Antimicrobials: Antifungal Medications Flashcards
Amphotericin is an
anti-fungal
Fungal cell membranes are composed of ________ not your usual cholesterol
ergosterol
amphotericin and nystatin bind
amphotericin and nystatin bind ergosterol to form holes in the fungal cell membrane
amphotericin treats
severe systemic fungal infections
IV administration of amphotericin is used for
treatment of severe systemic fungal infections
What decreases amphotericin toxicity
liposomal formulations of amphotericin prevent binding to human cholesterol membranes (decreased toxicity)
amphotericin toxicity results from
amphotericin toxicity results from non-selective binding to mammalian cholesterol membranes
What are immediate infusion-related toxicities of amphotericin
- hypotension
- headache
- fever
- chills
- thrombophlebitis
intrathecal administration of amphotericin to treat
fungal CNS infections
intrathecal administration of amphotericin can cause
seizure and other CNS side effects
______ is a cumulative toxicity of amphotericin
renal tubular acidosis (RTA) type 1
RTA type 1 is associated with
hypokalemia
amphotericin can cause
hypomagnesemia (due to renal magnesium wasting)
amphotericin can cause hypomagnesemia due to
renal magnesium wasting
volume expansion with IV normal saline before amphotericin administration prevents
kidney damage
___________ with IV normal saline before amphotericin administration prevents kidney damage
volume expansion
amphotericin induced damage to renal tubular cells can cause
anemia
amphotericin induced damage to renal tubular cells can cause anemia due to
decreased erythropoietin production
flucytosine is an
anti-fungal
cytosine deaminase in fungal cells converts
cytosine deaminase in fungal cells converts flucytosine (a fluorinated cytosine) into 5-fluorouracil (5-FU)
flucytosine halts
flucytosine halts fungal DNA and RNA synthesis
flucytosine and amphotericin combo treats
Cryptococcus infections (e.g. cryptococcal meningitis)
___________ combo treats cryptococcal meningitis
flucytosine and amphotericin combo treats cryptococcal meningitis
nystatin mechanism
nyastatin has the same mechanism of action as amphotericin
nystatin treats
Candida infections (candidiasis)
topical nystatin treats
mucocutaneous candidiasis (e.g. vaginal candidiasis)
oral nystatin rinse treats
oropharyngeal candidiasis
Cone-azole antifungals include
- voriconazole
- fluconazole
- itraconazole
- clotrimazole
- miconazole
- ketoconazole
_______ comprises the fungal cell membrane
ergosterol
_______ antifungals inhibit the synthesis of ergosterol
azole
azole antifungals inhibit the synthesis of
ergosterol
azole antifungals inhibit the conversion of
lanosterol to ergosterol
azole antifungals inhibit
- the synthesis of ergosterol
- conversion of lanosterol to ergosterol
- fungal cytochrome P-450
Voriconazole inhibits
mammalian cytochrome P-450
voriconazole side effects
- blurry vision of flashes of light
2. cause changes in color vision
voriconazole treats
- invasive aspergillosis (caused by Aspergillus fumigatus)
- Candida infections (e.g. esophageal candidiasis)
- Cryptococcus infections (e.g. cryptococcal meningitis)
fluconazole treats
Candida infections (e.g. mucocutaneous candidiasis)
fluconazole treats what type of candida infection
mucocutaneous candidiasis
voriconazole treats what type of candida infection
esophageal candidiasis
one-time oral dose of fluconazole treats
vaginal candidiasis
_______ treats vaginal candidiasis
one-time oral dose of fluconazole treats vaginal candidiasis
systemic fluconazole treats
esophageal candidiasis
fluconazole has high levels of
fluconazole has high levels of CNS penetration (treats cryptococcal meningitis)
itraconazole is an
azole antifungal
itraconazole treats
- systemic infections with dimorphic fungi (e.g. histoplasmosis, blastomycosis, coccidioidomycosis, sporothrix)
- onychomycosis and dermatophytosis
itraconazole treats systemic infections with
dimorphic fungi (e.g. histoplasmosis, blastomycosis, coccidioidomycosis, sporothrix)
itraconazole treats what diseases
onychomycosis and dermatophytosis
Dermatophytes are
tinea
What drugs are used to treat tinea infections (dermatophytosis)
- topical miconazole
2. topical clotrimazole
clotrimazole and miconazole treat
vaginal candidiasis
topical ketoconazole treats
dermatophytosis(e.g. tinea corporis)
ketoconazole inhibits
- 17,20-desmolase (the first step of steroid hormone synthesis from cholesterol)
- production of androgens and estrogens
3.
Ketoconazole can cause
anti-androgenic side effects (e.g. gynecomastia)
dermatophytes include
tinea corporis, tinea pedis, and tinea cruris
griseofulvin is an
antifungal agent
oral griseofulvin treats
dermatophytosis
oral griseofulvin and terbinafine are first line therapy for
tinea capitis in children
griseofulvin binds
griseofulvin binds fungal cell microtubules, halting mitosis
griseofulvin activates
cytochrome P-450
terbinafine is an
anti-fungal agent
topical terbinafine is used to treat
tinea infections (e.g. dermatophytosis)
oral terbinafine treats
onychomycosis
terbinafine inhibits
terbinafine inhibits fungal squalene epoxidase causing accumulation of squalene
Terbinfine side effects
- GI side effects
2. hepatotoxicity
echinocandins are
caspofungin, micafungin, anidulafungin
echinocandins act at the
echinocandins act at the fungal cell wall
echinocandins inhibit
echinocandins inhibit the synthesis of beta-1-3-glucan in the fungal cell wall
echinocandins have excellent activity against
Candida infections (e.g. mucocutaneous candidiasis)
echinocandins are delivered IV for
systemic Candida infections (e.g. candidemia)
echinocandins are delivered
IV for systemic Candida infections (e.g. candidemia)
echinocandins treat
- esophageal candidiasis
2. invasive aspergillosis (caused by Aspergillus fumigatus)