Antifungal agents Flashcards
Spectrum of amphotericin
broad - used for threatening systemic infections
Spectrum of Nystatin
superficial candidal infections
Which are topical only?
Nystatin, Terconazole, Clotrimazole/Miconazole
Which are IV only?
Caspofungin (for aspergillosis refractory to ampho b)
Amphotericin MOI
binds ergosterol and forms pores in membranes
Amphotericin Adverse Reactions
fever/chills on infusion, nephrotoxicity (80%)- slow excretion by kidney, anemia
Nystatin adverse reactions
well tolerated topically
Caspofungin adverse reactions
rash, puritis
Nystatin MOI
same as amphotericin
Triazoles MOI
inhibits P450 ergosterol synthesis altering membrane permeability
What is fluconazole used for?
orophoryngeal/esophageal/vulvovaginal candidiasis
Cryptococcal meningitis
Which readily enters the CSF?
Fluconazole
How is fuconazole administered and exreted?
IV/PO, renal excretion
Whats the difference between triazoles and imidazoles?
imidazoles have less selective inhibition of fungal P450
What is Ketoconazole used for?
systemic infections (candidiasis), used declining due to toxicity
Adverse reactions of Ketoonazole?
anorexia, hepatotoxic, P450 inhibitor, inhibits andgrogen GC biosynthesis
What forms of ketoconazole are available?
IV/PO/topical
What are clotrimazole and miconazole used for
oral and vaginal candidiasis (topical only)
What is terbinafine used for
onychomycosis (po) and athletes foot
What are side affects of terbinafine?
headache, diarrhea, rash, some DDIs with CYP450 substrates
How is terbinafine metabolized
hepatic P450
What is Grisefulvin used for ?
severe dermatophytosis of skin, hair, nails
Things to know about Grisefulvin
poor po absorption improved by fatty meals, hypersensitivity reactions, GI, headache & confusion
Things to know about flucytosine
renally eliminated, nv, skin rashes, bone marrow depression if prolonged use
