What are Dermatophytic inf?
Common in skin, hair, nails
What are Mucocutaneous inf?
Candidal infections involving moist skin or mucus membranes
Name the Anti-fungal drugs for subcutaneous and systemic drug infections.
- Amphotericin B (Fungizone)
- Flucytosine (Ancobon)
- Ketoconazole (Nizoral)
- Fluconazole (Diflucan)
- Itraconazole (Sporanox)
Name the drugs for Cutaneous Mycoses.
- Terbinafine (Lamisil)
- Griseofulvin (Fulvicin, Grifluvin)
- Nystatin (Mycostatin)
- Miconazole (Monistat)
- Clotrimazole (Lotrimin)
- Econazole (Spectazole)
What is Amphotericin B? What is its MOA?
- -Large molecule produced by Streptomycin
- -MOA: binds to sterol moiety (primarily ergosterol) present in membranes of sensitive fungi
- -This interaction pore or channel formation leakage of essential nutrients
Is Amphotericin B CIDAL or STATIC?
What is nice about Amphotericin B in reference to its spectrum?
Selective for fungi (no sterols in bacteria)
What is NOT nice about Amphotericin B in reference to its spectrum?
Some selective toxicity towards fungal membranes vs. mammalian cholesterol
What is Amphotercin B used for?
Drug of Choice for life-threatening systemic mycoses
T or F: Amp B is very important for immun compromised patients.
How is Amphotericin B administered?
IV or intrathecal if meningitis
Does Amphotericin B cross into the placenta?
Does Amphotericin B cross into the CSF?
Do you have to adjust Amphotericin B dose in renal dysfunction?
What are some adv effects for Amphotericin B?
- Low therapeutic index – test for anaphylaxis/convulsions
premedicate with antipyretic or steroid
Phlebitis at IV site in 70% pts
3. Dose-related Shock Nephrotoxicity Hypokalemia & Hypomagnesemia Anemia
What is Flucytosine and what is its MOA?
- -Fluorinated pyrimidine converted to fluorouracil
- -MOA – inhibits thymidylate synthetase, thus stops formation of thymidylic acid, an essential DNA component
Is Flucytosine CIDAL or STATIC?
What is Flucytosine used for?
Used only in combination with amphotericin B for treatment of systemic mycoses & candidal or cryptococcal meningitis
T or F: Flucytosine has major issues with resistance, is rapidly orally absorbed and gets into the CSF.
What are the adv effects of Flucytosine?
- GI irritation
- Bone marrow suppression (WBC plt)
- Hepatic toxicity
What is the MOA of Ketoconazole? And when would you use it?
- -MOA - Blocks demethylation of lanosterol to ergosterol
- -Additive with Flucytosine against Candida
What are the adverse effects of Ketoconazole?
–Suppresses testosterone & cortisol synthesis
–Decreases androgen = gynecomastia, impotence,
Where is Ketoconazole metabolized?
Extensively metabolized in liver
Blocks P450 = increases warfarin
How is Ketoconazole administered? What increases its absorption?
ORAL & Topical
Coca-Cola increases absorption = increased acidity