Triazole Anti-Fungals Flashcards

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1
Q

Give 2 examples of triazole anti-fungals

A
  • Fluconazole

- Itraconazole

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2
Q

What is the mechanism of action of triazole anti-fungals?

A

Inhibit fungal cytochrome P450 3A enzyme, which converts lanosterol to ergosterol (key component of fungal cell membrane), hence fungal cell replication is prevented

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3
Q

Are triazole anti-fungals broad or narrow spectrum?

A

Variable - some are broad, others are only effective against specific pathogens

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4
Q

What are the routes of delivery of triazole anti-fungals?

A
  • PO
  • IV
  • Topical
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5
Q

What are the indications for triazole anti-fungals?

A
  • Fungal respiratory tract infections, e.g. aspergillosis
  • Candidiasis
  • Skin and nail infections
  • Prophylaxis against fungal infections in immunocompromised patients
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6
Q

When are triazole anti-fungals contraindicated?

A

Acute porphyrias

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7
Q

When should triazole anti-fungals be used with caution?

A

QT interval prolongation

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8
Q

When should triazole anti-fungals be avoided?

A
  • Liver disease

- Pregnancy

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9
Q

Why should triazole anti-fungals be avoided in liver disease?

A

May cause hepatotoxicity

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10
Q

Describe the use of triazole anti-fungals in pregnancy?

A

Avoid fluconazole, only use itraconazole in life-threatening conditions

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11
Q

What might triazole anti-fungals interact with?

A
  • Warfarin
  • CCBs
  • Sulphonylureas
  • Colchine
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12
Q

Why should triazole anti-fungals be given with CCBs?

A

Negative inotrope, can precipitate heart failure

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13
Q

What might happen if triazole anti-fungals are given with warfarin?

A

Increased anticoagulant effect

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14
Q

What might happen if triazole anti-fungals are given with sulphonylureas?

A

Increased sulphonylurea concentration in plasma

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15
Q

What might happen if triazole antifungals are given with colchicine?

A

Increased risk of colchicine toxicity, hence colchicine should be withheld while anti-fungal is being taken

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16
Q

What is required before starting triazole anti-fungals?

A

Baseline ECG (to detect ECG changes in the future)

17
Q

What are the common/very common side effects of triazole anti-fungals?

A
  • GI disturbances, e.g. abdo pain, nausea, diarrhoea
  • Dyspnoea
  • Headache
  • Hepatitis
  • Hypokalaemia
  • Rash
18
Q

What are the uncommon side effects of triazole anti-fungals?

A
  • Oedema
  • Constipation, dyspepsia, and flatulence
  • Dizziness
  • Peripheral neuropathy and myalgia
  • Menstrual disorders
19
Q

What counselling is required for patients on triazole anti-fungals?

A
  • Complete antibiotic course
  • Use reliable contraception when taking the drug
  • Beware of signs of liver dysfunction