Anti-Fungal Agents Flashcards
Which Anti-Fungal drugs have good oral bioavailability?
1) Triazoles (Flucanazole & Voriconazole)
2) 5-Flucytosine
3) Echinocandins
Use of 5-Flucytosine?
Combination (+) Amphotericin B:
1) Candidiasis
2) Cryptococcosis (Meningitis & Pul Infections)
ADE of 5-Flucytosine
1) GI effects
2) Hepatotoxicity
3) Bone marrow supression
Use of Echinocandins
1) 1st line for invasive candidiasis
2) 2nd line for invasive asperigillosis
Which agents can be used for Asperigillosis?
1) Amphotericin B
2) Itraconazole (Intolerant to AB)
Which agents can be used for Invasive Asperigillosis?
1) Voriconazole (1st line)
2) Echinocandins
Which agents can be used for Invasive Candidiasis?
Echinocandins (1st line)
Which agent should not be given IV?
Nystatin (systemic toxicity)
Which drug should not be taken with antacids?
Itraconazole (low pH for better absorption)
Which agents can be used for Onychromycoses?
Itraconazole, Terbinafine
What is oral Terbinafine used for?
1) Onychromycoses (nail)
2) Tinea capitis (scalp)
What is Miconazole used for?
1) Tinea pedis
2) Tinea cruris
3) Tinea versicolor
4) Vulvovaginal candidiasis
What is Nystatin used for?
Commonly used for candida & oral cutaneous infections:
1) Oropharyngeal candidiasis (oral)
2) Vulvovaginal candidiasis (intra-vaginally)
3) Cutaneous candidiasis (topical)
4) GIT fungal infections
What is topical Terbinafine used for?
1) Tinea pedis
2) Tinea cruris
3) Tinea corporis (ringworm)
Safe for pregnancy
Amphotericin B
Terbinafine - Vaginal (A), Oral (B)
ADE of imidazoles
1) Contact dermatitis
2) Vulvular irritation
3) Edema
4) GIT (Oral)
ADE of terbinafine
GIT, Headache, Rash, Elevated liver enzymes
Administration of Amphotericin B
Topical or Slow IV
Which Anti-fungal agents can be given orally?
1) 5-Flucytosine???
2) Triazoles
3) Imidazoles (lozenges)
4) Nystatin
5) Terbinafine
Which agents can be used for Candidiasis?
1) Amphotericin B
2) 5-Flucytosine
3) Voriconazole
Which agents can be used for Cryptococcus meningitis?
5-Flucytosine & Fluconazole
Use of Itraconazole?
1) Blastomycosis & Aspergillus (Intolerant to AB)
2) Onychomycosis (nail)
3) Esophageal oropharyngeal candidiasis (oral sol)
Name the polyenes & their MOA
Amphotericin B & Nystatin
MOA: Binds to ergosterol, form pores in c.m & causing leakage
Coverage & use of Amphotericin B
Broad-spectrum Fungistatic & Fungicidal
1) Candidiasis
2) Crytococcus neoformans
3) Asperigillosis
4) Histoplasmosis
ADE of Amphotericin B
- Fever/Chills (Infusion-related)
- Nephro & Ototoxicity
- Bone marrow suppression
- Thrombophlebitis
- Hypotension
MOA of 5-Flucytosine
Inhibits protein synthesis:
Converted to 5-FTU by cytosine deaminase -> FUTP -> Incorporated into fungal RNA instead of uridylic acid
Use of Fluconazole
1) Single-dose oral for vulvovaginal candidiasis
2) Cryptococcal meningitis
Use of Voriconazole
1) Invasive asperigillosis (1st line)
2) Candida
MOA of Echinocandins
Inhibits activity of glucan synthase complex
-> Loss of structural integrity
Adverse Side Effects of Triazoles
GIT
Hepatotoxicity
QT Prolongation
MOA of Triazoles
Inhibits C-14 a-demthylase -> Blocks demthylation of lanosterol to ergosterol
Use of Clotrimazole
1) Dermatophyte infections
2) Vulvovaginal candidiasis
Adverse Drug Effects of Imidazoles
- Contact dermatitis
- Vulvular irritation
- Edema
- GIT (oral)
Contraindications for Terbinafine
Nursing mothers & renal impairment
