Sq Pharm Exam 2 - Antifungals & Antivirals

Front 1

This drug inhibits the microtubules of fungal cells, inhibiting mitosis:

Back 1

Griseofulvin

Front 2

This drug class inhibits B-(1,3)-D-glucan on fungal cells:

Back 2

Echinocondins

Front 3

_____ inhibit lanosterols while ____ inhibit squalenes in the synthesis of ____ in fungal cells.

Back 3

Azoles inhibit lanosterols and terbinafines inhibit squalenes, which are enzymes involved in the synth of ergosterol in fungal cells.

Front 4

Of all the antifungals, this one actually inhibits DNA synthesis:

It is often combined with ____ for the tx of cryptococci:

Back 4

Flucytosine

Amphotericin B

Front 5

This drug causes the formation of ion pores in the PM of fungal cells:

Major toxicity?

Back 5

Amphotericin B

Nephrotoxic so don't use with aminoglycosides

Front 6

Besides forming ion pores, what is another mech for amphotericin B?

How is it administered and why do we care?

Back 6

(-) AA uptake

IV mostly. Usually hospitalized.

Front 7

What is a topical "version" of amphotericin B?

What is it used for?

Back 7

Nystatin

Candida mostly

Front 8

Your pt has histo, crypto, blasto, glabrata, and braziliensis. Luckily, you can give them what to tx all that?

Back 8

Amphotericin B

Front 9

How does the concentration of Amphotericin in the CSF and eye compare to serum?

What if you get an OD of amphotericin B?

Back 9

lower.

Tough cookies. It cannot be removed via hemodialysis.

Front 10

This antifungal can cause eye discoloration if injected in the subconjunctiva:

Back 10

Amphotericin B.

Front 11

This drug is used for crypto, candida, aspergillus and sporo. It inhibits thymidylate synthase in fungi:

Route?

Back 11

Flucytosine

Oral

Front 12

Your pt has paracocci infection and mucocutaneous candida. They are also experiencing gynecomastia as a result of their drug tx. How does this drug work?

Back 12

This drug is ketoconazole and is an inhibitor of fungal CYP3A (aka lanosine 14a demetheylase)

Front 13

How is ketoconazole normally administered?

What are it's major SEs (3)?

Back 13

Orally.

CYP3A inhibitor and gynecomastia/testicular atrophy

Front 14

Which azole is used topically for M. furfur?

How do you NOT administer it?

Back 14

Chlortrimazole

NO subQ admin.

Front 15

How does fluconazole differ from ketoconazole in terms of coverage?

Why is it good for the first listed?

Back 15

Good for crypto meningitis and HIV/transplant candidiasis.

90% avail in CSF vs 10% ketoconazole

Front 16

What are the two routes of admin for fluconazole?

It is okay in pts taking drugs that inhibit CYP3A?

Back 16

oral and IV

nope. less worrisome than ketoconazole but still dangerous.

Front 17

How do ketoconazole and fluconazole differ in terms of SEs?

Can fluconazole be used in onchomycosis?

Back 17

No gynecomastia/testicular atrophy with fluconazole.

yes.

Front 18

This triazole is great for Aspergillus:

What is the DOC for Aspergillus?

Back 18

Itraconazole

DOC is Voriconazole

Front 19

How is the administration of Itraconazole different from ketoconazole?

Back 19

Oral dosing can be in capsules or solution. Capsules are best with meal; solution is best without a meal. Do not mix these routes.

Front 20

This drug has a PPB rate of 99%, is metabolized to 30 metabolites but only one is active, and often causes a rash:

What is the active metabolite?

Back 20

Itraconazole

Hydroxy-itraconazole

Front 21

Voriconazole is most like what other azole?

What is different in it's metabolism?

Back 21

Fluconazole.

Metabolizes many more P450 enzymes: 2C19, 2C9, 3A4.

Front 22

Your pt has been diagnosed with an Aspergillus infection and you rx them the DOC. A few weeks later they come back freaking out because they are losing their sight. What is the appropriate course of action?

Back 22

Leave them on it. It usually resolves. You may also take them off. Either way, it's reversible.

