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62 Cards in this Set
- Front
- Back
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what is the MOA of azoles?
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inhibits a fungal enzyme that synthesizes ergosterol
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what is an imidazole?
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ketoconazole
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what azole is seldom used and usually only PO or in shampoo?
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ketoconazole
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what are 4 adverse effects of ketoconazole?
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N/V
hepatotoxicity dose related inhibition of P450 severe drug interactions |
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how is ketoconazole eliminated? (3)
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hepatic
bile kidney |
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what 3 candida is fluconzole effective against?
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albicans
tropicalis parapsilosis |
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what is the work horse azole?
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fluconazole
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what are 2 niche azoles?
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itracanazole
posaconazole |
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what is a gorilla azole?
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voriconazole
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what non-candida fungi does fluconazole cover? (2)
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crypto and coccidiomycosis
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how is flouconazole administered?
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PO and IV
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how is floconazole excreted?
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urine
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what makes floconazole unique in terms of its availability?
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it can cross the BBB so it can treat CNS infections
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what CYP does fluconazole inhibit?
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2C9
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what therapeutic uses does fluconazole have? (2)
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oropharyngeal, vaginal, esophageal candidiasis
systemic fungal infections |
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what is flucanzole used as maintenance therapy for?
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crytococcal meningitis
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what is fluconazole used as a prophylaxis for?
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bone marrow transplant patients
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what are 3 adverse effects of fluconazole?
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N/V
rash drug interactions |
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what are 2 mechanisms of resistance for fluconazole?
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genetic mutaton - altered target site
upregulation of efflux pumps |
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what is good about itrazonazole?
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it has a broader spectrum than fluconazole
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what does Itraconazole not cover? (2)
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c. glabralta
c. kruzei |
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how is itraconazole administered?
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PO only
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what is the problem with itraconazole absorption?
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PO absorption is variable
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what can fluconazole do that itraconazole cannot in terms of availability?
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Flu can cross the BBB, I cannot
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what are 5 adverse effects of itraconazole?
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taste disturbances
N/V osmotic diarrhea rash hepatotoxicity |
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what patients should not be given itraconazole?
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patients with ventricular dysfunction
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what is the main therapeutic use of itraconazole? (2)
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2nd line (after ampho) for
blasto histo 3rd line for aspergillus |
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what is voriconazole active against? (5)
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aspergillus
c. glabralta c. cruizei fusarium scendosporium |
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what is voriconazole not acitve against? (2)
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zygomycetes
blasto |
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how is voriconazole administered?
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IV and PO
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where is voriconazle metabolized?
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liver
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what is the main adverse effect of voriconazole? (2)
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numerous drug interactions
reversible visual disturbances |
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what is voriconazole a first line drug for?
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invasive aspergillosis
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what candida infections of voriconazole good for? (2)
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glabralta and kruzei
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what makes posaconazole a niche player?
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available PO which limits it use because it treats more severe infections which usually require IV
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what is the prophylactic antifungal of choice to prevent aspergillus or candida infections?
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posaconazole
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what increases the absorption of posaconazole?
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high fat meals
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what is lamisil primarily used for?
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onchomycosis in the finger/toes
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what is the MOA of allylamines?
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similar to azoles except works earlier in the process, inhibiting squalene oxidase
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what type of antifungal is amphotecerin B?
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polyene (cell membrane agent)
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what is the MOA of ampho B?
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binds to ergosterol in fungal cell membranes, resulting in membrane permeability and leakage
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why does ampho B have so many side effects?
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may damage mammalian cell membranes due to the similarity between ergosterol and cholesterol
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what is the broadest spectrum antifungal on the market?
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ampho B
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what is ampho B effective against? (4)
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aspergillosis
blastomycosis candidiasis coccidio |
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what are 2 adverse effects of flycytosine?
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bone marrow suppresion
can rarely be used as a monotherapy |
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how is ampho B administered?
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IV
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what are 2 methods to combat nephrotoxicity in ampho B?
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sodium loading to blunt vasoconstriction
liposomal agents |
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who are the adverse effects of ampho B enhanced in? (2)
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patients who are volume depleted or on concomitant nephrotoxic agents
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what is an important consideration of oral administration of nystatin?
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it is safe to swallow because it is not absorbed from the GI tract and thus cannot cause nephrotoxicity
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wher is nystatin primaruly used? (3)
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topically
vaginally orally |
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what are the 2 main adverse effects of ampho B?
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nephrotoxicity
electrolyte disturbances |
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what may occur within minutes of ampho B administration and what can be given to combat this?
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fever, chills, and hypotension
can be given demerol |
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why type of drug is nystatin?
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polyene (cell membrane agent)
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what is the MOA of echinocandins?
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competitively inhibit the enzyme responsible for the production of glucan, a major component of the fungal cell wall
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what are 3 echionocandins?
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caspofungin
micafungin anidulafungin |
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what will echinocandins cover? (2)
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most strains of candida and aspergillus
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what are the side effects of echinocandins usually due to?
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infusion related reactions
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what are 3 advantages of echinocandins?
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no P450 interactions
cross-resistance is unlikely no renal penetration |
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what is the downside of echinocandins in terms of spectrum?
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limited spectrum against fungi other than candida and aspergillus
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how is echinocandins administered?
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IV only
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what will echinocandins cause that may require dosage adjustment?
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asymptomatic increase in liver enzymes (only worry about hepatic patients)
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what is the MOA of flucytosine?
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mimics uracil to be incorporated into the growing fungal DNA
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