Antifungals Flashcards
topical antifungals - uses
*superficial mycoses
*vulvovaginal candiasis
*thrush
topical antifungals - benefits
*safe and generally effective
amphotericin B - mechanism of action
*binds to ergosterol in the cell membrane of yeasts and some molds, increasing cell permeability
amphotericin B - overveiw
*IV only
*broad spectrum of activity
amphotericin B - indications
deep-seated or systemic fungal infections
-yeasts (candida, cryptococcus)
-dimorphic fungi
-aspergillus
amphotericin B - problems
*NEPHROTOXICITY (dysfunction of PCT of kidney)
*infusional toxicity
flucytosine - overview
*pyrimidine analog
*given orally
*ALWAYS given WITH AMPHOTERICIN
flucytosine - mechanism of action
*inhibits RNA and DNA synthesis (b/c its a pyrimidine analog)
flucytosine - indications
*cryptococcal infections (given w/ amphotericin, esp in HIV patients)
azole class - mechanism of action
*interferes with synthesis and permeability of fungal cell membranes through inhibiting fungal p450 and synthesis of ergosterole
fluconazole - spectrum
*YEASTS only (candida, cryptococcus, coccidioidomycosis)
*NOT C. krusei (resistant)
fluconazole - benefits
*EXCELLENT penetration into CSF for fungal infections (crypto meningitis)
*IV and oral
fluconazole - resistance to what organisms
*intrinsic: ALL C. krusei, many C. glabrata
*acquired: C. albicans
itraconazole - indications
*mostly the dimorphic fungi
*activity against molds
voriconazole - indications
*yeasts AND molds (especially ASPERGILLUS)
voriconazole - side effects
rash, hepatitis, visual disturbances, heart dysrhythmia
isavuconazole - indications
*yeasts and molds, especially good for mucormycosis
echinocandins - examples of drugs
- caspofungin
- micafungin
echinocandins - mechanism of action
*inhibits 1,3-beta-glucan synthetase (key cell wall component)
echinocandins - indications
*activity against candida and aspergillus
*NO activity against crypto
*drug of choice against resistant candida infections
terbinafine - mechanism of action
*an analymine, which inhibits SQUALENE EPOXIDASE, thereby inhibiting ergosterol synthesis for the fungal cell membrane
terbinafine - indications
onchomycosis of toenails/fingernails (must be given for a long time)
therapy for pneumocystis jirovecii
primary therapy = TMP/SXT (trimethoprim/sulfa) NOT ANTIFUNGAL
do we use antifungals for pneumocystis jirovecii
NO, we actually use an antibacterial
posaconazole - indications
*yeasts AND molds, including mucormycosis
