Antifungals

Question 1

Oral TRIAZOLES

Answer 1

Itraconazole
Voriconazole
Fluconazole

Question 2

Itraconazole Oral

Answer 2

Triazole Antifungal
Blocks ergosterol synthesis
Fungistatic, lipophilic,
SE: ↑ LFTs, ↓ WBC, ↑ TG, nephrotoxicity, CHF worsening
Tx: candidiasis, superficial dermatophytes, onychomycosis, sporotrichosis
-Lab, CBC, LFTs, repeat q4-6 weeks
-take with acidic food, avoid antacids, H2 blockers, PPIs

Question 3

Fluconazole Oral

Answer 3

Triazole Antifungal

Fungistatic, crosses blood-brain barrier
Tx: candidiasis, pityriasis versicolor (PV), superficial dermatophytes
Preg C
-Lab, CBC, LFTs, repeat q4-6 weeks

Question 4

Ketoconazole Oral

Answer 4

IMIDAZOLE Antifungal
Fungistatic, lipophilic, needs acidic milieu for absorption, ↑ absorption with food, inhibits cyt p450
SE: fulminant hepatitis (rare), ↑ LFTs
Tx: dermatophytes, candidiasis, dimorphic fungi, PV
Preg C

Question 5

Terbinafine Oral
(Lamisil)

Answer 5

ALLYLAMINE Antifungal
Fungicidal, biotransformed in liver, does NOT inhibit cyt p450
SE: nausea, metallic taste, liver damage, drug- induced LE
Tx: onychomycosis, tinea corporis, tinea pedis
Preg B
-Lab, CBC, LFTs, repeat q4-6 weeks
-take with food

Question 6

Griseofulvin Oral

Answer 6

-Other oral antifungal
-Disrupts microtubule function
-Fungistatic, ↑ absorption w/ fatty meal, induces cytochrome p450 (may ↓ warfarin level)
SE: headache, paresthesias, photosensitivity, worsens porphyria
Tx: dermatophytes (NOT yeast or bacteria)
-Lab, CBC, LFTs, repeat q6 weeks
-Take with fatty food

Question 7

Topical Imidzaole / Azole

Answer 7

Cover Dermatophytes and yeast
-Blocks Ergosterol, cell membrane cant grow -> death and blocks p450 in fungus -> buildup H202 -> cell death
Miconazole
Clotrimazole (Lotrimin) - 1% lotion, cream, lozeng, powder, troche
Ketoconazole (Nizoral)
Econazole (Spectazole) -covers the dermatophytes, yeast, and bacteria
Efinaconazole (Jublia) -10% sltn
Ketoconazole shampoo - 2/ week, leave 5 minutes before rinsing out
Eficonazole and tavaborole - daily x 48 weeks, more effective

Question 8

Topical Allyamines

Answer 8

Terbinafine (Lamisil) - covers dermatophytes and candida
Naftifine (Naftin) - covers dermatophytes
Butenafine (Lotrimin Ultra) - covers dermatophytes and candida
Tolnaftate (Tinactin) good ringworm, bad tinea pedis

-Fungistatic and Fungicidal, inhibts ergosterol synthesis

Question 9

Topical Polyenes

Answer 9

Nystatin - cover yeast only
-cause cell membrane to leak
Covers Candida Albicans

Question 10

Topical Oxaborole

Answer 10

Tavaborole (kerydin)
MOA: inhibits protein synthesis,
* Covers: T rubrum or T. mentagrophytes (onychomycosis)-can penetrate; covers dermatophytes and Candida

Question 11

Cicloporix Olamine Topical

Answer 11

• Covers: dermatophytes, yeasts, molds.
• Medication: Ciclopirox 8% nail lacquer
• Apply daily x 1 week then wipe off with ETOH and allow to dry before applying more x 48 weeks, can use bid over nailpolish

Question 12

Selenium Sulfate (Selsun Blue)

Answer 12

OTC, pityriasis versicolor.
* Cytostatic-reduces adhesion in stratum corneum leading to fungal shedding.
* Possible fungicidal activity for M. Furfur.

Question 13

Propylene gylcol

Answer 13

irritant that causes contact dermatitis
-Not in Clotrimazole (Lotrimin), Econazole, Vaftifine, and cicloporix, miconazole (monostat), Terbinafine (lamisil)

Question 14

Topical Tolnaftate

Answer 14

-spray, less effective than azoles for tinea pedis, ok for tinea cruris