Pharm - Antifungal Therapy

Front 1

Broad spectrum antifungals

Back 1

-amphotericin
-azoles
-terbinafine

Front 2

Narrow spectrum antifungals

Back 2

-grieofulvin

Front 3

-Aspergillus spectrum

Back 3

-amphotericin
-itraconazole
-voriconazole
-terbinafine

Front 4

Therapeutic drug angle for antifungals

Back 4

-patient
-drug
-fungus

Front 5

Amphotericin B
-organism derived from

Back 5

-Streptomyces nodosus

Front 6

Amphotericin B
-mechanism of action

Back 6

-bind to ergosterol in the cell wall
-increases cell permeability resulting in cell death

Front 7

Amphotericin B
-adverse effects

Back 7

-nephrotoxic at high concentration
-tremors, anorexia, vomiting, pyrexia, phlebitis

Front 8

Amphotericin B
-oral bioavailability

Back 8

-poor

Front 9

Amphotericin B
-opthalmic penetration

Back 9

-good penetration into aqueous humor
-poor penetration into vitreous humor and CNS

Front 10

Amphotericin B
-half-life

Back 10

-long

Front 11

Amphotericin B
-route of elimination

Back 11

-hepatic metabolism (renal toxicity if liver disease present)

Front 12

Amphotericin B
-efficacy spectrum

Back 12

-broad
-Aspergillus & Leishmania

Front 13

Amphotericin B
-when to use in horses

Back 13

-when systemic disease is not responsive to fluconazole

Front 14

Azole
-mechanism of action

Back 14

-reduce ergosterol through fungal Cyt P450 inhibition

Front 15

Azole
-adverse effects

Back 15

-nausea, vomiting, anorexia
-hepatotoxicity
-CYP inhibition

Front 16

Ketoconazole
-Spectrum of efficacy

Back 16

Broad spectrum
-Aspergillus mostly resistant
-Leishmania
-Staphylococcus

Front 17

Ketoconazole should not be used in _______

Back 17

horses

Front 18

Ketoconazole
-bioavailability

Back 18

Dependent on acid environment
-don't administer w/ acid suppression therapy (PPIs, H2 antagonists, antacids, sucralfate
-give with food to increase acid and biliary secretion

Front 19

Ketoconazole
-route of elimination

Back 19

-hepatic metabolism

Front 20

Ketoconazole
-adverse effects

Back 20

-nausea, anorexia, vomiting, hepatotoxicity
-dec. cortisol synthesis
-cataracts
-hair coat lightening

Front 21

Ketoconazole
-Drug interactions

Back 21

CYP 3A inhibitor
-drug exposure of time increases because it inhibits its own metabolism

P-gp Inhibitor

Front 22

Itraconazole
-adverse effects

Back 22

-CYP inhibition
-minimal effect on steroid synth.
-anorexia, vomiting, nausea, hepatotoxicity

Front 23

Itraconazole
-spectrum of efficacy

Back 23

Broad
-Aspergillus (slightly higher than ketoconazole)
-Leishmania

Front 24

Should Itraconazole be used in horses? Why?

Back 24

No, Poor bioavailability making it very expensive to treat with

Front 25

Why should compounded formulas of Itraconazole not be used?

Back 25

very unstable

Front 26

Itraconazole
-route of elimination

Back 26

-hepatic metabolism

Front 27

Itraconazole
-dosing

Back 27

-daily for systemic fungals
-pulse dosing for dermatophytes

Front 28

Fluconazole
-efficacy spectrum

Back 28

Broad
-Leishmania

Front 29

Fluconazole
-oral bioavailability

Back 29

-Good (even horses)

Front 30

Fluconazole
-adverse effects

Back 30

-hepatotoxicity

Front 31

Fluconazole
-Route of Elimination

Back 31

-renal (active in urine)

Front 32

Voriconazole
-derivative of

Back 32

Fluconazole

Front 33

Voriconazole
-efficacy spectrum

Back 33

Aspergillus & Fusarium (treatment of choice)
Equine Fungal keratitis

Front 34

Voriconazole
-bioavailability

Back 34

Good oral absorption (even horses)

Front 35

Drug of choice for CNS and Aqueous humor penetration

Back 35

Fluconazole

Front 36

Voriconazole
-how to administer for accessing aqueous humor

Back 36

-topically

Front 37

Voriconazole
-adverse effects

Back 37

-transient visual distrurbances
-rash
-hepatotoxicity

Front 38

Terbinafine
-mechanism of action

Back 38

-Inhibit squalene epoxidase
-decrease ergosterol synthesis

Front 39

Terbinafine
-efficacy spectrum

Back 39

Broad
-Aspergillus
-Malassezia

Front 40

Terbinafine
-CNS penetration

Back 40

-poor

Front 41

Terbinafine
-route of elimination

Back 41

hepatic metabolism

Front 42

Terbinafine
-adverse effects

Back 42

-vomiting, anorexia
-hepatitis

Front 43

Griseogulvin
-mechanism of action

Back 43

deposition in skin keratin to inhibit fungal mitosis

Front 44

Griseofulvin
-efficacy spectrum

Back 44

narrow
-dermatophytes

Front 45

Griseofulvin
-dosing

Back 45

-administer with a fatty meal

Front 46

Griseofulvin
-route of elimination

Back 46

hepatic metabolism

Front 47

Griseofulvin
-adverse effects

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-Teratogen (abortion causing)
-anemia, leukopenia (in FIV cats)
-Anorexia, depression, vomiting, diarrhea

Front 48

Topical use only antifungals
-drugs

Back 48

-nystatin
-micronazole
-clotrimazole
-terbinafine

Front 49

Nystatin
-efficacy spectrum

Back 49

Broad
-similar to amphotericin

Front 50

Nystatin
-primary use

Back 50

Malassezia otitis in dogs

Front 51

Nystatin
-adverse effects

Back 51

renal toxicity with systemic administration

Front 52

Miconazole & Clotrimazole
-efficacy spectrum

Back 52

Broad
-similar to ketoconazole & Itraconazole

Front 53

Miconazole & Clotrimazole
-primary uses

Back 53

-Malassezia otitis
-local dermatophyte infection
-nasal sinus treatment of Aspergillus