Exam III Anti-fungal Drug Names Flashcards
Yeast
Candida SP.**
Pneumocystis jyrovecii
Cryptococcus neoformans
Mold
Aspergillus SP.**
Mucor
Dermatophytes
Dimorphic
Blastomyces
Coccidiomycosis
Histoplasma
Sporotrichosis
Allylamines
4 Fines
Terbinafine
Butenafine
Naftifine
AmorolFine
Allylamine MOA
Inhibit Squalene -> no ergosterol synthesis (reducing fungal cell membrane)
Allylamine Coverage
Tinea (Cosporis/Pedis/Cruris)
Onychomycosis (Terbinafine)
Allylamine MISC facts
Terbinafine is the only one you can use for Onychomycosis
Polyenes
Nystatin (PO/Topical/Susp)
Amphotericin B Deoxycholate (AmB-d) (IV)
Amphotericin B​ Lipid complex (ABLC)
Liposomal Amphotericin B (L-AmB)
Polyenes MoA
Binds Ergosterol. Cell Leaks
Nystatin Coverage
Candida only
Amphotericin B (and Derivs) Coverage
Most Candida spp. and Aspergillus spp.
Most Fungi except no Fusarium spp. and A. Terreus
Amphotericin B ADRs/DDIs
Extremely nephrotoxic. Dose-Dependent decrease in GFR (monitor).
K, Mg, HCO3 wasting (electrolyte derangement)
Decreased EPO production. Avoid W/other nephrotoxic drugs
Acute Infusion RXN. (pre-medicate with APAP, or IBU, diphenhydramine +/- steroids, Rigors: meperidine)
Support with Fluids (Hydrate)
Thrombophlebitis (heparin), cardiac arrhythmias, and Rash
Amphotericin B DDIs worst to least.
AmB-d (base)
ABLC
(Less Nephrotoxic & Less infusion RXN)
L-AmB
(Less nephrotoxic & Less infusion RXN & better CNS penetration)
Imidiazoles
Clotrimazole
Ketoconazole
Miconazole
Econazole
Mebendazole
Oxiconazole
Sertaconazole
Sulconazole
Thiabendazole
CloK ME MOST azole
Ketoconazole (and other Imidazoles) MoA
Inhibit 14a-demethylase. No conversion of lanosterol to ergosterol. No CM synthesis.
Ketoconazole Coverage
Andida spp., blastomycosis, histoplasmosis (high failure)
Ketoconazole DDIs
CYP450/3A4 substrate ->CYP inhibition
Needs acidic gastric pH -> H2RA, PPI, antacid interactions
Ketoconazole MISC
Poor distribution into CSF and eye
Contraindicated in patients w/ hepatic impairment
Excreted in Feces
Available in many forms
Half-life 8 Hrs