Front 23

You tx a pt for Aspergillus and a few days later they are seen in the ER for severe hepatotoxicity sxs. What happened?

Back 23

The pt may have had a genetic polymorphism that left them 4x more susceptible to the P450 inhibition that occurs with use of Voriconazole.

Front 24

What are two lesser SE of voriconazole?

Back 24

CP, edema.

Front 25

How do echinocandins work against fungi?

How is resistance developed?

What are the main CIs and SEs?

Back 25

Inhibit the B-(1,3)-D-glucans in the fungal PM.

It isn't.

There aren't.

Front 26

How are the enchinocandins administered?

This one comes with inc LFTs:

Back 26

IV.

Caspofungin

Front 27

This enchinocandin may be used for pts with invasive Aspergillus or refractory esoph candida:

Back 27

Caspofungin but is not DOC

Front 28

Which enchinocandin was listed specifically as fungicidal vs fungistatic?

Back 28

Anidulafungin

Front 29

This drug is mostly used for systemic tx of dermatophytoses (like 'ringworm'):

Back 29

Griseofulvin

Front 30

This antifungal is poorly orally absorbed, which is made worse by barbituates and better with fatty foods or it's microcrystalline form:

Back 30

Grisofulvin

Front 31

Your pt has dermatophytosis and you need a drug that binds keratin. What are the main CIs of the drug you would choose (4)?

Back 31

Do not use in:
* Acute intermittent porphyria
* Hepatocellular failure
* Rx of warfarin (dec warfarin)
* Barbiturate use (dec Gris)

Front 32

This antifungal may cause GI sxs, hemo sxs, estrogen-like effects in kids, disulfiram like effects, and photosensitivity:

Back 32

Griseofulvin

Front 33

This drug sucks for candida but is great for onchomycosis:

Describe it's mech:

Back 33

Terbinafine

Inhibs squalene monoxygenase and interferes with ergosterol synth

Front 34

These two antifungals interfere with amphotericin B via their mech:

Back 34

Azoles and terbinafine

Front 35

Terbinafine is usually administered _____ for tx of onchomycosis:

Back 35

Orally. 99% PPB and great oral abs. Sits around in CNS and nail beds.

Front 36

What is a very rare complication of terbinafine tx?

But considered ok in?

Back 36

Hepatic failure in pts with preexisting liver dz

Notes say hepato-renal dz.

Front 37

Which broad spectrum antifungal tinea tx would you avoid using in your eyes?

What is an alternate tx for tinea?

Back 37

Naftifine

Tolnaftate

Front 38

You want to tx tinea pedis with a cream. What is it and for how long do you tx?

How about for vag candidiasis?

Back 38

Miconazole nitrate

4 wks for tinea pedis.

2 wk cream or 7 day tabs for vag.

Front 39

Which is better for vaginal yeast infections - miconazole or nystatin?

Back 39

Miconazole

Front 40

Terbinafine >> _____ and _____ for onchomycosis.

Back 40

Griseofulvin and itraconazole

Front 41

Name the 4 flu drugs:

Back 41

Oseltamivir, Zanamivir, Amantadine, Rimantadine

Front 42

How do neurominidase inhibiting antivirals impact the virus?

What are they used for?

Back 42

Prevents release of virus

Flu drugs

Front 43

This antiviral blocks the uncoating of influenza and has a very long t1/2:

What are the two main side effects (related)?

Back 43

Amantadine

Crosses BBB and is a DA agonist, so may make people go nuts.

Front 44

This drug has GI issues, blocks uncoating of the virus once inside the host, does not cross the BBB, and is used in flu tx:

Back 44

Rimantadine

Amantadine also has GI issues. Both are oral admin.

Front 45

Your neonatal pt has RSV. You are pregnant. What do you have to ask someone else to administer?

Mech?

Back 45

Ribavarin

Gets phosphorylated and inhibs viral mRNA synth.

Front 46

This drug is used to treat active RSV or HCV:

For HCV it is combined with:

Back 46

Ribavarin

IFN

Front 47

Your pt has Lassa fever. What drug might save her life?

What side effects might she experience (5)?

Back 47

IV Ribavarin.

