Slide 7 Antifungal Flashcards
Amphotericin B
- Polyene
- Must give IV or intrathecal
- membranes & forms artificial “ pores”
- binds to ergosterol
- liposomal
Amphotericin B D.O.C.
Aspergillus, cryptococcus
Why does Amphotericin B cause nephrotoxicity?
Highly water soluble after first 24 hours, its a large molecule. Its main job is to create pores, so it creates pores in the lining of the nephron.
Side affects of Amphotericin B?
Fever, nausea, vomiting, headache. Treat with antihistamines.
Flucytosine mechanism?
Cytosine deaminase is converted to - 5FU - then FUTP decreases RNA, F-dUMP decreases DNA
Flucytosine is given
orally, and distributed in CNS
You should always give Flucytosine in combination with?
Amphotericin B
-Azoles mechanism?
14 alpha demethylase - converts lanesterol to ergosterol.
IT is a CYP450 enzyme which can affect the hosts ability to make cholesterol and sex androgens.
Voriconazole
invasive Aspergillosis,
Fluconazole
- DOC or Co-DOC in most systemic fungal infection (less toxic than AMB)
- Good CSF delivery (prophylaxis & supression of cryptococcal meningitis)
- more selective for fungal P450s
Echinocandin drug name?
Caspofungin
Caspofungin mechanism
inhibits b-glucan, glucan synthase.
Caspofungin effects
Hypotension and tachycardia Fever, chills and headache Rash Anemias Hypokalemia
Caspofungin use?
Treatment of invasive Aspergillus infections in patients who are refractory or intolerant of other therapy
Nystatin
Similar to amphotericin B, too toxic for systemic use.Swish & swallow in oral candidiasis,topical for diaper rash or vaginal candidiasis.
