Antifungals

Question 1

Polyenes (amphotericin B)

Answer 1

MOA: interact with ergosterol in fungal membranes to form artificial pores
Indication: broad spectrum and DOC for severe infections caused by aspergillus, candida, cryptococcus, and histoplasma
AEs: infusion related rxns bc given IV (HA, fever, myalgia, chills), nephrotoxic (give w saline), hypokalemia, hypomagnesemia

Question 2

5-FC aka 5-flucytosine

Answer 2

MOA: penetrates cell wall and deaminated by cytosine deaminase to 5-FU which inhibits RNA and DNA synthesis
AEs: hematologic toxicities (anemia, leukopenia, thrombocytopenia)

Question 3

Azoles (fluconazole, voriconazole, posaconazole, isavuconazole)

Answer 3

MOA: blocks conversion of lanosterol to ergosterol
Class AEs: n/v, hepatotoxic
- Fluconazole= causes GI w chopped lips
- Voriconazole- causes visual disturbances
Drug interactions w CYPs and all are PO or IV formulations

Question 4

Echinocandins (micafungin, caspofungin, anidulafungin)

Answer 4

MOA: inhibit beta-glucan synthase enzyme
AEs: some histamine release (flushing, HA, urticaria, pruritus) but minor
Note: all are IV formulation

Question 5

Terbinafine

Answer 5

MOA: inhibits squalen-epoxidase
Uses: dermatophyte skin infections (tinea) esp w fingers or toenails
AEs: taste, GI, hepatotoxicity, headache

Question 6

What are indications for fluconazole?

Answer 6

Only for yeast infections–> candida and cryptococcus

Question 7

What are indications for voriconazole?

Answer 7

Used for yeast (candida, cryptococcus) and some mold infections (aspergillus)

Question 8

What are indications for posaconazole?

Answer 8

Wide variety of yeast and mold infections (candida, cryptococcus, aspergillus, mucorales)

Question 9

What are indications for micafungin?

Answer 9

Used specifically for yeast (candida) and mold (aspergillus)

Question 10

What are indications for 5-FC and ampho?

Answer 10

Only yeast for one type of yeast infection which is cryptococcus