Anti-Fungals

Question 1

Amphotercin B

Answer 1

MOA: binds ergosterol making electrolyte-leakage pores in cell membranes

Use: systemic mycoses (Cryptococcus, Blastomyces, Coccidiodes, Aspergillus, Mucor, Histoplasma, Candida), fungal meningitis
-supplement K and Mg because of altered renal tubule permeability

Toxicity: fever/chills, hypotension, nephrotoxicity, arrhythmia, anemia, IV phlebitis

Question 2

Nystatin

Answer 2

MOA; binds ergosterol making electrolyte-leakage pores in cell membranes (topical form)

Use: diaper rash, oral candidiasis (mouthwash), vaginal candidiasis

Question 3

Fluconazole, Ketoconazole, Clotrimazole, Miconazole

Answer 3

MOA: inhibit fungal ergosterol synthesis by inhibiting P450 enzyme

Use: less severe local mycoses (don’t cross BBB so not for meningitis)

Toxicicty: hormone inhibition (gynecomastia), liver dysfunction (inhibits cyt P450), fever/chills

Question 4

Flucytosine

Answer 4

MOA: inhibits DNA synthesis by conversion to 5 fluorouracil by cytosine deaminase

Use: systemic fungal infections (Cyrptococcus)

Toxicity: N/V, diarrhea, bone marrow suppression

Question 5

Caspofungin

Answer 5

MOA: inhibits cell wall synthesis by inhibiting beta-glucan synthesis

Use: invasive aspergillosis

Toxicity: GI upset, flushing

Question 6

Terbinafine

Answer 6

MOA: inhibits fungal enzyme squalene epoxidase

Use: dermatophytoses (esp. onychomycosis)

Toxicity: abnormal LFT and visual disturbance

Question 7

Griseofulvin

Answer 7

MOA: interferes with microtubule function, disrupts mitosis

Use: superficial infection, dermatphytes, tinea, ringworm

Toxicity: Teratogenic, carcinogenic