Antifungals

Question 1

Echinocandins (Caspofungin, Micafungin, Anidulafungin (IV)

Answer 1

1. Cell-wall inhibitor, inhibits B-1,3-D-glucan synthesis
2. Use for Invasive Candida (esophagitis), candidemia and Invasive Aspergillus
3. Don’t use for C. neoformans and endemic fungi

Question 2

Ampho B, Nystatin

Answer 2

1. Binds and forms pore at ergosterol
2. Broad spectrum: Use for Cryptococcal meningitis, mucormycosis, resistant Candida, serious endemic
3. Nephrotoxicity, ototoxicity, electrolyte changes, infusion-related toxicity

Question 3

Fluconazole

Answer 3

1. inhibits ergosterol synthesis at 14α-demethylase step
2. Use for yeasts and endemic fungi. Cryptococcus at maintenance phase.
3. Don’t use for Candida krusei
4. hepatitis, long QT, CYP 450 inhibition

Question 4

Endemic fungi treatment

Answer 4

Ampho B + azoles (vori-, posca-, itra-), Fluconazole for CNS cocci

Question 5

Voriconazole, Posaconazole, Isavuconazole

Answer 5

1. inhibits ergosterol synthesis at 14α-demethylase step
2. Use for molds (asp. fumigatus), endemic
3. Visual changes (vosi), hepatitis, long QT, CYP 450 inhibition

Question 6

Cryptococcus neoformans treatment

Answer 6

Ampho B + Flucytosine (induction)

Fluconazole (maintenance)

Question 7

Flucytosine

Answer 7

1. Chain terminator; 5-FU disrupts pyrimidine synthesis
2. Use for Cryptococcus neoformans (together with Ampho B)
3. Do not use alone
4. BM suppression (cytopenia)