Pharm Exam 4: Antifungals

Front 1

Fungi are eukaryotic or prokaryotic?

Back 1

Eukaryotic

Front 2

Selective toxicity is lesser/greater of a challenge with fungi and why?

Back 2

Greater b/c they are eukaryotic

Front 3

Fungi are dimorphic T/F

Back 3

True

Front 4

Most pathogenic forms of fungi are unicellular or multicellular?

Back 4

Unicellular (but can also be multicellular - dimorphic)

Front 5

What kind of infection is acquired by breathing in spores?

Back 5

Fungal infection

Front 6

Moisture/molds present in home and immunosuppression are risk factors for infection by what?

Back 6

Fungi

Front 7

Candida, Histoplasma, Cryptococcus, and Aspergillus are four most common causative agents of what kind of infection?

Back 7

Fungal infection

Front 8

Name an opportunistic fungal infection:

Back 8

Aspergillosis

Front 9

What opportunistic infection has a 50-60% mortality rate?

Back 9

Aspergillosis

Front 10

Glucan synthase inhibitors inhibit what part of the fungus?

Back 10

Cell wall

Front 11

Griseofulvin inhibits what?

Back 11

Mitosis

Front 12

To what structure does griseofulvin bind to?

Back 12

Tubulin (Microtubules) - Mitosis inhibitor

Front 13

What is the cholesterol-like structure that is present uniquely in fungal cell walls?

Back 13

Ergosterol

Front 14

Polyenes bind to what part of the fungus?

Back 14

Cell membrane

Front 15

What drug forms pores in the fungal cell membrane?

Back 15

Polyenes

Front 16

Imidazoles and allylamines inhibit enzymes that are unique or not unique to fungi?

Back 16

Unique to fungi

Front 17

Name an antifungal in the Echinocandins class:

Back 17

Caspofungin

Front 18

What antifungal is used to treat invasive Candidiasis?

Back 18

Caspofungin

Front 19

Caspofungin can also be used to treat aspergillosis T/F?

Back 19

True

Front 20

What antifungal inhibits cell wall synthesis by inhibiting 1,2-beta glucan synthase enzyme?

Back 20

Caspofungin

Front 21

Name a major component of fungal cell walls:

Back 21

Glucan

Front 22

What is the mode of elimination of caspofungin?

Back 22

Hepatic

Front 23

Anidulafungin is the newest FDA approved drug in what class?

Back 23

Echinocandins

Front 24

Anidulafungin degrades in plasma enzymatically or nonenzymatically?

Back 24

Non enzymatically due to pH

Front 25

Significant or nominal hepatic elimination of Anidulafungin?

Back 25

Nominal

Front 26

What drug is safer to give than Caspofungin if liver is impaired?

Back 26

Anidulafungin

Front 27

Name a Polyene:

Back 27

Amphotericin B

Front 28

Fungal plasma membrane has more ergosterol or cholesterol?

Back 28

More ergosterol than cholesterol

Front 29

What drug binds ergosterol and forms pores in membranes?

Back 29

Polyenes
Amphotericin B or Nystatin

Front 30

What is the drug of choice for cryptococcal meningitis?

Back 30

Amphotericin B

Front 31

What kind of impairment can Amphotericin B cause?

Back 31

Renal impairment

Front 32

What drug can cause infusion-related reactions of fever and chills, "Shake and Bake"?

Back 32

Amphotericin B

Front 33

What drug is also known as amphoterrible?

Back 33

Amphotericin B

Front 34

Amphotericin B causes what in 80% of people?

Back 34

Nephrotoxicity

Front 35

Liposome formulations of Amphotericin B are more/less nephrotoxic?

Back 35

Less nephrotoxic

Front 36

Oral preparation of what drug is used for oral thrush (oral candidiasis) and is nontoxic to kidney?

Back 36

Amphotericin B

Front 37

Although different formulations of Amphotericin B were developed to reduce toxicity, what are the effects on dosage and cost?

Back 37

Dosage varies, cost rises

Front 38

What polyene is used for oral candidiasis with instructions "swish and swallow"?

Back 38

Nystatin

Front 39

Name a polyene other than Amphotericin B:

Back 39

Nystatin

Front 40

What is Nystatin used to treat?

Back 40

Candidiasis

Front 41

Nystatin is/is not toxic for systemic use?

Back 41

Toxic - topical use only

Front 42

Topical preparations of what drug that is too toxic to be used systemically to treat cutaneous fungal infection, diaper rash, and vaginal candidiasis?

Back 42

Nystatin cream

Front 43

What enzyme catalyzes squalene --> squalene epoxide?

Back 43

Squalene epoxidase

Front 44

Squalene epoxidase is also known shorthand as what?

Back 44

ERG1

Front 45

C14 demethylase is also known short hand as what?

Back 45

ERG11

Front 46

Name an Allylamine:

Back 46

Terbinafine (Lamisil)

Front 47

What is first line treatment for dermatophytes?

