NR566 Midterm
1. What are some important CYP3A4 Inhibition:
drug interactions to con- Increases levels of drugs like cisapride and
sider when prescribing itra- warfarin (may increase risk of side effects)
conazole?
Drugs that raise gastric pH:
Can reduce itraconazole absorption (e.g.,
antacids, PPIs)
2. What is the primary func- Itraconazole: Broad-spectrum azole antifun-
tion of itraconazole and how gal
does it compare to ampho- Function: Treats systemic fungal infections
tericin B? Advantages over Amphotericin B:Lower tox-
icityCan be taken orally (oral administra-
tion)Alternative to Amphotericin B in many
cases
3. What is the primary func- Type: Narrow-spectrum echinocandin (IV)
tion of caspofungin, and how
does it differ from other anti- Targets: Fungal cell wall
fungal agents?
Effective against: Aspergillus and Candida
Comparison: Better tolerated than ampho-
tericin B, similar efficacy
4. What are the key therapeutic Invasive aspergillosis: For patients unrespon-
uses of caspofungin? sive to amphotericin B or itraconazole
Systemic Candida infections: Including can-
didemia and intraabdominal abscesses
5. What is the primary indica- -Treats superficial mycoses
tion for griseofulvin? (3)
-Specifically for dermatophytic infections of
skin, hair, and nails
-Not effective against systemic mycoses or
Candida species
, NR566 Midterm
6. How does griseofulvin work -Inhibits fungal mitosis by binding to micro-
to combat fungal infections? tubules
(3)
-Deposited in keratin precursor cells
-Newly formed keratin becomes resistant to
fungal invasion
7. What are the primary indica- -Treats onychomycosis (fungal nail infec-
tions for oral terbinafine? (2) tions)
-Effective for dermatophyte infections (e.g.,
ringworm)
8. What is the mechanism of -Inhibits squalene epoxidase
action of terbinafine? (3)
-Reduces ergosterol synthesis
-Highly active against dermatophytes; less
effective against Candida
9. What considerations should -Higher risk for achlorhydria (condition in
be taken when prescribing which the stomach produces little or no hy-
azoles like itraconazole to drochloric acid) affecting absorption
older adults? (3)
-Increased plasma levels of medications
(e.g., warfarin, phenytoin)
-Need for careful medication reconciliation
due to polypharmacy
10. What factors affect the phar- -Age-related changes in metabolism and ex-
macokinetics of azoles in cretion
older adults? (3)
-Ability to self-administer medications safely
-Risk of drug interactions with multiple med-
ications
11.
, NR566 Midterm
What the key pharmacoki- Poorly absorbed from the GI tract; requires IV
netic properties of ampho- administration
tericin B? (4)
Extensive binding to sterol-containing mem-
branes
Limited penetration to cerebrospinal fluid
(CSF)
Long elimination time; detectable in tissues
for over a year
12. What are the major consid- High incidence of infusion reactions (fever,
erations regarding ampho- chills)
tericin B's toxicity? (4)
Nephrotoxicity is common; renal function
should be monitored
Use with caution in patients taking other
nephrotoxic drugs
Should only be used for life-threatening infec-
tions due to toxicity
13. What is the treatment of amphotericin B
choice for most systemic
mycoses?
14. What are the alternatives to Azoles (e.g., itraconazole, fluconazole,
amphotericin B for systemic voriconazole) serve as alternatives.
mycoses and what are their
advantages? Advantages: Lower toxicity and can be given
orally.
15. What is the main drug in- inhibits CYPA4 increasing levels of drugs like:
teraction concern with itra- cisapride, pimozide, dofetilide, quinidine (risk
conazole? of ventricular dysrhythmias)
16. How do drug that raise gas- Antacids, H2 antagonists, and proton pump
tric pH affect itraconazle? (2) inhibitors can reduce absorption of itracona-
, NR566 Midterm
zole.
These agents should be given at least 1 hour
before or 2 hours after itraconazole.
17. What are the key drug inter- Cytochrome P450 Inducers: Drugs like
actions that affect caspofun- efavirenz, rifampin, and phenytoin can de-
gin levels? (2) crease caspofungin levels, possibly requiring
dosage increases.
Tacrolimus Interaction: Caspofungin can low-
er tacrolimus levels; monitor and adjust
dosage as needed.
18. What are the risks associ- Increased risk of liver injury due to transient
ated with combining caspo- elevation in liver enzymes.
fungin and cyclosporine? (2)
Combination should generally be avoided to
prevent liver toxicity.
19. What are the primary treat- Terbinafine: Topical or oral; inhibits squalene
ments for tinea pedis? (2) epoxidase, effective against dermatophytes.
Butenafine: Topical; same mechanism as
terbinafine, applied once daily for 2-4 weeks.
20. What are some important Wear absorbent cotton socks.
non-drug recommendations
for managing tinea pedis? Change shoes frequently.
(3)
Dry feet thoroughly after bathing.
21. How can nephrotoxicity from Administer 1 L of saline on days of ampho-
amphotericin B be mini- tericin infusion.
mized? (3)
Monitor kidney function tests every 3-4 days.
Reduce dosage if plasma creatinine exceeds
3.5 mg/dL.
