Drugs Three Last Time Flashcards
RIP Etika
Amphotericine B mechanism of action
Bind ergosterol and disrupt fungal cell membrane by making it leak intracellular content especially K+
Example of polyene antibiotic
Amphotericin B
Amphotericin B spectrum
Broad for fungi such as histoplasma, cryptococcus, candida, DOC for most systemic mycoses in life threatening fungal infections especially
Amphotericin B ADRs
Renal toxicity, infusion related thrombophlebitis
Amphotericin B resistance
Very rare, only after long term exposure fungi reduce ergosterol content in cell membrane
Amphotericin B drug interactions
Use with other nephrotoxic drugs increases risk of injury to the kidneys
Flucytosine is almost always used in combo with…
…amphotericin B
Flucytosine spectrum
Narrow, candida and cryptococcus species
Flucytosine mechanism of action
Taken up by cell and converted via cytosine deaminase to 5-fluorouracil that then disrupts DNA and RNA synthesis (only in organisms that have cytosine deaminase, humans and many fungi do not)
Flucytosine absorption
GI route
Flucytosine ADRs
- Hematologic bone marrow depression
- Hepatotoxicity
Example of pyrimadine analog
Flucytosine
Examples of azoles
- Fluconazole
- Itraconazole
- Ketoconazole
- Posaconazole
- Voriconazole
- Isavuconazole
Azoles mech of aciton
Inhibit synthesis of ergosterol disrupting fungal cell wall
Azoles ADR
Inhibit hepatic p450 enzymes increasing plasma levels of many drugs
Ketoconazole spectrum
Many fungi causing systemic, and some causing superficial infections
Ketoconazole absorption
PO
Fluconazole spectrum
Primarily candidiasis and cryptococcus
Fluconazole absorption
PO
Fluconazole is generally less toxic but has the same effectiveness as….
ketoconazole
Itraconazole spectrum
Broad, Blastomycosis, histoplasmosis, onychomycosis, aspergillosis
Cisapride interacts with what to increase risk of torsades de pointes
Intraconazole
Itraconazole ADR
Neg inatropic effect
Miconazole
Topical treatment because of toxicity rarely given for systemic infections (must be IV)
Voriconazole spectrum
Broad spectrum
- blastomycosis
- histoplasmosis
- onchyomycosis
- aspergillosis
Posaconazole spectrum
Asprgillus and candida including resistant infections
Posaconazole absorption
PO
Isavuconazole spectrum
Aspergillus and mucormycosis
Isavuconazole ADR
Steven Johnson syndrome
Echinocandins mechanism of action
Disruption of fungal cell wall
Echinocandins spectrum
Narrow, aspergillus and candida species
Echinocandins absorption
IV only
Echinocandin examples
- anidulafungin
- caspofungin
- microfungin
Caspofungin spectrum
Invasive aspergillosis in patients intolerant to other treatments and systemic candida
Caspofungin is generally better tolerated than…
…amphoB
Tinea pedis/cruris/corporis/capitis treatment
Topical treatment such an azole
Vulvovaginal candidiasis treatment
PO fluoconazole
Oral candidiasis treatment
Topical agents such as miconazole, or in immunocompromised patient fluconazole or ketoconazole
Clotrimazole
DOC for dermatophytic infections and candiasis of skin, mouth and vagina, can cause stinging when applied
Griseovulvin
PO treatment for superficial mycoses by implanting into the keratin of the cells
