Antifungals

Question 1

Miscellaneous (Antifungals)

Answer 1

ex: allylamines, thiocarbamates, fluorocytosine (5FC)
mxn of action: inhibit DNA synthesis
mxn of resistance: rapid
Coverage: crypto 
pharmacology: *IV (chemo)*
primary indications: synergy
side effects/toxicity: bone marrow, GI

Question 2

Echnicocandins (Antifungals)

Answer 2

ex: caspofungin, micafungin, anidulafungin
mxn of action: inhibit fungal cell wall synthesis (1,3 beta glucan synthase)
Coverage: systemic candida, aspergillus
pharmacology: IV
primary indications: systemic candidiasis, resistant aspergillosis
side effects/toxicity: very little

Question 3

Azoles (Antifungals)-vori/posacon.

Answer 3

ex: vori/posacon.
mxn of action: inhibits fungal cytp450, toxic byproducts kills membrane
mxn of resistance: nonalbicans candida, alter p450, permeability
Coverage: aspergillus, resistant candida
pharmacology: oral/IV
side effects/toxicity: drug-drug interactions!

Question 4

Azoles (Antifungals)-itraconazole

Answer 4

ex: itraconazole
mxn of action: inhibits fungal cytp450, toxic byproduct kills membrane
mxn of resistance: nonalbicans candida, alter p450, permeability
coverage: histo, blasto, sporo
pharmacology: oral
primary indications: nail derma.

Question 5

Azoles (Antifungals)-fluconazole

Answer 5

ex: fluconazole
mxn of action: inhibits fungal cytP450, toxic byproduct kills membrane
mxn of resistance: nonalbicans candida, alter p450, permeability
Coverage: crypto, candida, no molds
pharmacology: oral
primary indications: crypto meningitis
side effects/toxicity: hepato

Question 6

Polyenes (Antifungals)

Answer 6

ex: nystatin, amphotericin B
mxn of action: macrolide ring inserts into membrane, binding to sterols, lyses cell
mxn of resistance: not much
Important coverage: yeasts, molds, dimorphs
notable resistants: bile salt
pharmacology: IV
primary indications: yeasts, molds, dimorphs
side effects/toxicity: lots: infusion-related, renal, anemia