Pharm Antifungal Questions

Front 1

Name the 4 classes of Antifungal drugs

Back 1

Polyenes

Echhinocandins

Azole

Flucytosine

Front 2

2 forms of fungi

which one causes higher mortality rate?

Back 2

yeasts

molds = more dangerous

Front 3

most common yeast species

Back 3

Candida Species

Front 4

Most common pathogen(Yeast)

found with HIV/Immunocompromised pts

Back 4

Cryptococcus Neoforman

Front 5

Opportunistic Fungi

Normal Flora(1)

Back 5

Candidia Spec.

Front 6

Opportunistic Fungi

Ubiquitous in our environment

Back 6

MAC

Mucor

Aspergillus

Cryptococcus

Front 7

Opportunistic Fungi

Newly emergin

Back 7

Fusarium

Secdosporium

Trichosporon

Front 8

Geographically Restricted

Blastomyces =

Coccidomycosis =

Histoplasma =

Back 8

Blastomyces = NA

Coccidomycosis = SW

Histoplasma = MI and Ohio River Valley

Front 9

So Aspergillus species found where?

Back 9

ubiqoutous, soil

Front 10

So Cryptococcus Neoformas found where?

Back 10

bird

Front 11

Rhizopus, Mucor found where

Back 11

soil, plants

Front 12

Rhizopus, Mucor causes what?

Back 12

Zygomycosis

Front 13

Fungi are primarily dominant upper gi/airway and as you go down body you find less.

Back 13

k

Front 14

Antifungal therapy target these 3 areas of fungi.

Name em

Back 14

Cell membrane = ergosterol

DNA Synthesis

Cell Wall

Front 15

Polyenes Moa

Back 15

Attacks Cell Memrbane(ergosterol)

Front 16

Echhinocandins moa

Back 16

attacks cell wall

Front 17

Azole Moa

Back 17

Attacks Cell Memrbane(ergosterol)

Front 18

Flucytosine moa

Back 18

attacks DNA synthisis

Front 19

Down side of AMP B?

So how has it been formulated?

Back 19

very toxic to kidney

so formulated in lipid form for less toxicity to kidney

Front 20

Is there a difference in spectrum of activity between AMP B and the lipid AMP B?

Back 20

NO, all the same

Front 21

dosing of AMP B depends on what?

Back 21

pathogen

if aggressive(like aspergillus) = more

Front 22

AMP B premedicated for infusion related reactions with which 2 drugs

Back 22

Acetaminophen and Benadryl

Front 23

AMP B is given really slowly to prevent what?

Back 23

acute infusion related reactions(fever,chills, phlebitis,anphylaxis)

Front 24

To Prevent toxcities of AMP B, you load this ion before and after administration.

Back 24

Na loading

Front 25

Dosing of Lipid Formulation usually higher

Back 25

k

Front 26

Name the 3 Lipid AMP B formulations

Back 26

ABLC

Lamb

ABCD

Front 27

Most common AE of AMP B(50%)

Back 27

Nephrotoxicity

Front 28

Which polyenes have infusion related toxicities?

Back 28

All of them

Front 29

Of all polyenes, which one has greatest efficacy?

Back 29

Lipid formulation slightly more then AMB deoxy(B_

Front 30

Of all poleynes, rank nephrotoxicty from least to greatest and cost

Back 30

LAMB

ABLC

ABCD

AMB B(deoxy)

Front 31

Name the 2 drug classes that are IV only

Back 31

Polyenes and Echinocandins

Front 32

All Azoles have which enzyme interaction?

Fluconazole interaction with which drugs?

Back 32

CYP 450

Rifampin, Cyclosporin, Tracrolimus

Front 33

Absorption of Itraconazole is decreased by which 2 types of drugs?

Back 33

H2

and PPI

Front 34

A unique side effect of Voriconazole bc of its penetration abilities.

How long does it last?

Back 34

Transient ocular symtpoms

Enhanced brightnes and blurred vision

30-60 mins

Front 35

With Posaconazole, what do you need to do for to increase absorption?

Back 35

eat with high fat foods

Front 36

Name the 3 Echinocandins

Back 36

Caspofungin

Micafungins

Anidulafungin

Front 37

Which Echinocandins do you need to reduce dose on hepatic impaired pts?

Back 37

Caspofungin

Front 38

Caspofungin with which drug may cause hepatic impairment?

