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Flashcards in Anti-Fungals Deck (36)
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1

What cellular structure do Echinocandins target?

Cell wall: glucan synthesis

2

What cellular structure do Polyenes and Azoles target?

Cell membrane: ergosterol synthesis

3

What cellular structure do Flucytosines target?

DNA/RNA synthesis: pyrimidine analogues

4

What is the mechanism of action of polyenes?

Bind directly to ergosterol

5

What are the polyenes?

Amp-B
Nystatin

6

How would you treat cryptococcal meningitis?

1. Amp-B w/ Flucytosine
2. Fluconazole

7

Which azole crosses the BBB?

Fluconazole

8

What is the mechanism of action of Allylamines?

Inhibit fungal squalene epoxidase --> cannot convert squalene to lanosterol
Interfere with ergosterol synthesis

9

What is ergosterol?

Sterol that is part of the fungal bilayered cell membrane

10

What are fungal cell walls comprised of?

90% chitin, GLUCAN, mannan
10% proteins, glycoproteins

11

What do anti-fungals target?

Proteins
Nucleus
Cell wall, especially glucan
Cell membrane, especially ergosterol

12

Effective anti-fungals typically have a _____, which leads to ______.

High therapeutic index / many adverse side effects

13

What was the first anti-fungal and when was it approved?

Nystatin -- 1954

14

What class of anti-fungals is Terbinafine?

Allylamine (targets squalene epoxidase)

15

What is the mechanism of action of Azoles?

Bind to and inhibit cytochrome p450 and 14-alpha demethylase --> cannot convert lanosterol to ergosterol

16

What class of anti-fungals is Flucytosine?

Antimetabolite (pyrimidine analogue)

17

What are side effects of Amp-B?

Chronic: Dose-dependent severe nephrotoxicity (decrease in GFR); may require dialysis
Acute: chills, fever, vomiting

18

What OTC drug can you NOT take with azoles?

Antacids. Azoles are weak acids, therefore an antacid would inhibit them.

19

What are the imidazoles?

Ketoconazole
Miconazole

20

What are the triazoles?

Itraconazole
Fluconazole

**these drugs are newer and less toxic

21

Broad spectrum
PO administration
Mostly replaced by Fluconazole

Ketoconazole

22

Side effects of Ketoconazole

Gynecomastia
Hepatic failure

23

Topical and vaginal suppositories
Dermatophytes

Miconazole

24

Topical and vaginal suppositories

Clotrimazole

25

Oral, esophageal, and vaginal candidiasis
Used for Cryptococcal meningitis (after initial treatment with Amp-B and Flucytosine)
Oral and IV

Fluconazole

**only azole to cross BBB

26

Broad spectrum including tinea unguium
Indicated for systemic fungal infections
Also for oral and esophageal candidiasis

Itraconazole

27

Oral and IV introduced in 2002
High bioavailability
Indicated for invasive Aspergillosis

Voriconazole

28

How would you treat superficial fungal infections?

Terbinafine

29

What is Flucytosine used for?

Systemic Candida and Cryptococcus neoformans infections

30

What is Flucytosine not effective against?

Aspergillus