Antifungals Flashcards
Amph B SE
Azolemia: increased creatinine
Nephrotoxic
Can lead to irrevers kidney damage
Amphotericin B
Broad
Systemic
No CSF
Azolemia is a side effect of
Amph B
increased creatinine
Does renal and hepatic impairement interfere with Amph B dosing?
No
Amph B MOA
binds to ERGOSTEROL (but doesn’t inhibit its synthesis) - and creates pores - depolarization)
Depolarization of bacterial membrane is MOA of 2 drugs:
Amph B and Daptomycin
Flucocytosine (+Amp B) is DOC for
Cryptococcus
Flucytosine MOA
prodrug converted to 5FC -> inhibits DNA and RNA synthesis -> CIDAL????
which drugs penetrate CSF?
Flucocytosine
Fluconazole
Depressed bone marrow is SE of 2 drugs:
anemia, leukipenia, thrombocytopenia
Flucocytosine
Cloramphenicol
2 major side effects of Flucocytosine
Depressed bone marrow (anemia, etc)
Increased liver enzymes: ALT AST (reversed if stop tx)
Ketoconazole 2 main SE
Gynecomastia: inhibited adrenals and testes (breasts in males)
High drug interactions bc it inhibits P450 leading to other drugs accumulating in the system
Ketoconazole MOA
Inhibits SYNTHESIS of ergosterol -> increased permiability and decreased fungal growth -> static
Fluconazole DOC or good for
fungal meningitis
Good CFS
Voriconazole (+ Amp B) is DOC
Invasive Aspergillus
but… invasive aspergillus in refractory pts is tx’d by CASPofungin
Voriconazole SE
VISUAL
High drug interactions: it inhibits P450 and is metabolized by P450
Polymorphism to Gene: High met’m= low [ ]
Low met’m=high [ ]
Visual side effect is seen in
Voriconazole
reversible
Vori and Intraconaoles are metabolized by
Liver
Echinocandins are and MOA
fungins
MOA: inh synthesis of B (1,3) D-Glucan (component of CW) -> CIDAL
What is the DOC for invasive Aspergillus in refractory pts
CASPAfungin
which drug has low drug interactions and no kidney toxicity
CASPAfungin (very attractive option)
but can have elevated liver enzymes
Cleared by liver
Mica(fungin) and ANIdul(fungin) are similar to
Caspofungin
Griseofulvin DOC for
ONYCOmycosis
Ring worm/dermatophytosis
2 SE of griseofulvin
Acute intermittent PORPHYRIA (increased heme and not made properly) Liver Failure (don't give to pts with liver failure)
excreted: feces
griseofulvin DOC
- binds to microtubules of fungi->destroys mitotic spindle -> STATIC
- binds to keratin in skin (food source for fungi)
Turbanalene MOA
inhibits converstion of squalene to ERGOSTEROL (inh sterol synthesis) -> CIDAL
(increased squalene is toxic to fungi)
Nystatin is primarily used for (but DOC is different)
GI Candida (orally) and topical candida
DOC: CAspafungin OR (and?) Amph B
Is GI candida same as systemic candida?
POLYENE AB (like Amp B)