Dyspnea, cardiac arrest, hypotension, anemia, depression.

Front 48

Ribavarin is an analog of what nucleic acid?

Back 48

Purine, specifically Guanosine

Front 49

You decide your high risk RSV pt needs prophylactic treatment. What do you prescribe?

Back 49

Palivizumab

Front 50

Your pt has HSV & VZV, what do you prescribe?

Your other one has HSV and CMV, what do you prescribe?

Back 50

Acyclovir

Ganciclovir

Front 51

This drug gets phosphorylated by viral thymidine kinase and ultimately becomes up to 300x concentrated in infected cells. It is used for (4):

Back 51

Acyclovir.

Used for HSV, VZV, Hairy leukoplakia in AIDS, prophylaxis in transplants.

Front 52

Why might you choose famciclovir over acyclovir (2)?

Back 52

Pt also has EBV or HBV, OR because it's only taken 2x/day.

Front 53

This drug is converted into panciclovir in vivo:

Back 53

Famciclovir

Front 54

How does ganciclovir work in HSV?

In CMV?

Back 54

Gets phosphorylated by thymidine kinase

Gets phosphorylated by viral protein kinase phosphotransferase

Front 55

This drug, often combined with foscarnet, may be used IV in serious CMV cases, or as a retinal implant for eye CMV:

Back 55

Ganciclovir

Front 56

What happens if you combine AZT with acyclovir?

With ganciclovir?

Back 56

Somnolence

Hematological issues!

Front 57

What three antivirals are indicated for CMV retinitis?

Which one is an antisense mech?

Back 57

Ganciclovir (implant), cidofovir (renal tub necrosis), and fomivirsen (injection.)

Fomivirsen

Front 58

This drug inhibits viral DNA polymerase, RNA polymerase, and reverse transcriptase:

What is it?

Back 58

Foscarnet

Inorganic analog of pyrophosphate

Front 59

This drug is IV only and administered for resistant HSV and CMV infections in AIDS pts:

Name the major SEs (5):

Back 59

Foscarnet

Front 60

Your AIDS pt receives an IV only drug for tx of his resistant CMV & HSV. He comes in complaining of CVA pain and genital ulcers. What drug was he on?

Back 60

Foscarnet

Front 61

Your AIDS pt has P. jirovecii and CMV. She is on two drug regiments. She tells you she keeps tetanic contractions. What are the drugs, and what do they cause when combined?

Back 61

Foscarnet and pentimadine.

Together cause hypocalcemia.

Front 62

What is the goal in tx of chronic HBV?

What is the only acceptable monotherapy?

Back 62

Seroconversion

Lamivudine

Front 63

Lamivudine is cross reactive with ____ but not with ____.

Back 63

entecavir but not adefovir.

Front 64

Adefovir is used in ____ and has these two toxicities:

Back 64

HBV

Renal tox and lactic acidosis

Front 65

This drug is a major tx of HCV and pretty much does everything but blocks microtubules:

Route?

Back 65

IFN.

SubQ 1x/week

Front 66

Major side effects of IFN tx:

Back 66

Flu-like, depression, myalgia, hemo sxs, edema, hypotension, inc ALT

Front 67

How long do you tx a pt with IFN for HCV genotype I?

What other drugs might you add to this?

Back 67

At least 1 year.

Boceprivir and/or telaprevir AND ribavarin

Front 68

How long do you tx a pt with IFN for HCV genotypes 2 or 3?

What else can it be used to tx (2)?

Back 68

24 weeks

warts, HSV keratitis

Front 69

These two drugs inhibit viral replication and are often adjunct txs in pts with HCV genotype I:

Their mech?

Major SEs (2)?

Back 69

Bocepriver and teleprevir

Protease inhibitors

(-) CYP3A4, hemo sxs

Front 70

What is the 1st choice drug combo for HIV?

2nd choice?

Back 70

Tenofovir and emtricitabine

AZT & Lamivudine

Front 71

Your prego HIV pt is on a drug that has a high first pass metab, good oral abs, and decreases the disease progression but does not eradicate it?

Back 71

AZT.

