

Front 22

What is resistant to azoles

Back 22

1. Zygomycetes
2. Candida Krusei

rm)

Front 23

topical ketoconazole TX what?

Back 23

dermatophytes and seborrheic dermatitis

Front 24

What does ketoconazole require for activation? where is there little penetration?

Back 24

Requires acidic stomach environment (not with achlorhydria patients)
→Little penetration into CFS and urine

Front 25

What enzyme does ketoconazle inhibit

Back 25

450, steroid hormone syn

Front 26

What else does ketoconazole inhibit

Back 26

androgen synthesis resulting in gynecomastia and impotence
(Use with Prostate Ca and Adrenal Ca)

Front 27

what are other topical antifungals?

Back 27

Clotrimazole
Miconazole
Econazole
Butoconazole
Oxiconazole
Sertazconazole
Sulconazole

Front 28

what do these topical imidazoles TX what dont they TX

Back 28

1. Stratum corneum
2. Squamous mucosa
3. Cornea

→Ineffective against hair or nail funga infections
dont TX systemically

Front 29

What are the TRIAZOLES ( FIT-VP)

Back 29

– Itraconazole (Sporanox)
– Fluconazole (Diflucan)
– Voriconazole (Vfend)
– Terconazole (Terazol)
– Posaconazole (Noxafil)

Front 30

What is itraconazole used for

Back 30

1. Aspergillosis
2. Blastomycosis
3. Histoplasmosis
→Not efficiently transported into CSF, urine or saliva
→Has high concentration in MENINGES (Used for meningitis)

Front 31

SE itraconazole

Back 31

HEPATOXICITY
Minor:
1. N/V
2. Abdominal Pain
3. Diarrhea
4. Hypokalemia
5. Pedal Edema
6. Hair Loss

Front 32

Primary use of oral Posaconazole?

Back 32

Prophylaxis and RX of invasive fungal infections

Front 33

Posaconazole SE

Back 33

1. N/V
2. Diarrhea
3. Rash
4. Hypokalemia
5. Thrombocytopenia
6. Abnormal LFT’s

Front 34

Posaconazole interacts with what

Back 34

Cimetidine
Rifuabutin
Phenytoin

Front 35

most widely used triazole

Back 35

fluconazloe→Oral and IV
→Near 100% bioavailable
**NOT influenced by Gastric acid**

Front 36

fluconazole penetrates?

Back 36

1. CSF
2. Sputum
3. Urine
4. Saliva

Front 37

fluconazole excretion?

Back 37

Excreted by Kidneys
→Low adverse effect profile

Front 38

Fluconazole is the DOC for?

Back 38

1. Histoplasmosis
2. Blastomycosis
3. Sporotrichosis

Front 39

What is fluconazole inaffective against?

Back 39

Aspergillosis

Front 40

Fluconazole increases the levels of what drugs

Back 40

1. Amytriptyline
2. Cyclosporine
3. Phenytoin
4. Warfarin

Front 41

fluconazole is decreased with what

Back 41

1. Carbamazepine
2. Isoniazid
3. Phenobarbital

Front 42

fluconazole SE?

Back 42

N/V, Abdominal pain
→Reversible Alopecia
→SJS
→Hepatic Failure

Front 43

DOC for aspergillosis? what is it's SE?

Back 43

Voriconazole
hepato tox, visual: photophobia, colored lights

Front 44

Terconazole TX

Back 44

Used to treat vaginal candidiasis
→Available as vaginal suppository for bedtime insertion

Front 45

other things vorconazole works on

Back 45

1. Candida species
2. C. Krusei
3. C. Glabrata

1. Allogeneic bone marrow transplant
2. CNS infections
3. Disseminated infections

Front 46

What are the INHBITORS OF FUNGAL MEMBRANE STABILITY: POLYENES

Back 46

→AMPHOTERICIN B
→NYSTATIN

Front 47

How must you give amphotocericin B? what is it used for

Back 47

IV, Binds to ergosterol and disrupts fungal membrane stability

Front 48

Amphotocerin B imeadiate reaction

Back 48

• Cytokine storm (IL-1, TNF-A)
• Causes Fevers, Chills, Rigors, Hypo-Tn
• RX: with antipyretics

Front 49

Amphotocerin B hematological TOX

Back 49

• Decreased erythropoietin production
• Anemia
• Renal and hematologic toxicities

Front 50

Amphotocerin B renal TOX

Back 50

• Due to Vasoconstriction of afferent
Arterioles leading to renal ischemia
• Renal tubular acidosis
• Lipid formulas are less nephrotoxic
• Lipid forms are more expensive

Front 51

Nyastin used for?

Back 51

Used topically to treat candidiasis involving
1. Skin
2. Vaginal Mucosa
3. Oral Mucosa

Front 52

How do ECHONOCANDINS INHIBITORS OF FUNGAL WALL SYNTHESIS

Back 52

Target fungal wall synthesis by noncompetitively inhibiting synthesis of B1,3 D- glucans
(Makes up Chitin)

Front 53

What are the echonocandins

Back 53

1. Caspofungin (Cancidas)
2. Micafungin(Mycamine)
3. Anidulafungin (Eraxis)

Front 54

What does Caspofungin (Cancidas) TX

Back 54

Primary therapy for
1. Esophageal Candidiasis
2. Candidemia
→Salvage Therapy: ASPERGILLOSIS
→Empiric Therapy: Febrile Neutropenia
→Poorly penetrates CSF

Front 55

Caspofungin (Cancidas) increases

Back 55

Tacrolimus

Front 56

what increases Caspofungin (Cancidas) levels

Back 56

cyclosporin

Front 57

when may you need to inc caspfungin dose

Back 57

1. Nelfinavir
2. Efavirenz
3. Phenytoin
4. Rifampin
5. Carbamazepine
6. Dexamethasone

Front 58

Micafungin (Mycamine) TX?

Back 58

esophageal candidiasis
→ Can be used as an antifungal prophylaxis for recipients of hematopoietic stem cell transplants
→Effective against Candidemia and Pulmonary Aspergillosis

Front 59

Anidulafungin
(Eraxis)

Back 59

Approved for the treatment of esophageal candidiasis and candidemia

Front 60

ECHINOCANDINS→ Can be used in combo with

Back 60

1. Amphotericin B
2. Flucytosine
3. Itraconazole
4. Voriconazole