Antifungal 1 & 2 (Lam)

• Unicellular; smooth in appearance

• Asexual reproduction (budding/fission) is more common than sexual reproduction

• HEAT

yeast or mold?

yeast

• Multicellular; fuzzy in appearance

• Hyphae: determines the type of mold

• Mold spores can survive harsh environments

• COLD 

yeast or mold?

mold

person to person transmission does not occur (t/f)

true

Candida &. Cryptococcus are examples of mold or yeast?

yeast

Aspergillus & Mucormycetes are examples of molds or yeast?

molds

Coccidioides , Histoplasma, Blastomyces are examples of yeast, molds, or dimorphic

dimorphic

Major risk factors of fungal infections ?

• transplant

• induction chemotherapy

• HIV

Which of the following cutaneous mycoses is described as "jock itch"?

1. Tinea capitis

2. Tinea barbae

3. Tinea corporis

4. Tinea cruris

4

Which fungal disease is localized in the semiarid, hot climates and endemic to the southwestern US?

1. Blastomycosis

2. Coccidioidomycosis

3. Histoplasmosis

4. Dermatophytosis

2

Which of the following fungi causes an infection called "Ohio Valley Fever"?

1. Blastomyces dermatitidis

2. Coccidioides immitis

3. Histoplasma capsulatum

4. Sporothrix schenckii

3

ringworm of the scalp is what tinea

tine capitis

ringworm of the beard is what tinea

tinea barbae

ringworm of the body is what tinea

tinea corporis

ringworm of groin or “jock itch” is what tinea

tinea cruris

ringworm of the foot and hand is what tinea

tinea pedis & tinea manuum

ringworm of nails is what tinea

tinea unguium

(a.k.a. “cave disease”) is what

Histoplasmosis

(a.k.a. “valley fever”) is what

coccidioidomycosis

Coccidioides immitis – dimorphic fungus

• valley fever

• southwestern US

• Treatment: amphotericin B

Coccidiodomycosis

Histoplasma capsulatum – dimorphic

fungus

• eastern and central regions of US

• treatment: Amphotericin B

• Ohio valley fever

Histoplasmosis

Blastomyces dermatitidis – dimorphic fungus

• midwestern and southeastern US

• Treatment: amphotericin

North American Blastomycosis

what is used for Tinea infections; onychomycosis (fingernails & toenails)

Terbinafine (lamisil)

Terbinafine is a potent inhibitor of what?

CYP2D6

What is the prescription treatment of choice for dermatophytes (i.e., tinea unguium or fungal infxn of the nails)?

1. Miconazole

2. Nystatin

3. Tolnaftate

4. Terbinafine

4

What is the treatment duration for onychomycosis of the toenail?

12 weeks

Which oral antifungal is the preferred treatment for onychomycosis (fingernail and toenail)?

1. Lamisil

2. Nizoral

3. Mycelex

4. Penlac

1

what monitoring & counseling parameters are recommended while a patient is taking oral Lamisil? (Select all that apply)

1. Transaminases

2. Taste disturbance

3. Headache

4. Hallucinations

A,B,C

topical onychomycosis (toenail) treatment are what ?

• Ciclopirox (Penlac)

• Efinaconazole (Jublia)

• Tavaborole (Kerydin)

what is the DOC for Toenail treatment

• oral terbinafine & Itraconazole x 12 weeks

what is duration for terbinafine for fingernail

6 weeks

what is the duration for terbinafine for toenail

12 weeks

shake well before using; should be swished about the

mouth and retained in mouth for as long as possible (several

minutes) before swallowing for what ?

nystatin suspension

what is the treatment for cutaneous, mucoctaneous, and oral cavity fungal infections caused by Candida spp.

nystatin

against yeast and mold is what drug

amphotericin B

preferred therapy for patients intolerant of or refractory to conventional amphotericin B

lipid formulations

monitor K and Mg for which drug

amphotericin B

What is nystatin primarily used for?

fungal infection (candida) : mucotaneous

Select the most appropriate dose and ROA for nystatin (Mycostatin) for treatment of oral candidiasis.

1. 100,000 units QID swish and spit

2. 100,000 units QID swish and swallow

3. 400,000 - 600,000 units QID swish and spit

4. 400,000 - 600,000 units QID swish and swallow

4

List 2 lab parameters that need to be monitored at baseline and during amphotericin B treatment?

Mg & K & Scr

Conventional amphotericin B treatment has more infusion-related side effects than liposomal amphotericin B.

True

False

true

Which electrolytes should be monitored during amphotericin B therapy? (Select all that apply)

1. Bicarbonate

2. Magnesium

3. Potassium

4. Calcium

2,3

which polyene is composed of a unilamellar liposomal product?

A. Fungizone

B. Abelcet

C. Ambisome

D. Amphotec

C

Which premedication meds should be considered before administering amphotericin B infusion? (Select all that apply)

A. Acetaminophen

B. Diphenhydramine

C. Hydrocortisone

D. Meperidine

A, B

Which azole is available as a slowly dissolving troche or lozenge and primarily used to treat "oral thrush"?

A. clotrimazole (Mycelex)

B. fluconazole (Diflucan)

C. itraconazole (Sporanox)

D. posaconazole (Noxafil)

A

Which of the following azoles are considered imidazoles? (Select all that apply)

A. miconazole (Monistat)

B. fluconazole (Diflucan)

C. clotrimazole (Mycelex)

D. ketoconazole (Nizoral)

A,C,D

Which triazole is available in oral solution formulation?

A. fluconazole (Diflucan)

B. itraconazole (Sporanox)

C. voriconazole (Vfend)

D. posaconazole (Noxafil)

B

Fluconazole has activity against all Candida species.

A. True

B. False

False

Fluconazole does NOT have activity to which of the following fungi? (Select all that apply)

A. C. albicans

B. C. krusei

C. C. auris

D. Cryptococcus neoformans

B, C

Sporanox solution is BEST absorbed when taken on an empty stomach.

A. True

B. False

true

Voriconazole is the preferred azole treatment for which invasive fungal infection?

A. Aspergillosis

B. Candidemia

C. Histoplasmosis

D. Mucormycosis

a

What is the MOST common side effect associated with voriconazole that patients should be counseled about?

A. Nausea

B. Vomiting

C. Photosensitivity

D. Visual hallucinations

D

Which triazoles contain the SBECD excipient in its IV formulations, and should be avoided in patients with CrCl <50 mL/min? (Select all that apply)

A. Fluconazole

B. Isavuconazole

C. Voriconazole

D. Posaconazole

C, D

Isavuconazole is FDA-approved for which invasive fungal infections? (Select all that apply)

A. Aspergillosis

B. Candidemia

C. Histoplasmosis

D. Mucormycosis

A, D

Name 1 advantage that isavuconazole has over voriconazole and posaconazole (hint: renal related).

does not contain SBECD

Name 4 azole antifungals that are active against Aspergillus spp.

Vori, Itra, Posa, Isav

What will happen to the plasma concentrations of itraconazole (caps/tabs) and posaconazole (suspension) when coadministered with PPIs?

decrease