Lecture 2: Pharm of Pulmonary Infections - Fungal Flashcards Preview

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Flashcards in Lecture 2: Pharm of Pulmonary Infections - Fungal Deck (49)
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1

MOA of Amphotericin B?

Complexes with ergosterol to disrupt fungal cell membrane

2

Which 3 major classes of fungi can be treated with Amphotericin B and list the 7 organisms in these classes?

- Yeasts: Candida + Cryptococcus neoformans

- Organisms causing endemic mycoses: H. capsulatum + Blastomyces dermatitidis + Coccidioides immitis

- Pathogenic molds: Aspergillus fumigatus + agents of mucormycosis

3

What is the mechanism of resistance to Amphotericin B?

Alteration to ergosterol

4

What is the route of administration for Amphotericin B?

IV

5

What are the most common immediate and long term AE's associated with Amphotericin B?

- Immediate = FEVER, chills, muscle spasms, vomiting, HA, and hypotension

- Long term = renal toxicity

6

What is the MOA of Flucytosine?

Converted to FdUMP and FUTP, which inhibit DNA and RNA synthesis, respectively

7

Which 2 organisms can be treated with Flucytosine?

- C. neoformans

- Some Candida spp.

8

What is the mechanism of resistance to Flucytosine?

Altered drug metabolism

9

How is Flucytosine administered?

Water-soluble oral form

10

What are 3 AE's of Flucytosine?

- Anemia

- Leukopenia

- Thrombocytopenia

11

What is the MOA of the Azoles?

Inhibition of fungal CYP450 enzymes --> ↓ ergosterol synthesis

12

What is the mechanism of resistance to the Azoles?

Upregulation of fungal CYP450 enzymes

13

What are 2 AE's associated with the -azoles?

- Minor GI issues***

- Abnormalities in liver enzymes

*Relatively non-toxic

14

Which -azole has a greater propensity to inhibit mammalian CYP450 enzymes?

Ketoconazole

15

Which -azole used for fungal infections has poor CSF penetration and which has good CSF penetration?

- Poor penetration = Itraconazole

- Good penetration = Fluconazole

16

Which routes of administration exist for Itraconazole?

Oral and IV

17

List 6 fungi which can be treated with Itraconazole?

- Dimorphic fungi: Histoplasma, Blastomyces, and Sporothrix

- Aspergillus spp. (largely replaced by voriconazole)

- Dermatophytoses and onychomycosis

18

In which form does Fluconazole have the highest bioavailability and via which routes can it be given?

- High oral bioavailability

- Can be given via IV as well

19

Which 3 -azoles have the highest absorption and are more often used for systemic coverage?

- Fluconazole

- Voriconazole

- Posaconazole

20

What is the azole of choice for cryptococcal meningitis?

Fluconazole

21

Fluconazole is most commonly used for the treatment of what?

Mucocutaneous candidiasis

22

Via which routes can Voriconazole be given?

IV and oral

23

Voriconazole is an inhibitor of what?

Mammalian CYP3A4

24

Which 3 -azoles have both oral and IV formulations?

- Itraconazole

- Fluconazole

- Voriconazole

25

What is a common AE of Voriconazole?

Visual disturbances

26

Voriconazole has a similar spectrum to what other -azole?

Itraconazole

27

What is the treatment of choice for invasive aspergillosis and some enviornmental molds?

Voriconazole

28

Which -azole can be given for Candida infections, including fluconazole-resistant specices such as Candida krusei and the dimorphic fungi?

Voriconazole

29

How is Posaconazole administered?

Liquid oral preparation only

30

What is the only -azole with significant activity against the agents of mucormycosis?

Posaconazole