AntifungalsSH1 Flashcards
Amphotericin B
MOA: binds to ergosterol of fungal wall/cell membrane
**SE:
Infusion related shaking, chills, hypotension, NEPHROTOXICITY , decrease k, decrease Mg
Premedicate: apap, Benadryl, hydrocortisone, meperidine ( shaking and chills )
In your head think ampho D ( d for D5W ). Like Dactrim ( bactrim mixed in D5W)
Lipid formulation more expensive but less toxic
Azole Antifungals
Fluconazole, itraconazole , Ketoconazole, voriconazole, Isavuconazonium
MOA: inhibit Cyp450 dependent ergosterol synthesis
SE: hepatoxicity , fluconazole and itraconazole ( cross BBB HA vertigo )
DDI: cyp450 3a4 inhibitors Ketoconazole and Itraconzole : increase INR
Need acidic environment ( oral itraconazole & Ketoconazole ): with food
Fluconazole
Diflucan
PO, suspension, IV
Indications : vaginal candidiasis, Oropharyngeal / esophageal candidiasis, systemic candidiasis, coccidiodomycosis, cryptococcal meningitis
Pregnancy: single 150 mg dose is category C, all other category D. CDC recommends only using topical Antifungal
Itraconazole
Sporanox ( L/ C ) goes through liver, pregnancy category C
Indications: Onychomycosis, Asperiguillus coverage ** ( recall amphotericin B and itraconazole ) , Oropharyngeal / esophageal candida.
SE: hepatoxicity, negative Inotrope ( avoid in CHF ), edema, HTN, hyopkalemia, CNS, GI
Contraindications : felodipine, dofetilide, ergot alkaloids, lovastatin, simavsatin, PO Midazolam, triazolam, methdone
Ketoconazole
Nizoral
1% / 2% shampoo, cream; tabs 200 mg
Dose:
-tinea versicolor: 2% shampoo
-dandruff
Systemic fungal infection
SE: suppresses testosterone. LT use : gyencomastia, suppresses cortisol ( Cushings tx )
With food
Voriconazole
Vfend ( L/ D)
** Indication: aspergillosis ( like itraconazole and ampho B ). DOC is voriconazole
Empty stomach : 1 hour before meal s
Warnings: Monitor vision with tx > 28 days, photosensitive, CNS, LFT, QT
V👀RIC☀️AZOLE
Isavuconazonium
Cresemba
Indications: Aspergillosis * , mucormycosis
Contraindications: major cyp3a4 substrate,
Monitor LFT
Caspofungin
Cancidas
MOA: inhibit synthesis of glucan, component of the fungal cell wall.
Indication: invasive Aspergillosis
Dilution with NS or LR ( lactated ringers )
Andulafungin
Eraxis
MOA fungal cell formation inhibition
IV only
SE: histamine reaction give it slow
D5W or NS
Posconazole
Noxafil ( susp , po , IV)
Indications: prevention and treatment of invasive aspergillosis and candida
IV: avoid in renal impairment ( avoid if CrCl < 50)
With food: with high fat meal
SE: hepatoxicity, hypokalemia, LFT , QT
DDI: tacrolimus ( reduce by 66%)
Clotrimazole
Forms: creams, lozenges, gyne-lotrimin -yeast , vaginal tablet for yeast
Can be used in first trimester of pregnancy.
Nystatin
DOC : thrush
Swish and swallow for thrush tx. No systemic abs but slight GI upset. 5 ml swish and swallow
400,000, - 600,000 units 4 times a day
Can give to infants for oral thrush
Contains alcohol
SE: not absorbed but N/V/D GI
Candidiasis
Oral thrush:
Mild: swish and swallow nystatin QID 7-14 days,
-clotrimazole torches 5 times a day
- Fluconazole QD 7-14 days, if more severe
Uncomplicated vaginal candidiasis:
OTC or Rx fluconazole 150 mg ( single dose ). They all have similarly efficacy and work equally fast
Miconaozle
MOA: ergosterol synth inhibition
Used for Tinea corpis, , tinea pedis , vulvovaginal candidiasis, BUT NOT used for onchomycosis
Terbinafine
Lamisal - L For LFT monitor
Onychomycosis: one of the first line therapies
Lamisil 1% cream ( OTC ) : QD/BID for 1-4 weeks
