Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
31 Cards in this Set
- Front
- Back
|
a) the 2 polyenes r?
b) rx acute CN meningitis (in HIV pts) c)T1/2, how it works d) How to reverse Ampho B renal toxicity? *how it happens? e) Rx for azotemia due to amphotericin B? f) what r infusion related symptomps for Ampho B? *what does that mean? * rx? |
a)Ampho B & Nystatin
b)Variconazole, Ampho B, Itraconazole, capsofungin {IV / intrathecally, not orally absorbed} c) 15 days, Ampho B binds to ergosterol to create pores and then content leak out of fungus d) no more than 4g per trx episode, IV Na loading before it to expand vasculature & avoid vasoconstriction (afferent arter n renal). * Lytic effect on C rich lysosomal membrane of renal tubular cells e) Na (salt) loading f) N/V, Fever, chills, hypotension. * infused too fast. * Meperidine/Ibuprofen (NSAID)/hep/cortisol |
|
|
a) the 2 polyenes r?
b) Not toxic how, and toxic how? c) For fungal diarrhea? d) Swish and Swallow for... e) 2 uses of Nystatin? |
a)Ampho B & Nystatin
b) not toxic: orally (not absorbed), toxis systemically c) Nystatin, stays in the tract d) Oral candidiasis "thrush" e) Oral candidiasis & fungal diarrhea |
|
|
For fungal diarrhea?
|
Nystatin, stays in thetract
|
|
|
Ketoconazole
Side Effects? |
DOC for treating Cushing's Disease / treats mucocutaneous Candida infections
N/V inhibits formation of testosterone (dec libido, gynecomastaia, impotence, dysmenorrhea) Hepatotoxc, HTN, fluid retention |
|
|
For Oral candidiasis? How?
|
Nystatin, stays in the tract
Swish and swallow |
|
|
Fluconazole
Side Effects? |
DOC for oropharyngeal/systemic Candida infections
Chronic suppression of CN Meningitis only azole excreted primarily through the kidney RASH in immunocompromised patients Active infection treat with AmpB + Flucytosine |
|
|
a) Which is an antimetabolite rx? where is it converted?
b) Explain 2 reasons for basis of selectivity? c) Good for which disease? How it works for both? d) How is resistance? e) ADR's, how? |
a) Flucitosine, prodrug. * converted in fungal cell (not host)
b) cytosine permease in fungus only (hoe have generic permease), only fungi & bact. possess cytosine deaminase c) Candida: Flucytosine is synergetic w Ampho B (whole in membrane and Flu goes inside) CN meningitis: w AmphoB, crosses BBB d) rapidly, loss of Cytosine permease/deaminase, or defect in enz. e) Teratogeic effects, Bone marrow supp., hair loss (> 6 wks), bact convert Flucitosine to 5-FU, than in our cell to 5F-DUMP where our thymidylate synthetase is inhibited |
|
|
Itraconazole (Sporanox)
|
2nd line for systemic Aspergillus
treats ONYchomycosis Requires Acid (take with cola or grapefruit juice May exacerbate or cause heart failure |
|
|
Fungal static
(G-aflac) |
Ampho B (in vivo)
Flucitosine Azole Griseofulvin Ciclopirox |
|
|
Posaconazole
|
Posaconazole (Noxafil) & Voriconazole: broadest spectrum ever
-For fluconazole resistant Candida/aspergillus - Posaconazole & Ampho B cover Zygomycetes - Inh CYP3A4 |
|
|
Griseofulvin
|
microtubule of mitotic spindle, fungistatic, inducer, high affinity for Keratin (in hair & nails)
- absorp inc by fatty meals & microcrustalline formulation - CNS: h/a, blurred visin, fatigue, memory impairement,(parathesias, spychosis), GI, HEMATOLOGICAL EFFECT (need blood test /dec lots) - Not in pregnancy |
|
|
... replaces Ketonazoles systemically?
