24. a. Antifungals Flashcards
What are the 4 main methods of action of antifungals?
Act on cell membrane
Act on cell wall
Interfere with DNA/RNA synthesis
Interfere with folate metabolism
Which antifungals act on the cell membrane?
Polyenes
Azoles
Which antifungals act on the cell wall?
Echinocandins
What antifungal interferes with DNA/RNA synthesis?
5-flurocysteine
Which antifungal interferes with folate metabolism?
Co-trimoxazole
Name 2 polyenes
Amphotericin B
Nystatin
What type of coverage is given by amphotericin B?
Broad spectrum against yeasts
What are possible side effects of amphotericin B?
Rigors
Renal impairment
Name 4 azoles
Fluclonazole
Miconazole
Posaconazole
Voriconazole
How do azoles act on the cell membrane?
Inhibit ergosterol biosynthesis
What fungus is fluclonazole active against?
Candida albicans
What fungi is voriconazole useful against?
All candida and aspergillus
What fungi is posaconazole useful against?
Candida, aspergillus, mucorales
List the side effects associated with azoles?
Visual disturbances with voriconazole
Hepatotoxicity
CYP450 interactions
What is the first choice empiric treatment for a systemic fungal infections?
Caspofungin
What class is caspofungin from?
Echinocandins
How do echinocandins interfere with the cell wall?
Interfere with glucan synthesis
What fungi is caspofungin active against?
Candida and aspergillus
What is a possible side effect of caspofungin?
Liver toxicity
What infections can terbinafine be used for?
Tinea and nail infections, as it accumulates in keratin
What is the mechanism of action of terbinafine?
Interferes with ergosterol synthesis
What TDM should be done for a patient on oral terbinafine treatment?
Monitor LFTs
What treatment can be given for PCP?
High dose IV co-trimoxazole
Dapsone or clindamycin
Give corticosteroids if severe hypoxia
What prophylaxis should be given to HIV patients?
Anti-candida or after a cryptococcus infection: fluconazole
Anti-PCP: oral trimoxazole
Not needed for patients on viral suppression meds