Back 47

Terbinafine (Lamisil)

Front 48

Onychomycosis is fungal infection of what?

Back 48

Nail

Front 49

Tinea unguium infects what?

Back 49

Nail

Front 50

Tinea cruris causes what?

Back 50

Jock itch

Front 51

Tinea pedis causes what?

Back 51

Athlete's foot

Front 52

What antifungal inhibits Squalene Epoxidase ERG1 and interferes with ergosterol synthesis?

Back 52

Terbinafine (Lamisil)

Front 53

What antifungal causes accumulation of sterol squalene in fungi and is toxic to it?

Back 53

Terbinafine (Lamisil)

Front 54

Depletion of ergosterol alters membrane fluidity and rigidity T/F?

Back 54

True

Front 55

Oral form of Terbinafine (Lamisil) is very/not so lipophilic?

Back 55

Very lipophilic

Front 56

What antifungal is lipophilic and accumulates in skin, nails, and fatty tissues:

Back 56

Terbinafine (Lamisil)

Front 57

Name two Azoles;

Back 57

1. Fluconazole
2. Itraconazole

Front 58

Which azole is used for superficial and systemic fungal infections?

Back 58

Fluconazole

Front 59

Which azole is very broad spectrum?

Back 59

Itraconazole

Front 60

Name a new azole approved for invasive Aspergillus/Candida in immunosuppressed patientes less than 13 years?

Back 60

Posaconazole

Front 61

What antifungal inhibits Lanosterol 14a demethylase (ERG11)?

Back 61

Azoles

Front 62

Name two classes of drugs that interferes with ergosterol synthesis:

Back 62

1. Allylamines (Terbinafine)
2. Azoles (Fluconazole, Itraconazole)

Front 63

ERG11 is a CYP450 enzyme T/F?

Back 63

True

Front 64

Candida albicans is/is not resistant to azoles?

Back 64

Is resistant

Front 65

Should azoles be used in pregnancy?

Back 65

Avoid if possible - Pregnancy category C

Front 66

What azole is used to treat aspergillosis?

Back 66

Itraconazole

Front 67

What azole is contraindicated in patients with heart failure?

Back 67

Itraconazole

Front 68

Azoles inhibits what and therefore causes many drug interactions?

Back 68

CYP3A4

Front 69

What azole is NOT used to treat aspergillosis?

Back 69

Fluconazole

Front 70

Name an inhibitor of fungal DNA/RNA synthesis:

Back 70

Flucytosine

Front 71

Name a "suicide substrate" for fungi that use cytosine for DNA/RNA synthesis:

Back 71

Flucytosine

Front 72

Flucytosine is deaminated in the fungal cell to what?

Back 72

5-fluorouracil

Front 73

5-FU is finally converted to what that is an inhibitor of thymidylate synthase?

Back 73

5-FdUMP

Front 74

What antifungal is used with Amphotericin B to treat cryptococcal meningitis?

Back 74

Flucytosine

Front 75

Resistance to Flucytosine develops slowly/rapidly?

Back 75

Rapidly, sometimes during therapy

Front 76

Why should flucytosine always be used in combo therapy with amphotericin?

Back 76

Resistance develops rapidly

Front 77

What is the main ADR with flucytosine?

Back 77

BM suppression

Front 78

Treatment time with Griseofulvin must be continued until infected tissue is replaced T/F?

Back 78

True

Front 79

What antifungals' use is restricted to dermatophytes (skin, hair, nail infections)?

Back 79

Griseofulvin

Front 80

What is an alternate treatment for onychomycosis aside from Lamisil?

Back 80

Griseofulvin

Front 81

What antifungal binds microtubules and inhibits mitosis?

Back 81

Griseofulvin

Front 82

What antifungal can cause multinucleated cells?

Back 82

Griseofulvin

Front 83

What antifungal deposits in keratin percursor cells?

Back 83

Griseofulvin

Front 84

What antifungal is teratogenic and carcinogenic in animals at high doses?

Back 84

Griseofulvin

Front 85

DHPS or DHFR is not present in mammals?

Back 85

DHPS

Front 86

Which part of TMP-SMX inhibits dihydropteroate synthase (DHPS)?

Back 86

Sulfamethoxazole (SMX)

Front 87

Which part of TMP-SMX inhibits dihydrofolate reductase (DHFR)?

Back 87

Trimethoprim (TMP)

Front 88

What antifungal is used to treat PCP?

Back 88

TMP-SMX

Front 89

Name an alternative treatment for Pneumocystis (PCP) aside from TMP-SMX?

Back 89

Pentamidine

Front 90

What antifungal used to treat PCP can cause nephrotoxicity, cardiovascular complications, and hypoglycemia?

Back 90

Pentamidine

Front 91

What antifungal is important to monitor blood sugar, bun, CBC, creatinine, EKG, and blood pressure?

Back 91

Pentamidine