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WorksheetsIT 2 - Exam 4 Goo Fungal
Total questions: 151
Worksheet time: 1hrs 29mins
What are some cell wall components that are unique to fungi?
Chitin
B-16
B1-3
C-32
AA36
Where can true fungal pathogens cause disease
Immunocompromised patients
Healthy hosts
What is the most common opportunistic infection?
Candida albicans
Cryptococcus neoformans
Pneumocystic jirovecii
Aspergillus fumigatus
Mucor
What is the most common opportunistic infection in HIV patients?
Candida albicans
Cryptococcus neoformans
Pneumocystic jirovecii
Aspergillus fumigatus
Mucor
What doesn't have chitin and we have to use bactrim to treat?
Candida albicans
Cryptococcus neoformans
Pneumocystic jirovecii
Aspergillus fumigatus
Mucor
What occurs in more prolonged immunocompromised?
Candida albicans
Cryptococcus neoformans
Pneumocystic jirovecii
Aspergillus fumigatus
Mucor
What is known as Zygomycetes?
Candida albicans
Cryptococcus neoformans
Pneumocystic jirovecii
Aspergillus fumigatus
Mucor
What are the different types of infections?
Cutaneous
Invasive
Habitual
Erraneous
Which type of infection occurs in immunocompromised patients?
Cutaneous
Invasive
Habitual
Evasive
Powerful
For invasive infections which is associated with inoculated skin? Typically trauma?
Subcutaneous
Pulmonary
Disseminated
For invasive infections which is associated with inhalation of spores?
Subcutaneous
Pulmonary
Disseminated
For invasive infections which is associated with circulation affecting organs?
Subcutaneous
Pulmonary
Disseminated
How much of fungal infections is cause of nosocomial infections?
10%
90%
20%
50%
How much of bacterial infections is cause of nosocomial infections?
10%
90%
20%
50%
Which fungal pathogen is associated with leukemia, corticosteroids, TB, immunosuppression and IV drug use?
Aspergillus
Candida
Cryptococcus
Zygomycota
Which fungal pathogen is associated with antibiotic therapy, catheters, diabetes, corticosteroids, immunosuppression with transplants and HIV?
Aspergillus
Candida
Cryptococcus
Zygomycota
Which fungal pathogen is associated with diabetes, TB, cancer, corticosteroids, immunosuppresesion?
Aspergillus
Candida
Cryptococcus
Zygomycota
Which fungal pathogen is associated with burns and physical trauma?
Aspergillus
Candida
Cryptococcus
Zygomycota
Most fungal infections are non-communicable meaning....
can spread person to person
cannot be spread from person to person
What are the main defenses from the body for infections?
Skin barrier
Respiratory Cilia
Hair
Vaccinations
Prophylaxis
True or false: Long lasting immunity in common in opportunistic infections.
True
False
When a patient comes in with a fungal infection.. what could it be?
Yeast
Mold
Dimorphic
Hematogenous
Teratogenic
Candida, cryptococcus and pneumocystis are...
Yeast
Mold
Dimorphic
Hematogenous
Teratogenic
Aspergillus, mucor and dermatophytes is...
Yeast
Mold
Dimorphic
Hematogenous
Teratogenic
Cocciodiodoides, blastomyces, histoplasma and paracoccidioides is...
Yeast
Mold
Dimorphic
Hematogenous
Teratogenic
Is associated with pore formation?
Polyenes
Azoles, Allylamines
Flucytosine
Echinocandins
Griseofulvin
Is associated with inhibiting ergosterol biosynthesis?
Polyenes
Azoles, Allylamines
Flucytosine
Echinocandins
Griseofulvin
Is associated with inhibiting dTMP and protein synthesis?
Polyenes
Azoles, Allylamines
Flucytosine
Echinocandins
Griseofulvin
Is associated with cell well biosynthesis?
Polyenes
Azoles, Allylamines
Flucytosine
Echinocandins
Griseofulvin
Is associated with microtubules?
Polyenes
Azoles, Allylamines
Flucytosine
Echinocandins
Griseofulvin
Is associated with Na+/K+ ATPase?
Polyenes
Azoles, Allylamines
Flucytosine
Echinocandins
Ciclopirox
Amphotericin B and Nystatin are a part of which class?
