Phar 352 - Systemic Fungal Infections

Front 1

What are the common opportunistic fungi?

Back 1

1) Candida species

2) Aspergillus Species

3) Cryptoccus species

4) Mucer Species

Front 2

What are the common endemic geographically restricted fungi?

Back 2

1) Blastomyces species

2) Coccidoides species

3) Histoplasma species

Front 3

What are the common newly emerging fungi?

Back 3

1) Fusarium

2) Scedosporidum

3) Trichosporin

Front 4

What are the medically important fungi yeasts?

Back 4

1) Candida species

2) Cryptococci species

3) Trichosporon

Front 5

What are the medically important fungi molds?

Back 5

1) Asergillus species

2) Fusarium species

3) Pseudoallesceria boydii

4) Zygomycetes species

Front 6

"Candida and Aspergillus account for 76% of invasive fungal infections" True or False?

Back 6

TRUE

Front 7

Which group of patients is most susceptible to Cryptococcus?

Back 7

HIV patients (can cause meningits)

Front 8

What are the Innate Antifungal Host Defences? (5)

Back 8

1) Macrophages

2) Monocytes

3) Natural Killer Cells

4) Dendritic Cells

5) Solution factors

Front 9

What are the Adaptive Antifungal Host Defences? (3)

Back 9

1) T and B lymphocytes

2) Activated Phagocytes

3) Soluble Factors

Front 10

What are the Anatomical Antifungal Host Defences?(3)

Back 10

1) Mucosal Surfaces

2) Cutaneous Structures

3) Respiratory Tract Tissue

Front 11

What are the risks factors of Invasive Fungal Infections? (11)

Back 11

1) Broad Spectrum Antibiotics

2) Immunosupression/Corticosteroids

3) Neutropenia (Bone Marrow/Solid Organ Transplant)

4) Prolonged Hospitalization (ICU)

5) TPN (Intravascular Catheter Use)

6) Hemodialysis/Acute Renal Failure

7) Diabetes Mellitus 8) Mechanical Ventilation 9) Recent GI/Cardiac Surgery 10) Colonization 11) Burns

Front 12

How do we get a definitive diagnosis of fungal infections?

Back 12

Culture & Sensitivity Test

{Yeast can take up to 4-6weeks}

Front 13

When do we treat fungal infections? (5)

Back 13

1) Symptomatic patients

2) Positive Blood Culture

3) Critically ill in ICU

4) Post Renal Transplant/Neutropenia

5) Low Birth Weight Infant

Front 14

What are the treatment options for Urinary Candidiasis?

Back 14

Remove Catheter if possible.

DO NOT use lipid formulations or eichinocandins or non-fluconazole due to low renal tissue conc

Front 15

What are the treatment options for Invasive Candidiasis?

Back 15

Remove Catheter is possible.

1) Hemodynamically stable, and no azoles in past 3months; -> Use Fluconazole

2) Hemodynamically stable, azoles in past 3months; -> Use Echinocandins

Front 16

What are the monitoring parameters for Urinary Candidiasis?

Back 16

Repeat urine culture before and after antifungal treatment.

CT scan kidneys to rule out structural abnormalities or abscess

Front 17

What are the monitoring parameters for Invasive Candidiasis?

Back 17

Repeat urine culture before and after antifungal treatment.

CT scan kidneys to rule out structural abnormalities or abscess

Front 18

What are the generic names of Azoles?(4)

Back 18

1) Itraconazole

2) Fluconazole

3) Voriconazole

4) Posaconazole

Front 19

Which Azoles are given both PO and IV?

Back 19

Itraconazole, Fluconazole and Voriconazole

Front 20

Which Azoles are given PO only?

Back 20

Posaconazole

Front 21

What is the MOA for Azoles?

Back 21

Inhibits ergosterol synthesis (sterol synthesis) {Fungistatic}

Front 22

What are the adverse effects of Azoles?(4)

Back 22

1) Headaches

2) Increased QT interval

3) N/V/D

4) Elevated liver functional tests

Front 23

What are the generic names of Polyenes?

Back 23

Amphotericin B (and lipid formulations)

Front 24

"Polyenes are given PO only" True or False?

Back 24

False, They are given IV only

Front 25

Whar is the MOA for Polyenes?

Back 25

Binds to Ergosterol creating pores in the cell membrane {Fungicidal}

Front 26

What are the adverse effects of Polyenes?(3)

Back 26

1) Nephrotic + Hepatic failure

2) Histamine type of infection

3) Electrolyte abnormalities

Front 27

What are the generic names of Echinocandins?(3)

Back 27

1) Caspofungin

2) Micafungin

3) Anidulafungin

Front 28

"Echinocandins are given IV only" True or False?

Back 28

TRUE

Front 29

What is the MOA for Echinocandins?

Back 29

Inhibits cell wall synthesis {Fungicidal}

Front 30

What are the adverse effects of Echnocandins?(1)

Back 30

1) Histamine mediated infusion reactions

Front 31

What are the generic names of Allyamines?(1)

Back 31

1) Terbinafine

Front 32

"Terbinafine is given Topically" True or False?

Back 32

TRUE

Front 33

What is the MOA for Allyamines?

Back 33

Inhibits sterol synthesis

Front 34

What is the recommended drug therapy for Urinary Candidiasis?

Back 34

1) Fluconazole: 200mg PO/IV daily x7-14 days

2) Amphotericin B: 0.3-0.6mg/kg/day x1-7 days

Front 35

What is the recommended drug therapy for Invasive Candidiasis (Hemodynamically stable, no azoles in past 3 months)?

