Pharm 35 Fungal Infections Flashcards
Flucytosine Mechanism
converted to 5-FdUMP, which inhibits thymidylate synthase and interferes with DNA synthesis. Syngergy with amph B against aspergillus
Flucytosine Use
Candidiasis, Cryptococcosis, Chromomycosis
Flucytosine Side Effects
Bone marrow suppression, cardiotoxicity, GI disturbance, hepatic, dysfunction
Flucytosine Contraindications
Pregnancy
Griseofulvin Mechanism
Binds to tubulin and a microtubule-associated protein, disrupting assembly of mitotic spindle
Griseofulvin Use
Fungal infection of the skin, hair, or nail due to trichophyton, microsporum or epidermophyton
Griseofulvin Side Effects
Hepatotoxicity, albuminuria, leukopenia, neutropenia, monocytosis, serum sickness, angioedema, toxic epidermal necrolysis, headache, lethargy, vertigo, blurred vision, increased fecal protoporphyrin levels
Griseofulvin Contraindications
Pregnancy, porphyria and hepatic failure
Allylamines: Terbinafine, Naftifine, butenafine Mechanism
Inhibit conversion of squalene to lanosterol by inhibiting squalene epoxidase
Allylamines
Terbinafine, Naftifine (cream or gel), butenafine
Allylamines: Terbinafine, Naftifine, butenafine use
Onychomycosis (Nail fungus), Tinea corporis (Ringworm), tinea cruris (Fungus in groin, Jock Itch, Crotch Rot), tinea pedis (Athlete’s Foot), tinea capitis (Ringworm of the scalp)
Allylamines: Terbinafine, Naftifine, butenafine Side Effects
hepatotoxicity, stevens-johnson syndrome, neutropenia, exacerbation of psoriasis or subacute cutaneous lupus erythematosus, gi disturbance, burning sensation and local irritation of skin
Allylamines: Terbinafine, Naftifine, butenafine Contraindications
Hypersensitivity
Imidazole antifungals Mechanism
Inhibit ultimate conversion of lanosterol to ergosterol by inhibiting 14a-sterol demethylase; decrease in egosterol and accumulation of 14alpha-methyl sterols disrupt the tightly packed chains of phospholipids in the fungal membrane.
Imidazoles
Ketoconazole, Butoconazole, Clotrimazole
Imidazole antifungals Use
Coccidioides immitis, cryptococcus neoformans, candida species, histoplasma capsulatum, blastomyces dermatitids, dermatophytes, superficial fungal infections of stratum corneum, squamous mucosa, and cornea
Imidazole antifungals Side Effects
- GI disturb, hepatic dysfunction, gynecomastia, decreased libido, menstrual irregularities: Ketoconazole.
- pruritus and burning (All but Ketoconazole)
Imidazole antifungals Contraindications
Concurrent admin of ampho B or oral triazolam, hypersensitivity
Triazole antifungals Mechanism
Inhibit ultimate conversion of lanosterol to ergosterol by inhibiting 14a-sterol demethylase; decrease in egosterol and accumulation of 14alpha-methyl sterols disrupt the tightly packed chains of phospholipids in the fungal membrane.
Triazole antifungals Use
Aspergillosis, blastomycosis, candidiasis, histoplasmosis, onychomycosis, cryptococcal meningitis, vulvovaginal candidiasis
Triazoles
Fluconazole, Itraconazole, Posaconazole.
Triazole antifungals Side Effects
Heptatic toxicity, stevens-johnson syndrome, gi disturb, rash, hypokalemia, hypertension, edema, headache
Triazole antifungals Contraindications
Coadmin with dofetilide, oral midazolam, pimozide, levacetylmethadol, quinidine, lovastatin, simvastatin, or triazolam, pregnancy, hypersensitivity
Amphoterecin B Mechanism
Binds to ergosterol and form pores that alter fungal membrane permeability and stability. Polyene. Combo with with flucytosine for cryptococcal meningitis
Amphoterecin B Use
Potentially life-threatening aspergillosis, cryptococcosis, blastomycosis, systemic candidiasis, coccidiodomycosis, histoplasmosis, systemic candidiasis, zygomycosis
Amphoterecin B Side Effects
renal toxicity, cytokine storm, anemia, weight loss, gi distrubance
Amphoterecin B Contraindications
Hypersensitivity
Nystatin Mechanism
Bind to ergosterol and form bores that alter fungal membrane permeability and stability. polyene. Not absorbed systematically
Nystatin Use
Mucocutaneous candidiasis
Nystatin Side Effects
Rare contact dermatitis
Nystatin Contraindications
Hypersensitivity
Echinocandins: caspofungin, micafungin, anidulafungin Mechanism
Noncompetitively inhibit synthesis of beta-(1,3)-d-glucans which leads to disruption of cell wall integrity
Echinocandins: caspofungin, micafungin, anidulafungin Use
Esophageal candidiasis, candidemia, salvage therapy of aspergillus infections, antifungal prophylaxis for recipients of hematopoietic stem cell transplants
Echinocandins: caspofungin, micafungin, anidulafungin Side Effects
pruritus, rash, gi disturb, increased liver enzymes, thrombophlebitis, headache, fever
Echinocandins: caspofungin, micafungin, anidulafungin Contraindications
Hypersensitivity
Echinocandins
Caspofungin, micafungin, anidulafungin (Fungins are CANDINS that inhibit beta-(1,3)-d-GLUCANS - bad cell walls)