Polyenes
Azoles, Allylamines
Flucytosine
Echinocandins
Ciclopirox
Fluconazole, Itraconazole, Voriconazole, Posaconazole and Isavuconazoium are a part of which class?
Polyenes
Azoles, Allylamines
Flucytosine
Echinocandins
Ciclopirox
Naftifine and terbinafine are a part of which class?
Polyenes
Allylamines
Flucytosine
Echinocandins
Ciclopirox
Synergistic add ons are a part of which class?
Polyenes
Allylamines
Flucytosine
Echinocandins
Ciclopirox
Caspofungin, Micafungin and Anidulafungin are a part of which class?
Polyenes
Allylamines
Flucytosine
Echinocandins
Ciclopirox
What is the MAIN steroid in fungal membranes?
Ergosterol
Desoxycholate
Lebisterol
Nystatin
What is true about Ergosterol?
Main steroid in fungal membrane
Main steroid in bacterial membrane
Not found in animals
Found in animals
Selective for fungi
Which are a part of the polyenes class?
Amphotericin B
Nystatin
Amoxicillin
Bactrim
Which lipid formulation of Amphotericin is used for power resuspension?
c-AmB
ABCD
ABLC
LAmB
Which of these forms a colloid when resuspended?
c-AmB
ABCD
ABLC
LAmB
When using an in-line filter for c-AmB Amphotericin how big should the line be in order to avoid having colloidal suspension from getting clogged?
>1um
>2um
>3um
>4um
Resuspension of c-AmB is done using?
Sterile water
Normal saline
Glucose water
Which of these forms a COLLOID when suspended
c-AmB (Conventional AmB)
ABCD (AmB + Cholesteryl Sulfate)
ABLC (Lipid complex, containing AmB + Phospholipids)
LAmB: Liposomal containing AmB + Lipids
Which of these forms a RIBBON when suspended
c-AmB (Conventional AmB)
ABCD (AmB + Cholesteryl Sulfate)
ABLC (Lipid complex, containing AmB + Phospholipids)
LAmB: Liposomal containing AmB + Lipids
Which of these forms a VESICLES when suspended
c-AmB (Conventional AmB)
ABCD (AmB + Cholesteryl Sulfate)
ABLC (Lipid complex, containing AmB + Phospholipids)
LAmB: Liposomal containing AmB + Lipids
What is true about Amphotericin B mechanism?
K+ leaks OUT of cells
Na+ leaks INTO cells
Disrupts membrane
Causes fungal cell death
K+ leaks into cells
What is the main administration route for Amphotericin B?
IV
Oral
Subcutaneous
Rectal
What is true about Amphotericin B?
Broad spectrum
Shows concentration dependent antifungal effect
Narrow therapeutic index
Overdose can be fatal
Has adverse effects
What doesn't Amphotericin cover?
Candida lusitanie
Aspergillus terrus
Fusarium
Candida albicans
Candida glabrata
What are some Amphotericin B adverse effect
Febrile response
Renal toxicity
Hypotension
Anemia
Hypokalemia
A patient who is on Amphotericin B experiences fever, chills, nausea and headache should take _____ pre-administration to prevent fever
Acetaminophen
Diphenhydramine
Hydrocortisone
Meperidine
A patient who is on Amphotericin B experiences rigors should take ______ to prevent
Acetaminophen
Diphenhydramine
Hydrocortisone
Meperidine
_______ is a highly abused narcotic and is not really used as a pain reliever and seizures. It may interact with MAOIs, SSRIs and could cause serotonin syndrome.
Meperidine (Demerol)
Acetaminophen
Diphenhydramine
Hydrocortisone
What some signs of renal toxicity?
Hypokalemia
Azotemia (high blood nitrogen, urea and creatinine)
Hyperkalemia
Hypomagnesia
Tachycardia
How can you reduce renal toxicity in patients taking Amphotericin?
Sodium preload
Glucose preload
Taking Acetaminophen
Taking Demerol
Which nephrotoxic drugs should not be taken with Amphotericin B?
Aminoglycosides
Cyclosporines
Gallium
NSAIDs
Loop diuretics
What is true about Nystatin (Mycostatin)?
