Antifungals Flashcards
What are the classes of Antifungals?
Polyenes, Azoles, Antimetabolites, Allylamines, Echinocandins
What medications belong in the Polyenes class?
Amphotericin, Nystatin
What medications belong in the Azoles class? (a lot)
Fluconazole, Itraconazole, Voriconazole, Posaconazole, Isavuconazonium sulfate, Ketoconazole, Efinaconazole (Terconazole, Butoconazole, Clotrimazole, Miconazole nitrate, Triconazole)
Which medications belong to the Allylamine class? What are they most commonly used for?
Terbinafine, Nafifine, Butenafine; SKIN
Which medications belong to the Antimetabolite class?
Flucystosine
Which medications belong in the Echinocandins class?
Caspofungin, Anidulafungin, Micafungin
Why is Amphotericin called Amphoterrible?
Because it has so many adverse drug reactions
What is Amphotericin indicated for?
progressive, potentially life threatening fungal infections, disseminated candidiasis in immunocompromised patients, meningitis
What is Amphotericin a second line treatment for?
aspergillosis and leishmaniasis
What is a benefit of Amphotericin in regards to its spectrum?
It is the broadest spectrum of the antifungals
What does Amphotericin bind to in fungal cells that allows it to damage cell membranes?
Ergosterol
Is Amphotericin fungicidal, fungistatic, or both? What does that depend on?
both; concentration of medication in tissues and susceptibility of organism
What are some warnings or precautions that you should make sure to inform any patient of before prescribing them Amphotericin? What is a warning and precaution that you as a prescriber should pay attention to when writing out this Rx?
Pregnancy Category B
Nephrotoxicity (can cause permanent damage)
As a prescriber, beware of confusing Amphotericin B with Amphotericin B Liposomal (Ambisome) in cancer patients/infectious disease.
What can be done to prevent nephrotoxicity when prescribing patients Amphotericin?
close monitoring, interrupt therapy, decrease dosage, and increase dosing interval (also hydrate and replenish Na+)
What are some of the many Adverse Drug Reactions of Amphotericin?
Infusion reactions, anaphylaxis, leukoencephalopathy, HA, NVD
What can you do to avoid an infusion reaction in patients who are being administered Amphotericin?
premedicate and run the dose slowly (fast infusion can cause hypotension, hypokalemia, arrhythmia, and shock)
Amphotericin is excreted (quickly/slowly) by the ____
slowly (weeks to months); kidneys
Amphotericin is highly _____-bound
protein
Nystatin works by binding to ergosterol in fungal ____ _____
cell membranes
Nystatin is fungistatic, fungicidal, or both?
both
Nystatin should be prescribed to patients who have extreme ____ ____, oral ___, and ____ candidiasis.
diaper rash; candidiasis; vulvovaginal
When being prescribed to patients with extreme diaper rash, Nystatin is commonly combined with ___ to increase its effectiveness, even though the combination of an anti-fungal with a ____ medication is commonly contraindicated.
triamcinolone; steroid
Nystatin is a pregnancy category ___ medication.
C
Some ADRs of nystatin include
Common: NVD, cramps, rash, hypersensitivity and Rare: Stevens Johnson Syndrome, urticaria
Nystatin is excreted unchanged in the ___, so it does not affect the ____ .
feces; kidneys
All Azoles are ___ inhibitors, that increase the permeability of the fungal ____ ___, resulting in cell death.
CYP 450; cell membrane
Azoles are fungistatic, fungicidal, or both?
both
Fluconazole is most commonly indicated for use against:
YEASTS!, candidiasis, and cryptococcal meningitis
Fluconazole can be used off label to treat:
cryptococcal PNA
Fluconazole’s dosage should be adjusted in patients who have ___ issues
renal
ADRs of a majority of Azoles include:
QT prolongation and arrythmias
Fluconazole has a (long/short) half life
long
Itraconazole has a broader spectrum, and in addition to yeasts, can be used to treat ___, such as ____.
mold; histoplasmosis
Itraconazole can be used to treat ___ in patients who did not respond well to Fluconazole originally.
oropharyngeal/esophageal candidiasis
Itraconazole can be used to treat ___ as a 2nd line option
aspergillosis
Itraconazole is a pregnancy category ___
C
Voriconazole, like itraconazole, is of broad spectrum, and covers infections due to both ___ and ___
yeasts and molds
Voriconazole is the drug of choice (DOC) for treating____
invasive aspergillosis
Voriconazole is a pregnancy category ___
D
When adminstering Voriconazole IV, we should be concerned for the patient’s ____ function
renal
_______ is the broadest spectrum -azole and covers yeast and mold
Posaconazole
Posaconazole is best for the treatment of aspergillum and candida in patients who are ___
immunocompromised
Posaconazole can be used to treat yeast infections in patients where there has been resistance to ____
fluconazole
Isavuconazonium sulfate is a ___ that is used for specific ___ infections, such as ___ and ____
prodrug; fungal; aspergillosis and mucormycosis
The only thing that we really need to know about ketoconazole is that it is ____
not used anymore due to too many ADRs
Efinaconazole is administered (PO/IV/topically/IM)
topically
Efinaconazole is indicated for patients who have ___
onychomycosis
Beware, if using efinaconazole, a patient may develop ___
an ingrown toenail, and application site irritation
How many weeks does it take for efinaconazole to take full effect?
48 freaking weeks
Terbinafine, Naftifine, and Butenafine are all ___, and are indicated for the treatment of ___
allylamines; onychomycosis, tinea cruris/pedis/corporis
Terbinafine is fungicidal/fungistatic/both
fungicidal
What are some ADRs of terbinafine?
diarrhea, abd pain, LFT abnormalities, and dysgeusia
Rare: Stevens Johnson, TEN
Terbinafine is ___ soluble and thus distributes well into the ___, ___, and ___
lipid; nails, skin, fat
ADRs of Naftitine and Butenafine include
burning, stinging, itching, rash
Flucytosine must be _____ due to resistance
used in conjunction with other drugs
Flucytosine is an ____ drug that inhibits ___ and ___ synthesis
antimetabolite; fungal protein synthesis and DNA synthesis
Flucytosine is indicated for ___ and is sometimes used as a chemotherapy agent
very severe Fingal infections (candida, strep, crytococcus meningitis)
Flucytosine is a pregnancy category ___
C
Taking flucytosine can cause
NVD, rash, elevated LFTs
Echinocandin medications work by ____
weakening fungal cell wall
Echinocandins are used to treat ___ infections
severe, invasive fungal infections such as candida and aspergillus
ADRs of echinocandins include
NVD, infusion reactions
The really super duper thing about Echinocandins that makes Dr. Murfin really excited is that fact that Echinocandins do NOT have ____
P450 interactions (doesn’t cause drug interaction problems)
Cyclopirox is indicated for use in patients with ___ infections
dermatophyte (tinea, onychomycosis, candida)
Ciclopirox is fungicidal/fungistatic/both
fungicidal
Ciclopirox is a pregnancy category ___
B :)
Tavoborole inhibits_____
fungal protein synthesis
Using Tavoborole topically can cause ADRs such as ____
application site exfoliation, erythema, dermatitis, and ingrown toenail
