Anti-Fungals Flashcards
Which drugs affect membrane function
Amphotericin B
Which drugs affect cell wall synthesis
Capsofungin
Which drugs affect nucleic acid synthesis
5-fluorocytosine
Which drugs affect ergosterol synthesis
Azoles
Naftifine
Terbinafine
Amphotericin B
Use: serious life threatening systemic, preg
MOA: binds to ergosterol and causes leakage
AE: d/t action in host cells. Chills/fever/HA after infusion, renal damage long term
How can you reduce after infusion reaction of Amphotericin B?
Slow infusion
Antipyretic
Antihistamine
Sodium loading
What does the lipid formulation of Amphotericin B do?
Decreased renal issues and infusion reactions, has hepatotoxicity and is $$$
Azole antifungals in general
MOA, AE
MOA: dec ergosterol synthesis via inhibit 14-a-sterol demethylase
AE: all of them inhibit p450
Fluconazole (use and AE)
Use: best CSF penetration, used for cryptococcal meningitis, ppx in toxoplasma and HIV pts
AE: SJS, teratogenic, potent CYP2C9 inhibitor
Itraconazole (use/AE)
Use: poor CNS penetration, histoplasma and blastomyces
AE: CHF, don’t use with statins, midazolam
Voriconazole
Use: broadest spectrum, invasive aspergillosis
AE: visual disturbance
Capsofungin
Use: aspergillus and Candida when refrac to voriconazole
MOA: inhibits synthesis of B1-3 glucan
AE: hepatotoxic
Griseofulvin
Use: dermatophytosis only, deposits in new keratin
MOA: mitotic inhib and interfere w/ MT assembly
AE: CNS, p450 inducer (inc warfarin and phenobarbital)
Terbinafine
Use: dermatophytoses, esp nails
MOA: inhibits fungal enzyme –> inc squalene levels -> toxicity
AE: well tolerated
Flucytosine
Use: only in combination
MOA: taken up by fungal cells and covered to 5FU -> blocks DNA/RNA synthesis
AE: anemia, leukopenia, thrombocytopenia