Used topically
Used vaginally
Not absorbed orally
Not used systemic infections due to high toxicity
Not administered by injection
What is used orally but not absorbed orally to treat conditions such as oral candidiasis?
Nystatin
Fluconazole
Itraconazole
Voriconazole
True or false: Nystatin can be used for systemic treatment.
False
True
True or false: Nystatin is purely used topically.
True
False
How are the azole antifungals categorized?
Triazoles
Imidazoles
Hepazoles
Pisconazoles
Triethylzoles
What is true about Triazoles?
they are used for systemic infections
Should be used for fungal infections
Have too many SE
What mechanism does Azoles utilize?
Sterol 14-demethylase
Oxidine xanthase
Trimethoprim
CYP450
What is true about sterol 14-demethylase enzyme?
Inhibits biosynthesis of Ergosterol
Causes fungal cell death
Is only used topically
True or false: Azole antifungals can be used in pregnancy.
False
True
Can use but monitor
NO can't use no exceptions Category D
True or false: Voriconazole can be used in pregnancy.
False
True
Can use but monitor
NO can't use no exceptions Category D
Which are systemic antifungals?
Fluconazole
Itraconazole
Voriconazole
Posconazole
Tetraconazole
Which species are not covered by Azoles?
Candida glabrata
Candida krusei
Aspergillus fumigatus
Aspergillus flavus
Fasarium
What are some side effects of azole antifungals?
GI upset: cramps, nausea, vomiting
Skin rash
Increased liver function tests (LFTs)
QT Prolongation (cardiac comorbidities)
Steven's-Johnson Syndrome
Which drug class is mainly attributed to P450 inhibition?
Azole antifungal
Polyenes
Allylamines
Echinocandins
What should you do when considering putting a patient on -azole?
Drug interaction check
Not put patient on azole
Which of the following antifungals has the most likely chance of interacting with patient medication?
Amphotericin
Azole
Caspofungin
Caftifine
Which of the following antifungals has the most likely chance of interacting with patient medication or liver? Drugs such. Simvastatin, Rifampin and CYP systems such as St. John's Worts?
Azoles
Allylamines
Flucytosine
Echinocandins
What are the pros of Fluconazole?
Good CNS penetration for Cryptococcus meningitis
Good oral bioavailability
Does NOT require stomach pH
Coverage against Zygometes
Covers C.krusei
What are the cons of Fluconazole?
Not metabolized, excreted in the urine unchanged
May cause long QT
P450 inhibitor
CNS effects
Negative inotropic effect
What does fluconazole cover?
1st line for Candida
Have some resistance to Candida glabrata and Candida krusei
Does not cover Aspergillus
Does not cover zygomycetes
Does not cover blastomyces or histoplasma
Which has broader spectrum?
Itraconazole
Fluconazole
What are the cons of Itraconazole?
Requires fatty acid stomach pH so you need to eat with a fatty meal
Can't take with antacids or PPI
Poor CNS penetration
Has negative inotropic effect
May cause long QT
What is the spectrum of Itraconazole?
Some resistance in C.glabrata
Does not cover C.krusei
Gains coverage against Aspergillus and Fusarium but some resistance
DOES not cover mucor
Used outpatient because it is taken orally
What is the main CON of Voriconazole?
CNS effects suchs as hallucinations and visual changes
Poor CNS penetration
Negative inotropic effect
Must take with fatty meal
What are the cons of Posaconazole?
Requires acid stomach pH so must eat with fatty meals
CNS effects such as hallucinations and visual changes
Is NOT metabolized
Poor CNS penetration
Has negative inotropic effect
Which meds do you need to take with high fat meals?
Itraconazole
Posaconazole
Voriconazole
Fluconazole
Which meds do you need to take on an empty stomach?
Itraconazole
Posaconazole
Voriconazole
Fluconazole
Which meds do you need to take with or without meds?
Itraconazole
Posaconazole
Voriconazole
Fluconazole
Isavuconazonium
Which meds do you take with food?
Itraconazole
Posaconazole
Voriconazole
Isavuconazonium
Which medication has the MOST drug interactions?
Voriconazole
Fluconazole
Itraconazole
Posaconazole
Which drug is NOT metabolized?
Fluconazole
Isavuconazonium
Itraconazole
Posaconazole
Which drug has the shortest half-life of 6 hrs?