|
Itraconazole
|
|
|
Terbinafine
|
Terbinafine (Lamisil), m but topical form of bufenatine & Naftifine
- inh squalene oxidase, fungicidal - Onychomycosis (only 3 mo), lipohilic but not liver effect |
|
|
Voriconazole
|
Voriconazole (Vfend)
- For fluconazole resistant Candida, broadest spectrum (Posaconazole) - replaces Ampho B as DOC for INVASIVE ASPERGILLUS - inh. 2C19, 2C9,3A4 : inc liver enz. - Visual disturbances |
|
|
Needs acidity such as cola or grpefruit juice to be activated? which is unaffected of the azole?
|
Itraconazole
Ketonazole unaffected is Fluconazole |
|
|
Clotrimazole
|
Clotrimazole (Lotrimin)
topical for vaginal candida inf., for oral thrush (troches/losengers) |
|
|
Ciclopirox
how it works? which disease? |
- nail lacquer
- Chelates AL & Fe, inh metal-dependent enz. (toxic for fungal) -ONYchomycosis, cutaneous candidiasis & tinea infections |
|
|
fungal cidal
caat |
Ampho B (in vitro)
azoles Terbinafine capsofungin |
|
|
Capsofungin, Micafungin, Anidulofungin
|
- echinocandins, block synt of B (1,3)-D-glucan of cell wall
- invasive aspergillus (not responding to voriconazole) fungistatic - all elim in feces - Micafungin, Anidulofungin more potent than Capso |
|
|
Miconazole
|
Miconazole (Monistat)
topically, high incidence of phlebitis, rash, fever, nausea, anemia and spychosis if IV |
|
|
Micafungin & Anidulofungin
|
- Candda prophylaxis in HSCT (stem cell transplant)
- more potent than capso - use for fluconazole resistant |
|
|
Fluconazole resistant candida, they are...
|
a) Vorico/Posaco
b) Ampho B c) Nicafungin, Anidulafungin, Capsofungin they are IV only, histamine rxn sensitive on pts , (No BBB/oral) |
|
|
crosses BBB by fungal?
Fly accross BBB. |
Fluconazole, Flucitosine, Voriconazole
|
|
|
a) inh P-glycoprotein
b) cause heart failure ? inotropic effect on heart? c) all azole r safe for pregnancy. |
a) Ketonazole & Fluconazole
b) Itraconazole c) terarogenic |
|
|
inhibition for the azoles
|
Keto (3A4)> Itra=vori > flu
|
|
|
azole excreted primarily trhough the kidneys
|
Fluconazole
|
|
|
a) DOC for oropharyngeal systemic candida
b) treat ONYchomycosis c) cover Zygomycetes d) Cushing Disease e) Chronic CN meningitis f) mucocutaneous Candida g) Rash in immuno pts h) impotence, dec libido, dysmenorrhea, inh testosterone |
a) Fluconazole
b) Itraconazole orally c) Ampho B & Posaconazole d) ketonazole e) Fluconazole f) ketonazole g) Fluconazole h) Ketonazole |
|
|
a) vaginal candida
b) oropharyngela candida c) mucocutaneous candida |
a) Clotrimazole
b) Fluconazole c) mucocutaneous candida |
|
|
Miscellaneous
a) HSCT b) Capsofungin biggest use c) Invasive Aspergillus not responsive to any d) seldom effective <50 vs Onychomycosis (* only 50% respond for 6 mo of rx) e) taste,occular lens/retina, hemotopoeitic effect () disturbance f) Photosensitive |
a) Micafungin, fluconazole
b) Fluconazole resistant candida c) Capsofungin d) Ciclopirox (* Griseofulvin) e) Terbinafine f) Griseofulvine |
|
|
inh squalene oxidase (dec synt of ergosterol)
|
Terbinafine
|
|
|
Do not affect CYP450
|
Terbinafine
|
