Sketchy Pharm: Griseofulvin, Terbinafine, Echinocandins

Question 1

These three drugs are used to treat what kind of infections?

Answer 1

• Tinea capitis, cruris, and corporis (like the tinea Tin Man)
• Onychomycoses (like the farmer’s nasty nails)

Question 2

How is griseofulvin administered?

Answer 2

Orally (like the farmer putting GReaSe in the Tin Man’s mouth)

Question 3

Griseofulvin is first-line treatment for _________________.

Answer 3

tinea capitis in children (represented by the little boy wearing the metal funnel on his head)

Question 4

What is the mechanism of griseofulvin?

Answer 4

It inhibits fungal microtubules, thereby halting fungal cells in metaphase.

(Think of the vines growing over the Tin Man’s chest –they look like microtubules halted in metaphase!)

Question 5

Although griseofulvin causes many side effects – such as GI disturbance –the most important one to know is ____________.

Answer 5

induction of CYP450 (like the shiny bumper on the tractor)

Question 6

What is terbinafine used for?

Answer 6

Topical treatment of dermatophytes (represented by the Tin Man in the Wizard’s crystal ball) and oral treatment of tinea capitis (because the little boy with the funnel on his head is halfway between the grease-wielding farmer and the turban-wearing wizard

Question 7

Oral terbinafine is especially helpful for ________________.

Answer 7

onychomycosis (represented by the wizard biting his nails)

Question 8

How does terbinafine work?

Answer 8

It inhibits the enzyme squalene epoxidase –which is an intermediate in the ergosterol synthesis pathway – and therefore leads to the accumulation of squalene.

(Think of the squealing pigs in the pig with the turban-wearing wizard.)

Question 9

List two side effects of terbinafine.

Answer 9

• GI upset and diarrhea (like the mud piles in the pig pen)
• Hepatotoxicity (like the liver spots on the pigs)

Question 10

What are the echinocandins?

Answer 10

Caspofungin, micafungin, and anidulafungin (all of which are represented by the guy wearing the CAP with the CANaDIaN flag on it)

Question 11

How do the echinocandins work?

Answer 11

They inhibit the synthesis beta-glucan which is a component of the fungal cell wall (like the crumbling wall behind the guy with the Canadian cap)

Question 12

The echinocandins have excellent activity against _____________.

Answer 12

Candida (like the Canadian flag next to the beta-glucan truck)

Question 13

Caspofungin and the other echinocandins must be administered _______________.

Answer 13

intravenously (like the IVy wrapped to the flag pole)

Question 14

Patients with what conditions might be given echinocandins?

Answer 14

• Those with esophageal candidiasis (like the long esophagus exhaust pipes on the truck)
• Those with Aspergillosis that has not responded to amphotericin (like the scarecrow by the guy unloading the beta-glucan truck)