1. What are some important CYP3A4 Inhibition:
drug interactions to con- Increases levels of drugs like cisapride and
sider when prescribing itra- warfarin (may increase risk of side effects)
conazole?
Drugs that raise gastric pH:
Can reduce itraconazole absorption (e.g.,
antacids, PPIs)
2. What is the primary func- Itraconazole: Broad-spectrum azole antifun-
tion of itraconazole and how gal
does it compare to ampho- Function: Treats systemic fungal infections
tericin B? Advantages over Amphotericin B:Lower tox-
icityCan be taken orally (oral administra-
tion)Alternative to Amphotericin B in many
cases
3. What is the primary func- Type: Narrow-spectrum echinocandin (IV)
tion of caspofungin, and how
does it differ from other anti- Targets: Fungal cell wall
fungal agents?
Effective against: Aspergillus and Candida
Comparison: Better tolerated than ampho-
tericin B, similar efficacy
4. What are the key therapeutic Invasive aspergillosis: For patients unrespon-
uses of caspofungin? sive to amphotericin B or itraconazole
Systemic Candida infections: Including can-
didemia and intraabdominal abscesses
5. What is the primary indica- -Treats superficial mycoses
tion for griseofulvin? (3)
-Specifically for dermatophytic infections of
skin, hair, and nails
-Not effective against systemic mycoses or
Candida species
, NR566 Midterm
6. How does griseofulvin work -Inhibits fungal mitosis by binding to micro-
to combat fungal infections? tubules
(3)
-Deposited in keratin precursor cells
-Newly formed keratin becomes resistant to
fungal invasion
7. What are the primary indica- -Treats onychomycosis (fungal nail infec-
tions for oral terbinafine? (2) tions)
-Effective for dermatophyte infections (e.g.,
ringworm)
8. What is the mechanism of -Inhibits squalene epoxidase
action of terbinafine? (3)
-Reduces ergosterol synthesis
-Highly active against dermatophytes; less
effective against Candida
9. What considerations should -Higher risk for achlorhydria (condition in
be taken when prescribing which the stomach produces little or no hy-
azoles like itraconazole to drochloric acid) affecting absorption
older adults? (3)
-Increased plasma levels of medications
(e.g., warfarin, phenytoin)
-Need for careful medication reconciliation
due to polypharmacy
10. What factors affect the phar- -Age-related changes in metabolism and ex-
macokinetics of azoles in cretion
older adults? (3)
-Ability to self-administer medications safely
-Risk of drug interactions with multiple med-
ications
11.
, NR566 Midterm
What the key pharmacoki- Poorly absorbed from the GI tract; requires IV
netic properties of ampho- administration
tericin B? (4)
Extensive binding to sterol-containing mem-
branes
Limited penetration to cerebrospinal fluid
(CSF)
Long elimination time; detectable in tissues
for over a year
12. What are the major consid- High incidence of infusion reactions (fever,
erations regarding ampho- chills)
tericin B's toxicity? (4)
Nephrotoxicity is common; renal function
should be monitored
Use with caution in patients taking other
nephrotoxic drugs
Should only be used for life-threatening infec-
tions due to toxicity
13. What is the treatment of amphotericin B
choice for most systemic
mycoses?
14. What are the alternatives to Azoles (e.g., itraconazole, fluconazole,
amphotericin B for systemic voriconazole) serve as alternatives.
mycoses and what are their
advantages? Advantages: Lower toxicity and can be given
orally.
15. What is the main drug in- inhibits CYPA4 increasing levels of drugs like:
teraction concern with itra- cisapride, pimozide, dofetilide, quinidine (risk
conazole? of ventricular dysrhythmias)
16. How do drug that raise gas- Antacids, H2 antagonists, and proton pump
tric pH affect itraconazle? (2) inhibitors can reduce absorption of itracona-
, NR566 Midterm
zole.
These agents should be given at least 1 hour
before or 2 hours after itraconazole.
17. What are the key drug inter- Cytochrome P450 Inducers: Drugs like
actions that affect caspofun- efavirenz, rifampin, and phenytoin can de-
gin levels? (2) crease caspofungin levels, possibly requiring
dosage increases.
Tacrolimus Interaction: Caspofungin can low-
er tacrolimus levels; monitor and adjust
dosage as needed.
18. What are the risks associ- Increased risk of liver injury due to transient
ated with combining caspo- elevation in liver enzymes.
fungin and cyclosporine? (2)
Combination should generally be avoided to
prevent liver toxicity.
19. What are the primary treat- Terbinafine: Topical or oral; inhibits squalene
ments for tinea pedis? (2) epoxidase, effective against dermatophytes.
Butenafine: Topical; same mechanism as
terbinafine, applied once daily for 2-4 weeks.
20. What are some important Wear absorbent cotton socks.
non-drug recommendations
for managing tinea pedis? Change shoes frequently.
(3)
Dry feet thoroughly after bathing.
21. How can nephrotoxicity from Administer 1 L of saline on days of ampho-
amphotericin B be mini- tericin infusion.
mized? (3)
Monitor kidney function tests every 3-4 days.
Reduce dosage if plasma creatinine exceeds
3.5 mg/dL.
