Past Papers · SAQ

Antifungals — Fluconazole & Amphotericin

Current · V5 (2025) → O2.iv Historical · V4 (2023) → T2.ii 2 exam appearances

2025A Q20

Exam question

Fluconazole, amphotericin and caspofungin are anti-fungal drugs. (a) For each drug listed above, outline the following: (i) the class (15% of marks). (ii) the mechanism of action (45% of marks). (iii) TWO microbes against which they are active (30% of marks). (marks in each section are equally distributed between the 3 drugs listed) (b) List TWO serious side effects seen with ANY anti-fungal drug, include the agent most associated with each effect listed in your answer (10% of marks).

CICMWrecks answer

Master answer

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Field FLUCONAZOLE
Anti-infectives · Anti-infectives · Level 3
 AMPHOTERICIN B
Anti-infectives · Anti-infectives · Level 3
Mechanism of action

fluorinated bis-triazole
reduction of ergosterol synthesis by inhibition of fungal cytochrome P450 enzymes (greater affinity for fungal than for human)

Polyenes specifically target fungal membranes. They bind ergosterol, which is the principal sterol in fungal membranes as opposed to cholesterol found in host membranes. This interference creates a transmembrane channel and the resultant change in permeability allows leakage of intracellular components
Absorption

Well absorbed orally

only administered IV
Distribution

good CSF penetration

Poor tissue penetration. Negligable CSF or urine penetration.
Protein binding —

Highly protein bound
Metabolism

not metabolized well

Metabolised by the liver
Excretion

Urine unchanged

poorly characterized but does not accumulate in renal failure
Adverse Effects Toxicity

N/V/D, Abdominal pain
Headache
Skin rash
Reversible alopecia
Rare: Hepatic failure, SJS
Should be avoided in Pregnancy
Drug interactions: (inhibitor of CYP3A4, CYP2C9)

Dose related nephrotoxicity
Infusion related reactions (hypotension, fever, rigors)
Antimicrobial Spectrum

Candida
Cryptococcus
Coccidia
(No activity against histoplasma, blasto, sporotrichosis, Aspergillus, mucormycosis)

Broad antifungal cover including candida, Cryptococcus, aspergillus and zygomyces
Class Group

ANTIFUNGAL:
AZOLE

Antifungal
Introduction

Triazole

Polyene
Legacy Cicm Level

Level 3

Level 3
Resistance Mechanism

Some candida species,

Decreased drug concentration
Target site alteration
Up-regulation of target enzyme
Development of bypass pathways

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Special Points

potent CYP inhibitors with a wide range of drug interactions (including warfarin)

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Past papers

Exam appearances

2 appearances
Exam Exact exam wording Candidate success
2025A Q20 Fluconazole, amphotericin and caspofungin are anti-fungal drugs. (a) For each drug listed above, outline the following: (i) the class (15% of marks). (ii) the mechanism of action (45% of marks). (iii) TWO microbes against which they are active (30% of marks). (marks in each section are equally distributed between the 3 drugs listed) (b) List TWO serious side effects seen with ANY anti-fungal drug, include the agent most associated with each effect listed in your answer (10% of marks). 65%
2021B Q04 Compare the pharmacology of fluconazole and amphotericin. 6%