Anti-Fungals

Anti-Fungals

1. Pyrimidines

   • 5 Fluorocytosine
     • 5-Fluorouracil
       • FUTP
         • Fluorodine Triphosphate
           • Incorporated into RNA
       • FdUMP
         • Thymidine synthetase
           • Inhibits DNA synthesis
       • Cryptococcus
         • Most Candida
     • Taken up by fungal specific cytosine permease

2. Polyenes

   • Nystatin
     • Topical
     • Oral and Vaginal Candidosis
   • Amphotericin B
     • Broad spectrum empirical
     • IV 1x
     • Lipid ambisome
   • Bind sterols causing membrane breakage

3. Echocandins

   • Anidulafungin
     • headache, nausea, liver
   • Micafungin
     • headache, liver
   • Caspofungin
     • Hypookalemia, fever, chillls, liver
       • High conc, paradoxical effect
   • Bind to Fksp1 subunit of B-1-3-D glugan synthesis
     • Component of fungal synthase
   • IV 1x
   • aspergillus and most candida

4. Terbafine

   • Tinea infections
     • Capitis
     • Pedis
     • Corporis
     • Curis
   • Oral 1x
   • Tablets, cream, spray
   • altered liver function and taste perception
   • Inhibits squalene epoxidase (ergosterol)

5. Azoles

   • Imidazoles
     • Ketconazole
     • Topical
     • Superficial Skin Infections
     • Clotimazole
     • Econazole
     • Miconazole
   • Triazoles
     • Posconazole
       • Oral 3-4x
         • Aspergillus
           • Fusarium
             • coccididiomycosis
     • Fluconazole
       • Oral/IV 1x
         • Crypto, men.
           • Candida
             • coccididiomycosis
     • Itraconazole
       • Oral/IV 2-4x
         • Aspergillus
           • Candida
             • Cryptococcus
               • Histoplasmosis
     • Voricaonzole
       • Oral/IV 2x
         • Aspergillus
           • Candida
             • Fusarium
               • Scedosporum
     • lanosterol-14-a- demethylase
       • Inhibits ergosterol production
         • conv of lanosterol to ergosterol
           • build up of methylsterols