Front 72

You can use this drug in AIDS pts with Kaposi's sarcoma, pregnancy to prevent tranission, and in AIDS dementia?

Back 72

AZT

Front 73

This HIV drug is neurotoxic, nephrotoxic, has GI sxs, myelotoxic, and can also be used in psoriasis and Adult T cell leukemia:

Back 73

AZT

Front 74

AZT + acyclovir =

AZT + cimetidine/benzos =

AZT + probenicid =

AZT + tylenol or ganciclovir =

Back 74

somnolence

inhib liver metab of AZT

Probenecid impairs elim of AZT

Neutropenia

Front 75

Major SE of tenofovir?

Type of molecule?

Back 75

Flatulence

Adenosine analog

Front 76

This HIV drug is a deoxythymidine analog:

Route?

Back 76

AZT/zidovudine

Oral 5x/day

Front 77

Name the main NRTIs (4):

Name the special ones (3):

Back 77

AZT, tenofovir, lamivudine, emtricabine

didanosine, zalcitabine, stavidine

Front 78

These NRTIs cause peripheral neuropathy:

These NRTIs cause Lactic acidosis:

Back 78

Didanosine, stavudine, zalcitabine

AZT, didanosine, stavudine, zalcitabine

Front 79

These NRTIs cause anemia and granulocytopenia:

This NRTI causes major HS reactions and NVD:

Back 79

AZT, didanosine

Abacavir

Front 80

This NRTI is often combined with AZT and is an inhibitor of mito DNA synthesis:

This mechanism contributes to what major side effect?

Back 80

Didanosine

periph neuropathy

Front 81

This mito DNA synth inhibitor is used in HIV tx, may cause pancreatitis that is worse with ETOH and pentimadine, may also cause hyperuricema and lactic acidosis:

What would have been a dead giveaway?

Back 81

didanosine

Combo with AZT and causes periph neuropathy

Front 82

This dideoxythymidine analog NRTI should never be used with AZT:

Back 82

Stavidine

Front 83

What is so special about NNRTIs in AIDS tx?

What are they CI in (2)?

Back 83

They do not require phosphorylation

Protease inhibs and other strong CYP3A4 inhibs

Front 84

Besides being CI in pregnancy, what NNRTI crosses the BBB and should be eaten with fatty foods?

Back 84

Efavirenz

Front 85

Ketoconazole, cimetidine, and macrolides will increase the effect of what NNRTI?

What needs to be monitored?

What is another risk if combined with corticosteroids?

Back 85

Nevirapine

LFTs

SJS

Front 86

These drugs end in '-navir':

What is their major OTC CI?

Back 86

Protease inhibs used in HIV

St John's Wort!!! Increases their metab.

Front 87

This -navir causes increased bilirubin via inhib of UGT1A1:

May also cause (2):

Back 87

Atazenavir

NV, rash

Front 88

This -navir contains propylene glycol:

Should never be used with (2):

Notable risk:

Back 88

Amprenavir

Metro or disulfiram

SJS

Front 89

This -navir is used with ritonavir and causes diarrhea:

Back 89

lopinavir

Front 90

This drug is frequently used to increase the effects of -navirs. What is it and why?

Back 90

Ritonavir. Inhibs CYP3A4

Front 91

List the CIs for ritonavir (10 - FML):

Back 91

Metro, propofol, buproprion, quinidine, ergot/zolpidem, clozapine, pimozide, benzos, amiodarone, -cainides.

Front 92

What is an interesting SE of ritonavir use?

What does it contain?

Back 92

Mouth tingling.

ETOH!

Front 93

This -navir might be used with grapefruit juice or ritonavir to increase it's effects, but it also causes rhinitis:

Back 93

Saquinavir

Front 94

This navir is great for CSF penetration but might cause nephrolithiasis:

Back 94

Indinavir

Front 95

What is the only non-peptide PI for HIV tx?

Back 95

Tipranivir

Front 96

Name the two fusion inhibitors that are used in HIV:

What do they bind?

Back 96

Enfuviritide and Marviroc

gp41 and CCr5 respectively

Front 97

This HIV fusion inhibitor may increase risk of pneumonia and is administered subQ:

Back 97

Enfurvirtide