Week 10: Systemic Azoles

Question 1

Fluconazole MOA/indications

Answer 1

• interferes with fungal CYP 450 activity - inhibits cell membrane formation - broad spectrum
  Indications: candidiasis (vaginal, oropharyngeal, esophageal)

Question 2

Fluconazole cautions/CIs

Answer 2

• hard on liver - monitor hepatic function
• QT prolongation - check EKG
• avoid in pregnancy
• CYP 3A4 and 2C9 inhibitor

Question 3

Itraconazole MOA/indications

Answer 3

• interferes with fungal CYPE 450 activity - inhibits cell membrane formation - broad spectrum systemic treatment
  Indications: onychomycosis (fungal infection of nail bed)

Question 4

Itraconazole cautions/CIs

Answer 4

• hard on liver
• QT prolongation
• avoid in pregnancy
• BBW: avoid in patients with HF/myocardial dysfunction

Question 5

Terbinafine/Ciclopirox (topical) MOA/indications

Answer 5

• synthetic allylamine derivative - inhibits squalene eposidase enzyme, a key enzyme in sterol biosynthesis in fungi - results in fungal cell death - metabolized by CYP450
  Indication: onychomycosis (1st line) - off label: extensive tinea fungal infection

Question 6

Terbinafine cautions/CIs

Answer 6

• arrhythmias (think QT)
• hepatic impairment
• avoid in pregnancy

Question 7

Terbinafine ADRs

Answer 7

hepatotoxicity
hepatic failure
blood dyscrasias