antifungals Flashcards
list the antifungal classes
- polyenes
- azoles
- echinocandins
- terbinafine
- griseofulvin
- topical antifungals
list the polyenes
amphotericin B
nystatin
list the azoles
fluconazole
itraconazole
voriconazole
prosaconazole
list the echinocandins
corspofungin
andidulafungin
micafungin
list the topical antifungals
azoles: cotrimazole
hydroxy pyridones: ciclopirox
thiocarbamate: tolnafate
azoles MOA
inhibit synthesis of ERGOSTEROL via inhibition of lanosterol C14-demethylase
inhibits CELL WALL SYNTHESIS
protens CYP450 INHIBITOR
indications for azoles
UNCOMPLICATED systemic infections in immunocompromised patients
CANDIDA (fungistatic) aspergillus (fungicidal) CRYPTOCOCCUS blastomycosis coccidioimycosis histoplasmosis
why is fluconazole good for UTIs?
because it is renally eliminated and achieves reliable urinary concentration
which drug causes phototoxicity
voriconazole (azole)
what is a consideration with azoles RE: interactions
azoles are potent CYP3A4 inhibitors
echinocandin MOA
inhibit synthesis of GLUCAN SYNTHASE which is an essential component of cell wall synthesis
inhibition of glucan synthase weakens the fungal cell wall and results in lysis
echinocandin indications
for SEVERE INVASIVE CANDIDA (on which it is fungicidal)
aspergillis infection (fungistatic)
NOT renally eliminated
IV admin only
caspofungin requires hepatic dosage adjustment
polyenes MOA
bind to ERGOSTEROL in cell membrane resulting in development of PORES in fungal membrane
this disrupts the cell wall permeability and results in cell death
polyenes indications
serious, INVASIVE/SYSTEMIC fungal infections
Amphotericin B: poor CSF penetration but effective for aspergillus, invasive candida and cryptococcal meningitis
Amphotericin B: vitreal and urine penetration–NOT renally eliminated–IV only
Nystatin: good for candida–local/topical only because HIGHLY TOXIC in IV form
terbinafine MOA
inhibits ERGOSTEROL synthesis via inhibition of SQUALENE OXIDASE
distrubutes mainly to sebum and skin