Back 38

Cyclosporin

Front 39

Why is monotherapy of Flucytosine bad?

may cause this?

Back 39

builds resistance

causes urinary tract candidiasis

Front 40

How s Flucytosine eliminated

Back 40

Renally

Front 41

Major toxicity of Flucytosine

Back 41

Bone Marrow Suppression

Front 42

Griseofulvin vs Terbinafine

which one is fungicidal? fungistatic?

Back 42

Gris = static

Terb = Cidal

Front 43

2 systemic drugs for Superficial fungal infections (dermatophyte treatments = ring worm, athletes foot)

Back 43

Griseofulvin and Terbinafine

Front 44

Freebie -Terbanine doesn't have CYP450

Back 44

k

Front 45

Name the 2 topical azoles

Back 45

Clotrimazole

Miconazole

Front 46

Candidemia high mortality rate

read over cadidemia risk factors

Back 46

k

Front 47

Candidemia - C. Albicans shifts towards these 2 Candida species

Back 47

Glabrata and Krusei

Front 48

Polyenes covers which Candida species

Back 48

Everyone

Front 49

Fluconazole and Itraconazole cover all except these 2(maybe and definitely not)

Back 49

maybe(based on dosing) = glabrata

No: Krusei

Front 50

Echinocandins coverage for Candida species?

Back 50

everything except C. Parpsilosi

Front 51

Variconazole and Posaconazole cover all Candida Species. However these 2 species vary. Which one is OFTEN covered? Which one is MAYBE covered?

Back 51

Maybe = Krusie, Often = Glabrata

Front 52

Emphasis on these 2 drugs as preferred choices for proven/suspected invasive diseases.

Back 52

Fluconazole and Echnocandins

Front 53

Concept of step down therapy encouraged.

Which antifungal? for which Candida usually?

Back 53

Variconazole for C. Krusei

Front 54

Candidema without neutropenia Primary Treatmeant is Fluconazole if pt is what severity of illness

Back 54

less critically ill and no recent exposure to azoles

Front 55

Candidema with neutropenia Primary Treatment is Echinocandin if pt is what severity of illness

and which isolates are known

Back 55

moderate to severe ill

isolates = glabrate or krusie

Front 56

If pt on echinocandin and isolate comes back positive for C. Albicans then switch to what?

Back 56

Fluconazole

Front 57

If Candidemia is cleared from bloodstream, then can we stop treatment?

Back 57

no, continue 2 weeks after clearance from blood stream.

Front 58

how is fluconazole and echinocandins usually dosed?

Back 58

loading dosed 2x

Front 59

Remember not to give azole in pts that have had prior azole use. duhhh

Back 59

k

Front 60

How do you treat asymptomatic candiduria?

Back 60

no treatment, eliminate cause

Front 61

How do you treat high risk disseminated Candiduria?

Diabetics, HIV, etc are susceptible to disseminated Candiduria.

Also consider imaging Kidney/collecting system

Back 61

treat as invasive candidiasis

chart says fluconazole

ehh

Front 62

Which pathogen has strong link to Catheters?

Back 62

C. Parapsilois

Front 63

In summary of Cadidemia Treatment;

-remove or exchange IV catheters

-Choose appropriate therapy

-Start Promptly

*start therapy on day of culture if Candida is creeping into your thoughts

*Treat for a minimum of 14 days beyond clearance of cultures and resolution of clinical signs and symptoms

Back 63

k

Front 64

Fluconazole Dosing

with normal dosing, steady state is reached within how many days?

With 2x loading dose, state is reached when?

Back 64

5-10 days

on day 1

Front 65

Name the 4 types of pts you should give Antifungal prophylaxis to?

What's the antifungal usually given?

Back 65

ICU pt

Chemo induced pt

Stem cell recip pt

liver, pancreas, and small bowel transplant pt

Front 66

Only time you give azole with Echioandins is to treat what pathogen

Back 66

C. Parapsilosis

Front 67

Which drug class is Static?

Back 67

Azole

Front 68

Which drug class is Cidal(except slight static for some molds)?

Back 68

Echhinocandins

Front 69

Just Know polyenes can be either static or cidal, depending on pathogen.

Back 69

k

Front 70

Echhninocandins are good for everything except?

so usually paired with this antifungal to treat it?

Back 70

C. Parapsilosis

Front 71

Most common Candida in urine?

so whats treatment?

Back 71

Albican

Flucanazole