Back 35

1) Fluconazole: 800mg IV Loading Dose + 400mg IV/PO daily

[minimum 14 days after first negative blood culture and the resolution of signs and symptoms]

Front 36

What is the recommended drug therapy for Invasive Candidiasis (Hemodynamically unstable and Azoles in past 3months)?

Back 36

1) Any Echinocandin

[minimum 14 days after first negative blood culture and the resolution of signs and symptoms]

Front 37

What is the recommended drug therapy for Initial Invasive Aspergillus?

Back 37

1) Voriconazole IV then PO as stepdown

2) Amphotericin B

Front 38

"Fluconazole is not recommended for Invasive Aspergillosis because it has no activity" True or False?

Back 38

TRUE

Front 39

What is the recommended drug therapy for Refractory Invasive Aspergillus?

Back 39

1) Caspofungin

2) Micafungin

Front 40

What are the drug interactions with Azoles? (3)

Back 40

1) Azoles inhibit metabolism of agents which undergo cytochrome P450 metabolism

2) Decreased Absorption

3) Azoles inhibit metabolism of drugs and therefore increases their concentration

Front 41

What are the rankings of the azoles interactions?

Back 41

Ketoconazole>Itraconazole>Voriconazole>Posaconazole>Fluconazole

Front 42

Which medications are contraindicated for Azoles?

Back 42

1) Cisapride

2) Ergot

3) Alcaloides

4) Pimozide

5) Quinidine

6) Efavirenz

7) Sirolimus

{all of these medication have elevated conc due to azole interaction}

Front 43

Which organisms are susceptible to AmB?

Back 43

1) All Asepergillus (except A.terreus)

2) All Candida (except C.lusitaniae)

3) Cryptococcus neoformans

4) Coccidioides species

5) Blastomyces 6) Histoplasma species

7) Fusarium species

8) Scedosporium apiospermum

9) Zygomycetes

Front 44

Which organisms are resistant to AmB?

Back 44

1) Aspergillus terreus

2) Candida lusitaniae

3) Scedosporium prolificans

Front 45

Which organisms are susceptible to Fluconazole?

Back 45

1) All Candida (except C.krusei)

2) Cryptococcus neoformans

3) Coccidioides species

4) Blastomyces

5) Histoplasma species

Front 46

Which organisms are resistant to Fluconazole?

Back 46

1) All Aspergillus species

2) Candida krusei

3) Fusarium species

4) Scedosporium apiospermum

5) Scedosporium prolificans

6) Zygomycetes

Front 47

Which organisms are susceptible to Itraconazole?

Back 47

1) All Aspergillus

2) All Candida

3) Cryptococcus neoformans

4) Coccidioides species

5) Blastomyces

6) Histoplasma species

7) Scedosporium apiospermum

Front 48

Which organisms are resistant to Itraconazole?

Back 48

1) Fusarium species

2) Scedosporium prolificans

3) Zygomycetes

Front 49

Which organisms are susceptible to Voriconazole?

Back 49

1) All Asepergillus

2) All Candida

3) Cryptococcus neoformans

4) Coccidioides species

5) Blastomyces

6) Histoplasma species

7) Fusarium species

8) Scedosporium apiospermum

9) Scedosporium prolificans

Front 50

Which organisms are resistant to Voriconazole?

Back 50

1) Zygomycetes

Front 51

Which organisms are susceptible to Posaconazole?

Back 51

1) All Asepergillus

2) All Candida

3) Cryptococcus neoformans

4) Coccidioides species

5) Blastomyces

6) Histoplasma species

7) Fusarium species

8) Scedosporium apiospermum

9) Scedosporium prolificans

10) Zygomycetes

Front 52

Which organisms are resistant to Posaconazole?

Back 52

None

Front 53

Which organisms are susceptible to Anidulafungin?

Back 53

1) All Aspergillus

2) All Candida

3) Coccidoides species

4) Blastomyces species

5) Histoplasma species

Front 54

Which organisms are resistant to Anidulafungin?

Back 54

1) Cryptococcus neoformans

2) Fusarium species

3) Scedosporium apiospermum

4) Scedosporium prolificans

5) Zygomycetes

Front 55

Which organisms are susceptible to Caspofungin?

Back 55

1) All Aspergillus

2) All Candida

3) Coccidoides species

4) Blastomyces species

5) Histoplasma species

Front 56

Which organisms are resistant to Caspofungin?

Back 56

1) Cryptococcus neoformans

2) Fusarium species

3) Scedosporium apiospermum

4) Scedosporium prolificans

5) Zygomycetes

Front 57

Which organisms are susceptible to Micafungin?

Back 57

1) All Aspergillus

2) All Candida

3) Coccidoides species

4) Blastomyces species

5) Histoplasma species

Front 58

Which organisms are resistant to Micafungin?

Back 58

1) Cryptococcus neoformans

2) Fusarium species

3) Scedosporium apiospermum

4) Scedosporium prolificans

5) Zygomycetes

Front 59

Which organisms are susceptible to Flucytosine?

Back 59

1) All Candida species

2) Cryptococcus neoformans

Front 60

Which organisms are resistant to Flucytosine?

Back 60

1) Coccidiodes species

2) Blastomyces

3) Histoplasma species

4) Fusarium species

5) Scedosporium apiospermum

6) Scedosporium prolificans

7) Zygomycetes