AntiFungal and AntiViral Flashcards
Amphotericin B
Cidal Anti Fungal alters cell wall by binding ergosterol; used as initial induction therapy for serious systemic infections follows up by chronic therapy with less toxic agents (azoles etc)
Amphotericin B toxicity
Initial infusion reactions; dose limiting nephrotoxicity; thrombophlebitis
Nyastatin
similar to amphotericin but more toxic, no bioavailability after oral dosing, TOPICAL use for oral thrush (mouth wash) vaginal Candida (creams)
Fluconazole
PO IV; widely used, high bioavailability, well tolerated, renal elim., broad but NOT active against aspergillus or mucomycosis; crosses BBB, has some interactions via CYP P450 but less than other azoles
Azoles
Inhibit ergosterol synthesis disrupts membrane function and increases permeability
Intraconazole
wider spectrum than Fluconazole, less oral bioavailability, azole of choice for histoplasma, blastomyces, sporothrix, *active vs Aspergillus, widely used for onychomycoses (this is bolded)
Voriconazole
Rx of choice for invasive Aspergillus, inhibits metabolism of many drugs
Posaconazole
Most fungi causing mucormycosis (infection of sinus brain or lungs)
Clotrimazole
no oral bioavailabilitym OTC for topical for dermatophyte infections
Tebenafine
allylamine that inhibits ergosterol synthesis by blocking squalene epoxidase, topical or PO for dermatophytoses no drug interactions, deposits in hair and nails
Flucytosine
Pro drug related to 5-FU (fluorouracil) static or cidal; selective conversion by fungus into 5-FU by fungal cytosine deaminase not present in mammalian cells; limited spectrum cryptococcus, chromoblastomycosis, some candida; used with amphotericin B for cryptococcal meningitis, may be synergistic with amphotericin or azoles, bone marrow depression, diarrhea, colitis, hepatitis
Echinocandins (caspofungin, micafungin, anidulafungin)
semi synthetic lipopeptides; IV only; aspergillus and candida; empiric regimens for febrile neutropenia, very well tolerated