Fluconazole
Isavuconazonium
Itraconazole
Posaconazole
Voriconazole
Which medications need acid pH?
Itraconazole
Posaconazole
Fluconazole
Isavuconazonium
Voriconazole
What can you take to make stomach contents acidic?
Coke
Coffee
Tea
Apple juice
Allylamines inhibit ergosterol by using
Squalene epoxidase
Xanthine oxidase
CYP2D6
CYP3D2
Flucytosine inhibits _______ which leads to cell death.
Thymidylate synthase
CYP2D6
Glucan synthase
Which drug class has fewer interactions with azoles and do not interact with 450's and is active against azole resistant Candida?
Echinocandins
Griseofulvin
Antifungal
True or false: Echinocandins have great bioavailability.
False
True
True or false: Most Candida (c.glabrata and c.krusei) are susceptible to Echinocandins.
True
False
Griseofulvin may cause..
Allergic response
Headache/nausea
Photosensitivity
Disulfiram effects
Fever
Which agent would be useful against Malassezia spp. (ie Tinea versicolor)?
Ciclopirox
Tolnaftate
Amphotericin
Fluconazole
Which drugs are used topically?
Griziophobin
Tonifate
Nystatin
Micafugin
What does fluconazole mainly cover?
Candida
Aspergillus
Histoplasma
Zygomycetes
What species of Candida does Fluconazole NOT cover?
C.krusei
C.glabrata
C.tropicalis
C.albicans
What coverage do you gain with Itraconazole?
Blastomyces
Histoplasma
Candida
Aspergillus
Cryptococcus
How should a patient take Itraconazole?
With fatty meal
On empty stomach
What is a side effect that itraconazole has?
Negative inotrope
Visual disturbances
Insomnia
Uncontrolled bleeding
What coverage do you gain with Voriconazole?
Aspergillus
Candida
Histoplasma
Blastomyces
What is a special side effect that Voriconazole has?
Visual disturbances
Hallucinations
Fever
Rash
Disulfiram like effects
How should Posaconazole be taken?
On an empty stomach
With fatty meal
How should Voriconazole be taken?
On an empty stomach
With fatty meal
When should you start empiric therapy for Candida?
Critically ill patients with risk factors for candida infection
No other known cause of fever
Neutropenic patient w/ persistant unexplained fever despite 4-7 days of broad spectrum antibiotics
Those that are immunosuppressed
Which can occur in health individuals? (geographic location gives you a clue on the pathogen)
Histoplasma
Blastomyces
Coccidiomycosis
Paracoccidiodies
Aspergillus
Which can occur in nosocomial infections (can occur in patients with short-term immunocompromised ie broad spectrum antibioics)?
Histoplasma
Blastomyces
Coccidiomycosis
Candida
Aspergillus
Which can occur in patients with severe/prolonged immunodeficiency (ie genetic disorders, HIV, transplants)
Histoplasma
Aspergillus
Zygomycetes (mucor)
Cryptococcus
Pneumocystis
A patient on broad spectrum antibiotics can develop what type of infection?
Candida
Histoplasma
Blastomyces
Paracoccidioides
Only after patient has failed candida therapy should you suspect this pathogen..
Aspergillus
Histoplasma
Blastomyces
Paracoccidioides
When you are empirically treating a non-neutropenic patient the primary target is..
Candida
Aspergillus
Blastomyces
Histoplasma
What is the first line when treating Candida?
Fluconazole
Bactrim
Azithromycin
Nystatin
Amphotericin B
When empically treating a febrile neutropenic patient we should cover for both Candida and Aspergillus thus treatment of choice should be..
Amphotericin B
Voriconazole
Fluconazole
Nystatin
Bactrim
True or false: Candida is the MOST common cause of invasive fungal infection.
True
False
True or false: Candida is a normal part of skin flora, female genital tract and GI tract and the population is decreased by broad spectrum antibiotics
False
True
True or false: Candida is a normal part of skin flora, female genital tract and GI tract and the population is increased by broad spectrum antibiotics
False
True
_______ if the 4th most common cause of nosocomial blood stream infections.
Candida
Blastomyces
Aspergillus
Toxoplasma
Which is azole resistant and is becoming a problem?
C.krusei
C.glabrata
C.albicans
C.lusitaniae
Which is resistant to Amb?
