Antifungal agents Flashcards
Nucleic acid synthesis inhibitors
Flucytosine
Inhibitors of fungal membrane stability
Amphotericin B
Squalene epoxidase inhibitors
Terbinafine
Sterol demethylase inhibitors
Fluconazole
Mitotic inhibitors
Griseofluvin
Cell wall inhibitors
Caspofungin
Fungal infections can be either
Systemic or superficial
_ is used to maintain plasma membrane structure and function
Ergosterol
Aphotericin B method of action
Binds ergosterol and disrupts membrane stability
Forms pores in the membrane
Aphotericin B use
Only for life-threatening systemic mycoses (black box warning)
Aphotericin B adverse effects
Cytokines storm
Renal toxicity (ischemia, proximal tubular injury leading to hypokalemia)
Hematologic toxicity (myelosupression resulting in anemia-indirect effect)
Flucytosine mechanism
Inhibits DNA/RNA synthesis (inhibitos thymidylate synthase)
Fungistatic
Flucytosine use
No monotherapy due to resistance
Cryptococaal Meningitis and systemic candidiasis
Are used in combination with amphotericin B 
Flucytosine adverse effects
Black box warning Firdous reduction in patients with renal insufficiency
Myelosuppression-monitor CBC
Hepatotoxicity
Griseofulvin mechanism
Find tubulin disrupting assembly of mitotic spindle
Fungistatic
Not effective against candida and not useful set for systemic Mycoses
Griseofulvin uses
Oral for dermatophytic infections of hair, skin, nails
Scalp ringworm in children
Griseofulvin adverse rections
Headaches
photosensitivity
Terbinafine mechanism
Inhibits squalene epoxidase (stops production of ergosterol)
Sequale accumulation-Fungicidal
Terbinafine use
Ringworm infection caused by dermatophytes
Must be given orally for onychomycosis of toenails
Terbinafine adverse reactions
Irritation in Hypersensitivity
Disturbances of taste
Hepatotoxicity
Fluconazole mechanism
Inhibits 14 alpha sterol demethylase
Blocks conversion of lanosterol to egosterol
Increased membrane permeability (fungistatic
Must consult stanford guide to select appropriate drug when perscribing
Azoles
Fluconazole uses
Cryptococcal meningitsis
Superficial mycoses
Fluconazole adverse effects
Drug interactions due to inhibition of CYPS
Hepatotoxicity
Avoid when pregnant
Capofungin mechanism
Non competitive inhibitor of Beta 1,3 D-glucan synthase
Leads to cell lysis
Fungicidal
Peak/MIC
Capofungin is given
IV
Capofungin resistance
Due to FKS gene mutations
Capofungin use
Sever systemic candidemia
IV therapy for aspergillosis
Emperic therapy for febrile neutropenua