Antifungal Agents Flashcards
Opportunistic vs non-opportunistic infx?
Opportunistic: there is a prior infx/immunocompromised host
Non-opportunistic: any host can be infected
Anti-fungal: Drug class: “Polyene antibiotics” MOA?
BIND to ergosterol and disrupt the fungal cell membrane
Anti-fungal: Drug class: “Azoles” MOA?
INHIBIT synthesis of ergosterol and disrupt the fungal cell membrane
Anti-fungal: Drug class: “Echinocandins” MOA?
INHIBIT synthesis of beta-1,3-o-glucan and disrupts the fungal cell wall
Anti-fungal: Drug class: “Pyrimidine analogs” MOA?
Disrupts synthesis of RNA and DNA
Polyene antibiotics: Amphotericin B choice, spectrum, considerations?
FIRST choice for most systemic mycoses (fungal infx)
BROAD spectrum
prolonged tx 6/8 weeks - 3/4 mos
Polyene antibiotics: Amphotericin B a/e?
Infusion rx, pretreat with diphenhydramine and acetaminophen
dermal, psychiatric, CV, pulmonary, immunological negative aeffects
Nephrotoxicity:
reversible if dose is < 4 grams
monitor renal fx q3-4 days
< dose if creatinine > 3.5 mg/dl
What medication potentiates anti-fungal rx of Polyene antibiotics: Amphotericin B?
Flucytosine – creates a strong anti-fungal effect also allowing dose reduction of amphotericin B (having a lot of adverse effects
Azoles: Itraconazole tx?
Treats blastomycosis, histoplasmosis, and paracoccidioidomycosis
Azoles: Itraconazole a/e?
Transient cardiac suppression (resolves in 12 h) - AVOID HF pts or ventricular dysfx
LIVER FAILURE
Interacts with many drugs
Echinocandins: Caspofungin tx?
Treats aspergillus and candida, highly protein bound
Echinocandins: Caspofungin a/e?
AVOID IN PREGNANCY (cat C)
Phlebitis, histamine release
Pyrimidine Analog: Flucytosine spectrum, use, a/e?
NARROW spectrum for severe infx caused by candida
USED WITH amphotericin B – ENHANCES ANTIFUNGAL ACTIVITY
a/e: myelosuppression and agranulocytosis
Ringworm:
What is…
- Tinea pedis?
- Tinea corpis?
- Tinea cruris?
- Tinea capitis?
- Candidiasis?
- Onychomycosis?
- athletes foot
- ringworm
- jock itch
- scalp worm
- oral or vulvovaginal
- nail fungus
What medication can you use for superficial mycoses?
Griseofulvin
What does Griseofulvin do? What can decrease effect?
Inhibits fingal mitosis
if a pt is on warfarin
Mycoses and anti-fungal considerations across the life-spain?
- Infants?
- women?
- older adults?
- nystatin (oral) and fluconazole (systemic)
- azoles are cat C and D - BFing moms AVOID ketoconazole d/t hepatotoxicity
- drugs interact with warfarin, hypoglycemic agents, and phenytoin