C.krusei
C.glabrata
C.albicans
C.lusitaniae
What is the initial therapy 1st line therapy for Candidiasis?
Fluconazole
Amphotericin B
Voriconazole
If a patient has moderate-severe disease and had recent use of azole therapy what can you use?
Fluconazole
Amphotericin B
Voriconazole
Echinocandins
If a patient already tried using Fluconazole and Echinocandins what would be the alternative to treat for Candidiasis?
Fluconazole
Amphotericin B
Voriconazole
Echinocandins
Which aspergillus species is the most common?
Aspergillus fumigatus
Aspergillus terreus
Aspergillus hemophitus
Aspergillus lumigatus
Which aspergillus species is resistant to AmB?
Aspergillus fumigatus
Aspergillus terreus
Aspergillus hemophitus
Aspergillus lumigatus
True or false: Early initiation of antifungal therapy in patients with strongly suspected invasive aspergillosis is warranted while diagnostic evaluation is conducted.
True
False
True or false: without adequate therapy invasive pulmonary aspergillosis will always progress to fatal pneumonia.
True
False
What is the primary treatment for someone with invasive pulmonary aspergillus?
Voriconazole
Fluconazole
Bactrim
Azithromycin
True or false: Combination therapy is recommended for patients with invasive pulmonary aspergillosis.
False
True
What is the primary treatment for someone with Aspergillus in the CNS?
Voriconazole
Fluconazole
Bactrim
Amphotericin B
What are you looking for in patients with Aspergillus of CNS?
Prolonged neutropenia
Advanced HIV infection
Inherited immunodeficiency
Allogenic hematopoietic stem cell transplantation
Recently on azole
In a patient that has prolonged neutropenia what pathogen would you suspect?
Aspergillus
Candida
Toxoplasma
Blasomyces
Histoplasma
In a patient that has advanced HIV what pathogen would you suspect?
Aspergillus
Candida
Toxoplasma
Blasomyces
Histoplasma
In a patient that has inherited immunodeficiency what pathogen would you suspect?
Aspergillus
Candida
Toxoplasma
Blasomyces
Histoplasma
In a patient that has allogenic hematopoietic stem cell transplantation what pathogen would you suspect?
Aspergillus
Candida
Toxoplasma
Blasomyces
Histoplasma
Cryptococcosis is an opportunistic pathogen worldwide, it usually occurs in the lungs where else can the disease disseminate to?
CNS
Genitals
Kidney
Liver
Blood
How is cryptococcus transmitted?
Bird poop
Cat litter
Uncooked meat
Soil
Which pathogen is common in Midwestern soil and when spores are inhaled can cause flu-like symptoms?
Blastomycosis
Toxoplasma
Aspergillus
Candida
In a patient that you suspect may have a Blastomyces infection. What would be the treatment of choice for a mild-moderate infection?
Itraconazole
Fluconazole
Bactrim
None
What is the duration of therapy for Blastomyces?
7 days
10 days
6-12 months
3-5 months
Which bacteria is spread through bird and bat excretement?
Histoplasmosis
Blastomyces
Toxoplasma
Aspergillus
Candida
Which infection mostly occurs in US along the Ohio and Mississippi river valley?
Histoplasmosis
Blastomyces
Toxoplasma
Aspergillus
Candida
Which bacteria is common in the SW soil and also known as Valley Fever?
Cocciodomycosis
Blastomyces
Aspergillus
Candida
how long does treatment last for coccidiodomycosis?
3-6 months
3-6 weeks
7-10 days
1 year
Thrush is caused by which pathogen?
C.albicans
C.terreaneu
C.fuminagus
Aspergillus
What are the therapies for Thrush (Oropharyngeal/esophageal candidiasis)?
Clotrimazole 10mg Troche
Nystatin 100,000 units/mL suspension
Miconazole 100mg
Fluconazole 150mg
What is true about Vulvov
It is very common occurs in 75% of females
Do not recommend an OTC product
Does not occur often
Recommend douching
OTC products are first line
For a patient with Onychomycosis what is true?
Extremely hard to treat
Easy to treat
Takes 48 weeks to treat
Takes 7-10 days to treat
Ciclopirox 8% nail lacquer can be applied
