Antifungals Flashcards by Sophia Caccavale

polyene (names)

amphotericin B

nystatin

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polyene MOA

bind ergosterol –> damage cell mem

can be fungistatic or cidal

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amphotericin B indication

progressive/severe fungal infections
systemic fungal infect
GI infect by candida

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amphotericin B ADRs

infusion rxn
nephrotoxicity (esp if immunocomp)
hypotension
tachycardia
fever/chills
hypokalemia, hypoMg
anorexia, N/V/D/cramp
decrease renal fnx

binds human cholest too…

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amphotericin B CI

not during breast feeding

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amphotericin B drug interactions

nephrotoxic agents
some chemo/aminoglycosides
cyclosptrines
pentamidine
steriods --> hypoK
digoxin
imadazoles
flucytosine

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nystatin indication

candidiasis (intestinal, oral, vulvovaginal)

diaper dermatitis

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nystatin CI

preg cat C

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nystatin ADRs

N/V/D (only D with large dose)
abd cramp
rash, urticaria (rare)
SJS (rare)

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nystatin caution

avoid sex til done
avoid tampons, etc
avoid tight things

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antifungal azoles (names)

fluconazole, itraconazole, voraconazole, posaconazole, ketoconazole, isavuconazium sulfate, efinconazole

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antifungal azole MOA

inhib P450 (3A4 & 2C9) and the conversion of lanosterol –> ergosterol
–> increase cell mem perm
fungicidal

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fluconazole indications

candidiasis
cryptococcal meningitis
intertriginous candidia (off label)

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fluconazole ADRs

generally mild
1 dose: HA, N/V/D, dyspepsia, abd pn, metallic taste
multi-dose: N/V/D/pn, liver probs (rare)
QT prolongations

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fluconazole CI

preg cat C (except the 1 pill for vag infect –> cat C)

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itraconazole indication

pulm and extrapul blastomycosis
histoplasmosis
aspergillus
onychomycosis
oral/esoph candidiasis

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itraconazole ADRs

neuropathy
hepatic failure (rare)
hearing loss (rare)
gynecomastia (rare)
N/V
rash

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itraconazole CI

taking trazolam or midazolam
heart failure/venricular dysfunction
breast feeding

preg cat C

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itraconazole caution

CHF
use of Ca channel blockers
long T1/2

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voriconazole indication

invasive aspergillus
disseminated candidiasis
esophageal candidiasis
serious infect

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voriconazole ADRs

visual distrubances
fever/chills
N/V
rash
HA
abnormal LFT
tachycardia
hallucination
infusion rxn
SJS/TEN
photosensitivity

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voriconazole CI

preg cat D

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voriconazole caution

P450 at 3A4, 2C19, 2C9 metab

posaconazole indication

saved for immunocompromised pts

oropharyngeal condidiasis

posaconazole ADRs

fever N/V/D HA elevated LFTs

ketoconazole indication

systemic candidiasis and other bad dz itraconazole has taken over for keto :(

ketoconazole ADRs

``` photophobia impair hormone production N/V/D/on HA dizzy suicidal/depression thrombocytopenia, hemolytic anemia, leukopenia fatal hepatotoxicity pruritis long QT ```

isavuconazium sulfate indications

invasice aspergillus mucormycosis (bad infect) IV only

isavuconazium sulfate ADRs

``` elevate LFT infusion rxn SJS/TEN N/V/D peripheral edema hypoK ```

efinconazole indication

onychomycosis

efinconazole ADRs

ingrown toenail site dermatitis site pain site vesicles

allylamine (names)

terbinafine naftadine butenafine

allylamine MOA

inhib production of lanosterol | fungicidal

terbinafine indication

onychomycosis (esp in DM) | tinea cruris

terbinafine ADRs

``` diarrhea dyspepsia abd pn LFT abnormalities rash, pruritis dysguesia SJS/TEN (rare) ```

terbinafine caution

``` liver fnx (get baseline and monitor) T1/2 starts at 12 hrs, ends at 200-400 hours ```

naftadine/butenafine indication

tinea infection

naftadine/butenafine ADRs

burning stinging itching rash

pyrimidine (names)

flucytosine

flucytosine MOA

goes into DNA, converted into 5-FU in the cell inhib fungal prot and DNA synthesis with amph B --> more effective

flucytosine indication

candida: septicemia, endocarditis, UTI, pulm infect cryptococcus: meningitis, pulm infect, UTI

flucytosine ADRs

``` leukopenia, thrombocytopenia rash N/V/D elevated LFT ADRs = worse in post chemo/AIDS pts ```

flucytosine caution

``` increased toxic (and effect) with amph B used alone --> resistant fungi fast ```

echinocandins (names)

caspofungin anidulafungin micafungin

echinocandins MOA

inhib beta-glucan synthase --> affect cell wall synthesis --> lysis

echinocandins indication

severe (basic) infect (ie candida/aspergillus)

echinocandins ADRs

N/V/D | infusion rxn

griseofulvin drug intercation

oral contraceptives ETOH P450 3A4 inhib (maybe)

griseofulvin MOA

inhib cell mitosis

griseofulvin indication

tinea infect | NO candidia!

griseofulvin ADRs

lots of neuro: HA, neuropathy, fatigue, rash, etc

ciclopirox indication

onychomycosis

ciclopirox ADRs

burn itch irritate

tavoborale MOA

inhibit fungal prot synthesis

tavoborale indication

onychomycosis

tavoborale ADRs

site exfoliation dermatitis ingrown toenail