Antifungals Flashcards
DOC for superficial mycoses
topical Clotrimazole (Lotrimin)
Amphotericin B class
polyenes
antifungal
Amphotericin B MOA
Binds to ergosterol in fungal cell membrane forming pores; increased permeability –> cell death
Gold standard antifungal tx
Amphotericin B (IV)
**broadest spectrum of activity - works against all clinically significant yeasts (candid, histoplasma, aspergillus)
Amphotericin B toxicities
“shake and bake”
- infusion-related
- cumulative toxicity (renal damage)
(can pre-medicate with antihistamines, antipyretic, corticosteroids)
Azole Antifungals MOA
- inhibit cytochrome P450
- block formation of ergosterol
- slow-killing, considered “static” drugs
What is the MC imidazole drug (azole antifungal)?
Clotrimazole (topical only)
What is the MC triazole drug (azole antifungal)?
Fluconazole
Azole Antifungal ADRs
1) GI upset
2) Hepatitis (LC)
Azole Antifungal interactions
1) Drug interactions through the cytochrome P450 system of enzymes
2) increase levels of warfarin
What is the MC used systemic antifungal?
Fluconazole
Fluconazole is extremely active against ________
C. albicans
Echinocandins MOA
cause disruption of the fungal cell wall causing cell death
Echinocandins includes which drugs
Caspofungin
Micafungin
Anidulafungin
Echinocandins spectrum
Candida, Aspergillus, Pneumocystis
these drugs are IV only
Echinocandins s/e
mild GI and flushing
What is/are the DOC for superficial mycoses
1 topical Clostrimazole (Lotrimin)
other commonly used are: topical Nystatin (Mycostatin) and oral Terbinafine (Lamisil)
T/F: topical administration is not successful for nails and hair
TRUE
must take oral Rx
Clotrimazole (Lotrimin) Class
Antifungal (Azole)
Clotrimazole (Lotrimin) indication
superficial mycoses - tinea, yeast vaginitis, oral thrush
Clotrimazole (Lotrimin) MOA
binds to ergosterol molecules on fungal cell membrane and causes membrane leakage during cell division
Nystatin (Mycostatin) indication
superficial mycoses - tinea; oral, esophageal and vaginal Candida
Nystatin (Mycostatin) MOA
binds ergosterol molecules on fungal cell membrane resulting in loss of membrane integrity and death of fungal cell
________ is often used as prophylaxis in pt. who are at risk for fungal infx, such as AIDS pt with a low CD4 count and pt. receiving chemotherapy
Nystatin
Terbinafine class
antifungal (synthetic allylamine)
Terbinafine MOA
interferes with ergosterol biosynthesis
Terbinafine indications
used primarily for dermatophyte (nail/skin) infx
Terbinafine is given continuously for _______ to treat fingernail infx and _______ to treat toenail infx
6 weeks
12 weeks
Terbinafine s/e
MC = abdominal discomfort, diarrhea, nausea, HA
LC = elevated liver enzymes, hepatitis, liver damage, liver failure
