Antifungals

Description

Antifungal info from Dr. Chand's Lecture
jmburk07
Flashcards by jmburk07, updated more than 1 year ago
jmburk07
Created by jmburk07 almost 9 years ago
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Resource summary

Question Answer
Fungi Types Yeast, molds, and dimorphic Mycoses
Fungi -Where they are acquired -Who Gets them Surgical, ICU, Prostheses, IV catheters, HIV Immunosuppressant, Cancer, and transplant patients
Traditional Fungal Diagnostic Tests Culture
New Fungal Diagnostic tests (3) 1) PCR 2) Western Blot 3) Antigen Detection
First Antifungal Agent available Amphotericin B
Fungal Infections Subgroups (3) 1) Superficial mycoses 2) Subcutaneous mycoses 3) Systemic mycoses
Superficial mycoses Tx (3) Nystatin Terbinafine Griseofulvin
Subcutaneous Mycoses Tx Amphotericin Azole Derivatives Flucytosine
Systemic Mycoses Tx (3) Amphotericin Azole derivatives Flucytosine
Amphotericin B MOA Polyene antifungal binds to membrane sterols (ergosterol) in fungal cell membranes, resulting in increased cell membranes, resulting in increased cell permeability, cell leakage, and death
Amphotericin B Adverse Effects 1) Infusion Related Reactions: Chills, fever, HA, N/V. Premedicaiton advised w/ anti-inflammatory drugs, steroids, and antipyretics. Slow the infusion rate
Amphotericin B Adverse Effects 2) Cumulative Toxicity: Nephrotoxicity is severe (80% of patients), Acute Tubular Necrosis occurs which is irreversible. There may also be Anemia, Leucopenia, and severe Potassium and Magnesium loss
Nystatin (General) -Related to Amphotericin B -Topical therapy only [toxic when used systemically]
Nystatin -use -Available forms -Tx for topical vaginal and oral fungal infections (Candida infection) -Available as ointments, creams, mouthwash, suppositories
Azole Antifungals Classes Imidazoles Triazoles
Imidazoles Examples (3) Ketoconazole Clotrimazole Miconazole
Imidazole -Delivery -Contraindication -Delivery: Oral and topical -Contraindication: GI absorption of Ketoconazole does not occur in achlorhydria or when pt is receiving H2 blockers or PPI
Triazoles Examples (3) Itraconazole Fluconazole Voriconazole
Triazoles -Delivery -Delivery: Oral and IV
Triazoles Common Adverse Effects -Common adverse effects include GI disturbances, HA, dizziness -Alopecia areata and Stevens Johnson
Triazole Drug levels effected -Increased levels of Amitriptyline, Cyclosporine, Phenytoin, Warfarin -Decreased Fluconazole levels Carbamazepine, isoniazid, phenobarbital
Azole Derivatives and Use (4) Itraconazole-onychomycosis Voriconazole-aspergillus, Candida Ketoconazole-Seborrheic dermatitis Clotrimazole-Topical Candida
Echinocandins -Inhibit Fungal cell wall synthesis [Chitin, Beta D-Glycan] -Beta glucans are carbohydrate polymers cross-linked with other fungal cell wall components -Inhibition of Beta 1-3 glycans of the fungal cell wall
Echinocandins (Examples) -Caspofungin (Cancidas) for tx of Candida and Aspergillus -Micafungin: esophageal, oropharyngeal, and invasive candidasis -Used in hemaopoietic stem cell transplantation patients Adverse effects: HA, fever, phlebitis at injection site, abnormal LFTs
Grisefulvin -Deposited in keratin precursor cells of skin, hair, and nails where it disrupts microtubule function and inhibits dermatophyte growth -Induces CYP450 to reduce warfarin and Oral contraceptive concentration -Absorption enhanced w/ fatty foods
Terbinafine -Synthetic allylamine used for onychomycosis -Fungicidal because it interferes w/ Ergosterol synthesis -Used for Tinea corporis and tinea cruris
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