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164 Cards in this Set
- Front
- Back
fungi are -- cells
|
eukaryotic
|
|
fugi have -- cell wall containing ---
|
rigid
chitin |
|
cell membrane of fungi composed of --
|
ergosterol
|
|
fungi have different ----
distinct ---- |
ribosome
nuclear membrane |
|
fungi are resistant to ---
|
antibiotics
|
|
fungi are -- cells
|
eukaryotic
|
|
fugi have -- cell wall containing ---
|
rigid
chitin |
|
cell membrane of fungi composed of --
|
ergosterol
|
|
fungi have different ----
distinct ---- |
ribosome
nuclear membrane |
|
fungi are resistant to ---
|
antibiotics
|
|
predisposing factors for fungal infections to develop:
loss of ---- --- deficiency --- abnormalities suppression of ----- organism ---, ---- environment |
barriers
immunodeficiency metabolic competing warm, moist |
|
fungal infections most often involve the ---,but can be --- adn very difficult to tx
|
skin
systemic |
|
overview of drugs to tx fungal infections
|
polyenes
flucytosine imidazole triazoles echinocadins griseofulvin allyamines |
|
polyenes work by altering --- integrity and ------
also inhibit --- ---- |
membrane
permeability ergosterol synthesis |
|
azoles inhibit --- ------
decreased ----- |
innosterol demethylase
ergosterol |
|
allyamines: inhibit --- ----
decreased ---- |
squalene epoxidase
ergosterol |
|
enchinocandins inhibit --- in cell wall formation
|
D-glucans
|
|
which antifungal inhibit cell wall
|
echinocandins
|
|
which anitfungal inhibit cell membrane
|
polyenes
azoles allylamines |
|
cell division inhibition due to
|
griseofulvin
|
|
griseofulvin inhibits
|
microtubules
|
|
nucleic acid synthesis inhibition due to
|
flucytosine
|
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flucytosine converted to 5- ---- then to 5- -----
|
flurouracil
fluorouradine |
|
flucytosine inhibits --- synthase
inhibits --- synthesis |
thymidylate
dna |
|
ampotericin b forms channels in --- membranes to allow -- and -- to leak out/in of cells
|
ergosterol
K Mg out |
|
ampotericin b causes -- damage to membrane
|
oxidative
|
|
iv ampohtericin
|
amphotericin b deoxycholate
c-amb (fungizone) |
|
lipid formulations of amp b
|
amp b lipid complex
amp b colloidal suspension liposomal amp b |
|
amphotericin b txs
|
crytococcus
blatomyces histoplasma candida coccidioides aepergillus |
|
how long should u infuse amphotericin b for
|
4 hrs
|
|
what limits tx of amphotericin b
|
se
|
|
ae of amphotericin:
|
fever
chills |
|
why fever and chills w/ amp b
|
due to IL-1 and TNF
|
|
what do u pretreat w/ amp b
|
apap
antihistamine corticosteroids |
|
ae of amp b
--- abnormalities ---tension --ia decreased ---- |
electrolyte
hypotension uremia decreased filtration |
|
which med ahs a life dose
|
amp b
(3-5 g) |
|
amp b can cause -- ---damage
|
renal tubule
|
|
how to prevent renal tubule damage w/ amp b
|
hydrate w/ ns
to decrease amount in tubules |
|
route of nystatin
|
topical
|
|
nystatin used for --- ---
|
oral candidiasis
|
|
t/f
nystatin not absorbed |
t
|
|
nystatin is -- toxic
|
nephro
|
|
nystatin very similar to ---
|
amp b
|
|
5 flurocytosine converted to ---- by cytosine deaminase
why doesn't it affect human cells |
5-flurouridine
humans lack cytosine deaminase |
|
5-flurocytosine inhibits ----- syntase
this inhibits -- adn --- synthesis |
thymidylate
dna rna |
|
indicatiosn for 5-flurocytocine:
used w/ amp b for --- used w/ ----- in chrombobastomycosis |
cryptococcal meningitis
itraconazole |
|
ae of 5-flurocystosine:
---- suppression ---toxicity ---- disturbances ----- |
bone marrow
hepatotoxicity gi disturbances rash |
|
imidazoles and triazoles
inhibit ---- involved in conversion of ---- to ----- |
14-alpha-demethylase
lanosterol ergosterol |
|
indications for imidazoles and triazoles
|
aspergillis
athletes food ringworm jock itch onychomycosis: nails |
|
ketoconazole route
|
oral
|
|
t/f
ketoconazole should not be taken w/ meals |
f
take w/ meals |
|
t/f
ketoconazel enters the cns |
f
doesn't (rarely used) |
|
ae ketoconazole
|
n/v
anorexia |
|
ketoconazole inihibits cyp ------
|
3A4
|
|
itraconazole: --- active
|
orally
|
|
itraconazole has a --- spectrum
|
wider
|
|
itraconazole --- metabolite
|
active
|
|
itraconazole useful in
|
blastomycosis
histoplasmosis onchyomycosis febrile neutopenic patients not responding to abx |
|
itraconazole subrate for and inhibitor of cyp ----
|
3A4
|
|
t/f
ok to give itraconazole during pregnancy |
teratogenic
|
|
posaconazole is a imidazole/triazole
|
triazole
|
|
posaconazole structurally r/t
|
itraconazole
|
|
which is more potent against 14 alpha demethylase
posaconazole or itraconazole |
posaconazole
|
|
posaconazole route
|
oral
|
|
posaconazole mainly eliminated in --- unchaged
|
feces
|
|
posaconazole
high/low protein binding |
high
|
|
t/f
posaconazole given w/ food |
t
|
|
posaconazole effective against
|
aspergillis
candida zygomycetes refractory fungal infections |
|
only azole effective against zygomycetes
|
posaconazole
|
|
ae of posaconazole
|
qt prolongation
fever diarrhea hypokalemia thrombocytopenia |
|
imidazoles and triazoles cause
|
qt prolongation
|
|
which zole has the best oral absorption
|
fluconazole
|
|
t/f
fluconazole penetrates the cns |
t
so can be used in crytococcal meningitis, preventative in AIDS |
|
what's used for oral and vaginal candidiasis
|
fluconazole
|
|
fluconazole excreted in the ---
|
urine
|
|
how many dose of fluconazole given for vaginal candidiasis
|
single
|
|
fluconazole inhibits cyp --- and cyp -----
|
3A4
2A4 |
|
fluconazole can cause:
|
n/v
teratogenic in animals |
|
which has less se voriconazole or amphoterin
|
voriconazole
|
|
voriconazole route
|
oral
|
|
voriconazole effective against
|
systemic aspergillis
candida |
|
voriconazole effects
|
vision
liver and renal fx teratogenic in animals |
|
what's starting to replace amp
|
voriconazole
|
|
class of caspofungins
|
echinocandins
|
|
route of caspofungin
|
iv
|
|
caspofungin inhibit -- --- formation
|
cell wall
|
|
caspofungin used for
---- candidiasis systemic ----- not responding to itraconazole or amp ---- --- pt not responding to abx |
espohageal
aspergillis febrile neutropenic |
|
griseofulvin interupts --- ----, stops cell division in -----
|
mitotic spindles
dermatophytes |
|
griseofulvin deposited in ---- precursor cells in ---, --- and -----
|
mitotic spindles
skin hair nails |
|
what body parts will griseofulvin tx
|
skin
hair nails |
|
tx --- infections w/ griseofulvin for 1 month
|
scalp
|
|
tx -- infections w/ griseofulvin for 6-9 months
|
fingernails
|
|
tx ----- infections w/ griseofulvin for up to 12 months
|
toenails
|
|
griseofulvin is --- soluable
effective agains numerous ------ not candida (fungistatic) |
lipid
dermatophytes |
|
what will increase absorption of griseofulvin
|
high fat meals
|
|
ae of griseofulvin
|
ha
mental confusion fatigue blurred vision induces microsomal enzymes cyp 3a4 |
|
two drugs of allylamines
|
naftifine
terbinafine |
|
allylamines inhibit ---synthesis
|
ergosterol
|
|
which allylamines is used topically?
