antifungal meds Flashcards Preview

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Flashcards in antifungal meds Deck (14):
1

nystatin

polyene
like amphotoxin B but only topical
tx oral candida
bitter taste
too toxic for systemic use

2

griseofalvin

fungistatic
blocks microtubule polymerization
only use: oral tx for systemic dermatophytosis
CYP interaction
-warfarin
-oral contraceptives
-affects sperm production

3

flucytosine (5fu)

analog, prodrug
defective RNA> decreased protein synthesis
bacteriostatic
used with amphotericin B
good CNS penetration
tx Systemic candida and cryptococcus
AE
-GI
-decreased BM
-anemia
-leukopenia
-thrombocytopenia

4

ketoconazole

imidazole
fungistatic
local and systemic
inhibit ergosterol synthesis (CYP)
broad spectrum
numerous drug interaction
limited
AE
hepatitis

5

miconazole

imidazole
fungistatic
local only
inhibit ergosterol synthesis (CYP)
broad spectrum
numerous drug interaction
limited
tx jock itch and tropical candida

6

clotrimazole

imidazole
fungistatic
local and systemic
inhibit ergosterol synthesis (CYP)
broad spectrum
numerous drug interaction
limited
Tx: thrush prophylactic for AIDS patients

7

itraconazole

triazole
broader spectrum than fluconazole
absorbed well and iv (long half life)
tx
-aspergilla
-fluconazole resistant candida (esophageal)

8

fluconazole

triazole
more selective than imidazoles
better CNS penetration
Tx
-cryptococcal meningitis
-first line for invasive candida and mucocutaneous
-prophylactic tx in immunocompromized
Resistance
-intristic to C. Krusei
-C alabrata
-molds

9

voriconazole

triazole
same spectrum as itraconazole but more potent
oral and iv
TX
-invasive mold in immunocompromised> aspergillosis
-fusarum
-fluconazole resistant candida
Low toxicity (transient)
-skin rash
-^LFT
-drug interactions

10

posaconazole

triazole
spectrum like voriconazole
-> also tx zygomycoses
tx: BMT GVHD prophylaxis
AE
-skin rash
-^LFT
-drug interactions

11

Efinaconazole

triazole
newest
tx orychomycosis topical
safe

12

terbinafine

allylamine
blocks ergosterol synthesis
>squalene epoxide accumulates
-> fungicidal
oral, liver metabolized
tx
-dermpatophytosis
-> similar specturm to griseofulvin but less toxic
-phythium insidiosum (ling treatment time)

13

caspofungin, micafungin, anidulafungin

newest class antifungals
inhibit glucan synthesis
> causes lysis 2ndary to osmotic shock
tx
-aspergillus
-azole resistant candida

14

amphotericin B

polyene antifungal
binds ergosterol and forms pores
broadest spectrum
Tx
-first line for life threatening systemic fungal infections
>candida (rare resistance)
>apergilla
>crytpococcus
cidal but affected by (pH, concentration, organisms)
topical or IV (slow infusion), long 1/2 life (15 days)
AE: deoxycholate toxicity (lipid formulations much less toxic)
-hypokalemia > digitalis toxicity
-azoles >antagonism
-increased tox with other nephrotox
--aminoglycosides
--cyclosporine