Antifungals Flashcards
What antifungals are used to treat aspergillosis (first line)
Voriconazole, amphotericin
What antifungals are used to treat aspergillosis (intolerant to first-line)?
Caspofungin, itraconazole, posaconazole
First line and alternatives to treat vaginal candidiasis treatment?
Fluconazole (first line) or itraconazole or voriconazole (if resistant)
What is used to treat invasive or disseminated candidiasis?
Echinocandin
What is used to treat CNS candidiasis?
Amphotericin
What is the treatment for cryptococcosis mengingitis?
Amphotericin and flucytosine for 2 weeks then oral fluconazole for 8 weeks
What is the treatment for histoplasmosis (non-meningeal and severe)?
Itraconazole (non-meningeal) or amphotericin (severe) followed by itraconazole
Can oral terbinafine be used for pityriasis versicolor?
No
What is used to treat for tinea capitis and onychomycosis?
Griseofulvin, triazole antifungals, oral imidazole and terbinafine
What is used to treat prophylaxis in immunocompromised patients (fungal)?
Fluconazole (not against Aspergillus spp.), itraconazole (effective against Aspergillus)
What is caspofungin not effective against?
Fungal infections of the CNS
What can fluconazole be used to treat?
Fungal meningitis and candiduria (excreted largely unchanged in the urine)
When should itraconazole be avoided?
In patients with liver damage
What is posaconazole used to treat?
Invasive fungal infections unresponsive to conventional treatments
What is voriconazole used to treat?
Life-threatening fungal infections
What medications belong to the class of amidazole antifungals?
Clotrimazole, econazole, ketoconazole, ticonazole and miconazole
What are amidazole antifungals used to treat?
Vaginal candidiasis and dermatophyte infections
List polyene antifungals.
Amphotericin and nystatin
What cautions should be taken with amphotericin’s formulation?
There are lipid formulations of amphotericin as well as a conventional formulation. Lipid formulations are less toxic. The conventional formulation is associated with nephrotoxicity. These formulations are NOT interchangeable.
List echinocandin antifungals.
Caspfungin and micafungin
What are echinocandin antifungals used against?
Asperigillus spp. and Candida spp. They are not effective against fungal infections of the CNS.
Caspofungins are recommended to be used with what type of drugs?
Enzyme inducers such as carbamazepine, dexamethasone, phenytoin and rifampicin
What dose adjustments are recommended with caspofungin?
Half the dose in moderate (renal) impairment
What are the indications of amphotericin?
Aspergillosis, severe invasive candidiasis, cryptococcal meningitis and disseminated cryptoccocis in HIV patients
What are the monitoring requirements for amphotericin?
Hepatic and renal function tests, blood counts, and plasma electrolyte (including plasma-potassium and magnesium concentration)
When should amphotericin be discontinued?
Abnormal hepatic function
What is the licensing for fluconazole capsules OTC?
Age: 16-60
Indication: Vaginal candidiasis and candidal balanitis
Dose/container: 150mg, max dose of 150mg.
What are the indications of fluconazole?
Vaginal candidiasis, candidal balanitis, mucosal candidiasis, dermal candidiasis
Invasive candidal infections
Cryptococcocal infections (including meningitis)
Tinea pedis, corporis, cruris
What are the indications of isavuconazole?
Invasive aspergillosis
What are the indications of itraconazole?
Aspergillosis Histoplasmosis Cryptococcosis (inc. meningitis) Onychomycosis Pityriasis versicolor Systemic candidiasis Oral or oesophageal candidiasis in HIV+ Tinea pedis and manuum (30 days/7 days) Tinea corporis and cruris (15 days/7 days)
What should patients be advised when taking itraconazole?
Seek prompt medication attention if symptoms such as anorexia, nausea, vomiting, fatigue, abdominal pain or dark urine develop (indicative of liver disorder)