|
naftifine
|
|
which allylamines is used orally
|
terbinafine
|
|
allylamines are used for ----- --- infectins
|
superficial dermatophyte
|
|
tx --- infections w/ allylamines for 6-12 weeks
|
fingernail
|
|
tx --- infections w/ allylamines for up to 12 months
|
toenail
|
|
tolnafate effective against ---- ----
|
cutaneous mycoses
|
|
t/f
tolnalfate effective against candidda |
f
|
|
tolnafate used against
|
tinea pedia
tinea cruris tinea corporis NOT tinea unguium |
|
t/f tolnafate used for fingernail infection
|
f
|
|
stategies for prevention of protozoa
control --- supplying ---- improved ---- and ---- --- ---tx |
vector
parasite hygiene sanitation vaccination chemotx: prophylaxis |
|
tx of leishmaniasis
|
Na stibogluconate
|
|
leishmaniasis is spread by
|
sandflies
|
|
tx of trypanosomiasis
|
melarsoprol
nifurtimox |
|
tx of amoebiasis
|
iodoquinol
metronidazole |
|
tx of giardiasis
|
metronidazole
|
|
tx of trichomonaisis
|
metronidazole
|
|
metronidazole used to tx:
|
amebiasis
giardiasis trichomoniasis |
|
griseofulvin is fungi----
|
static
(why's it's ineffective against candida) |
|
metronidazole is converted by a --- enzyme to a free ------ which attacks the dna of the protozoa
|
protozal
nitroradicals |
|
ae of metronidazole
--- discomfort --- like rxn --- taste avoid taking in --- trimester |
gi
disulfiram metallic 1st |
|
what do you give for metronidazole resistant organisms
|
tinidazole
has similar ae |
|
malaria:
--- to liver -- to plasma |
sporozoite
merozoites |
|
malaria enters -----
|
rbc
|
|
malaria
--- rupture ------ |
schizonts
rbc |
|
what's associated w/ rupture of rbc
|
fever
chills |
|
t/f
malaria passed back to mosquito |
t
|
|
what prevents growth of malaria in rbc
|
pyrimethamine
|
|
what clears malaria protozoa from the blood
|
chloroquine
|
|
what med used in late hepatic stage
|
primaquine
|
|
what med is used in rbc stage
|
quinine
|
|
which med used as prophylaxis in malaria
|
atovaquone
proguanil |
|
what meds used in mild to mod attacks of malaria
|
atovaquone
proguanil |
|
how long will it take for chloriquine to clear blood of protozoa
|
about 72 hrs
|
|
t/f
chloriquine clears protozoa from the liver |
f
only the blood so malaria not completely gone |
|
pyrimethamine inhibits --- ----- reductase
|
protozoal dihydrofolate
|
|
pyrimethamine prevents formations of --- in blood cells
|
schizonts
|
|
ae of pyrimethamine
---- ---- deficiency ---penia -----penia w/ sulfa drugs: ---- ------ |
folic acid
leukopenia thrombocytopenia exfoliative dermatitis steven-johnson's syndrome |
|
t/f
chlorquine is used as tx only |
f
tx and prophylaxis |
|
chlorquine is effective against ---- ----- protozoa
|
blood borne
|
|
resistance developing for chlorquine against
|
p falciparium
most virulent form |
|
ae of chlorquine
|
itching
vomiting ha retinopathy caridac depression ototoxicity |
|
what used for chlorquine resistance
|
mefloquine
|
|
ae of mefloquine
neuro--- syndrome w/ mental ----- ---- anxiety seizures coma ---penia ---penia |
psychiatiric
confusion hallucinations anxiety seizures coma leuko thrombo |
|
t/f
worry about resistance for mefloquine |
t
|
|
what effective in late hepatic stage of malaria
|
primaquine
|
|
primaquine used in combo w/
|
chlorquine
|
|
ae of primaquine
-- disturbances --- in glucose-6-phosphate deficiency |
gi disturbances
hemolysis |
|
quinine used in --- stage of malaria
|
ethrocytic
|
|
quinine used in --- attacks or --- ---
|
mild
resistante |
|
what can be used in place of quinine
|
quinidine
|
|
ae of quinine
--- depression -- tension --- and --- disturbances blood ---- |
cardiac
hypotension visual/auditory blood dyscrasias |
|
atovaquone inhibits --- fx
|
mitochondrial
|
|
atovaquone used in combo w/ --- to prevent resistnace
|
proguanil
|
|
atovaquone inhibits -- stages of malaria
|
liver
|
|
ae of atovaquone
---- pain ---- --- |
abd pain
n/v |
|
doxycycline used as --- in malaria
|
prophylactic
|
|
when is doxycycline given for malaria
|
1-2 days before
during 4 weeks after return |
|
doxycycline used in combo w/ quinine for -- resistant plasmodium falciparium
|
chloroquine
|
|
pneumocystitis jiovicii is -- in nature
|
fungal
|
|
t/f
most kids have pneumocystitis jiovicii |
t
asymptomatic or mild infection by age 4 |
|
who's prone to getting pneumocystitis jiovicii
|
malnourished
premature infants immunocompromised |
|
tx for pneumocystitis jiovicii and is a prophylactic in AIDS patients
|
trimethoprim-sulfamthoxazole
|
|
what's used in pts unresponsive to trimethoprim-sulfamthoxazole
|
trimetrexate
|
|
why give leucovorin w/ trimetrexate
|
cuz trimetrexate also blocks production of folic acid
needed as a rescue |
|
what used as prophylaxis in pneumocystitis jiovicii
|
atovaquone
dapsone |
|
leucovorin is the active form of
|
folic acid
|