antifungal meds

Question 1

fungi characteristics

Answer 1

Fungi have rigid cell walls containing chitin and polysaccharides along with a cell membrane containing ergosterol.

Question 2

Drug for superficial mycoses

Answer 2

• Clotrimazole/ Lotrimin
• Nystatin/ Mycostatin
• Fluconazole/ Diflucan
• Griseofulvin/ Fulvicin
• Itraconazole/ Sporanox
• Ketoconazole/ Nizoral
• Miconazole/ Monistat
• Terbinafine/ Lamisil

Question 3

Drug for systemic mycoses

Answer 3

• Amphotericin B
• Fluconazole/ Diflucan 
• Flucytosine/ Ancoban 
• Griseofulvin/ Fulvicin 
• Itraconazole/ Sporanox 
• Ketoconazole/ Nizoral


Question 4

Clotrimazole/ Lotrimin

Answer 4

• Category: Antifungal
• Indication: Superficial mycoses such as
tinea pedis, tinea cruris and ring worm as
well as yeast vaginitis.
• MOA: Binds to ergosterol molecules on
the fungal cell membrane and causes
membrane leakage during cell division. • Char: Topical creams, lotions and
ointments. Increasing resistance of tinea and candida has occurred.

Question 5

Nystatin/ Mycostatin

Answer 5

• Category: Antifungal, may be used both topically and systemically.
• Indication: Superficial mycoses such as ring worm, tinea pedis, tinea cruris and treatment of oral candidiasis (thrush) as well as esophageal and vaginal Candida Cryptococcus is also sensitive to Nystatin.
• MOA: Binds to ergosterol molecules on fungal cell membrane resulting in loss of membrane integrity death of the fungal cell.

Question 6

Nystatin/mycostatin char , uses, se

Answer 6

Char: Topical creams, ointments, lotions and PO form for thrush often in the form of granules. Nystatin in parenteral form is being studied in Phase II and III trials.

• Negligible oral absorption allows for diminished side effects. N/V are possible.
• Nystatin is often used as prophylaxis in patients who are at risk for fungal infections, such as AIDS patients with a low CD4+ count and patients receiving chemotherapy.

Question 7

nystatin cont

Answer 7

Nystatin/ Mycostatin

• Nystatin oral suspension is indicated for the treatment of candidiasis in the oral cavity
• Nystatin suspension for oral administration contains 100,000 USP Nystatin units per mL.
• GI absorption of Nystatin is minimal and most orally administered Nystatin is passed unchanged in the stool.

Question 8

Terbinafine/ Lamisil

Answer 8

• Terbinafine is mainly effective on the group of fungi known as dermatophytes.
• As a 1% cream or powder it is used for superficial skin infections such as tinea cruris, tinea pedis and tinea corporis.
• Oral 250 mg tablets are often prescribed for the treatment of onychomycosis of the toenail or fingernail due to the dermatophyte Tinea unguium.

Question 9

Terbinafine/Lamisil dosage and SE

Answer 9

The FDA-labeled dosage of oral Terbinafine is 250 mg per day given continuously for 6 weeks to treat fingernail fungal infections and 12 weeks to treat toenail infections.
• Common side effects include abdominal discomfort, diarrhea and nausea as well as headache. Less commonly, elevated liver enzymes, hepatitis, liver damage and even liver failure have been reported

Question 10

Fluconazole/ Diflucan

Answer 10

• Category: Antifungal, both topical and systemic.
• Indication: Superficial mycoses such as yeast vaginitis as well as systemic or meningeal mycotic infections by fungi such as Cryptococcus or Histoplasmosis.
• MOA: Inhibits fungal membrane synthesis.

Question 11

Flucanozole/Diflucan SE, char

Answer 11

Fluconazole/ Diflucan
• Char: Oral, IV, vaginal suppository. It can inhibit the cytochrome enzyme systems responsible for metabolism of many drugs.
• Side effects: Nausea and vomiting with oral and IV doses.

Question 12

Amphotericin B/Amphocil

Answer 12

• Category: Antimycotic
• Indication: Systemic fungal infections such
as systemic Candidadiasis, Histoplasmosis, Coccidiomycosis, Aspergillus and Blastomyces.
• MOA: Binds to ergosterol molecules on the fungal cell membrane and disrupts membrane integrity, resulting in the death of the fungal cell.

Naturally occurring polyene macrolide produced by Streptomyces nodosus.

Question 13

Amphotericin B/Amphocil

Answer 13

• Char: IV. (May be used via intrathecal route for fungal meningitis or fungal brain abscess.
• Side effects: Very severe side effect profile. Fevers and shaking chills are common. (“Ampho-terrible” and “shake and bake” are terms used to describe the severe side effects).

Question 14

Amphotericin B/ Amphocil

Answer 14

Amphotericin B/ Amphocil
• Side effects: Pre-treatment with Benadryl, NSAIDs or Prednisone often used to mitigate the fever and chills. Hypotension, renal impairment and severe anemia can occur.

shake and bake