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Flashcards in Antifungal agents Deck (31)
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1

fungal infections- Dermatophytes are restricted to what?

restricted to the keratinized layers of the integument

2

Treatment for fungal infections- Dermatophytes

Treatment is usually conservative with use of topical antifungal agents

1. Clotrimazole
2. Terbinafine

3

Nail infection (onychomychosis) TX

This usually requires systemic Tx for weeks to 6 months

1. Itraconazole
2. Terbinafine

Topical therapy can be ciclopirox

4

Fungal infections- Candida Tx

Topical Tx: Clotrimazole

can use nystatin for mucocandidiasis

5

If someone tried using clotrimazole or nystatin for their candida infections what medicine can they try?

Flucanozole via systemic (oral)

6

Describe the organisms for systemic fungal infections

Causative organism are inherently virulent and cause disease in HEALTHY humans

7

Tx for systemic fungal infectons?

Amphotericin B infusions

8

Some with a BLASTOMYCOSIS systemic fungal infection needs to be Tx with what?

Amphotericin B then Itraconazole then fluconazole.

9

Tx for coccidiodomycosis systemic fungal infection?

Amphotericin B then maintenance with fluconazole or itraconazole

10

Tx for cryptococcosis systemic fungal Tx

Amphotericin B plus fluconazole

11

Tx for histoplasmosis systemic fungal infection

Amphotericin B or itraconazole

12

Tx for disseminated candidiasis

Fluconazole

13

Tx for aspergillosis opportunistic systemic fungal infection?

Amphotericin B, casopfungin, itraconazole

14

Tx for pnuemocystis pneumonia?

TMP-SMX (bactrim)

15

Amphotericin B pharmokinetics

rapidly sequestered in tissues then slowly released

16

Amphotericin B adverse reactions

Nephrotoxicity-major dose limiting factor
Infusion related toxicities
Anemia

Liposomal preps may reduce renal and infusion toxicities
The lipid vehicle serves as Amphotericin B reservoir reducing non-specific binding to human cell membranes

17

is Nystatin absorbed by GI tract

no

18

What limits nystatin use?

Toxicity limits systemic use

19

What is Nystatin safe and effective for?

Safe and effective for topical tx of candidal infections

20

MOA of Fluconazole - Itraconazole

selective inhibition of fungal cytochrome P450 (static-Cidal)

21

Clinical use of Fluconazole?

Vaginal Candidiasis- if topical tx fails taken orally
Oropharyngeal and esophageal Candidiasis- systemic

22

Pharmacokinetics of fluconazole?

cleared primarily by the kidneys so renal dosing adjustment if impaired- has the least effect on liver compared to other azoles

Readily enters CNS

23

Pharmacokinetics of itraconazole

Eliminated by the hepatic metabolism

24

What are the imidazoles?

Ketoconazole
Clotrimazole
Miconazole

25

MOA of imidazoles?

inhibit P450-dependent enzyme (fungicidal)

26

Imidazoles clinical uses?

-there is a decline in systemic use of ketoconazole
-Chronic mucocutaneous candidiasis
-ORAL AND VAGINAL CANDIDIASIS (CLOTRIMAZOLE TOPICALLY)

27

Imidazoles pharmacokinetics

-only ketoconazole has been used systemically (oral and IV)
-Eliminated by hepatic metabolism (CYP450 oxidation)
-Excreted in breast milk

28

Ketoconazole (can be used systemically) which causes what adverse reactions

Hepatotoxicity- generally avoid if liver dysfunction

Remember this one: CAN INHIBIT MAMMALIAN TESTOSTERONE SYNTHESIS CAUSING DECREASED LIBIDO AND GYNECOMASTIA

29

Is terbinafine bactericidal or static

Its CIDAL

it inhibits squalene oxidase

30

What is the agent of choice for toe/finger nail infections caused by onychomycosis?

Terbinafine- its a once daily oral dose

Available TOPICALLY for ATHLETES FOOT