Pharmacology - Antifungal Therapy - Christopher Miller Flashcards Preview

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Flashcards in Pharmacology - Antifungal Therapy - Christopher Miller Deck (37):
1

Class: Flocuonazole

Triazole
Antifungal

2

Class: Itraconazole

Triazole
Antifungal

3

Class: Voriconazole

Triazole
Antifungal

4

Class: Posaconazole

Traizole
Antifungal

5

Class: Amphotericin B

Polyene macrolide
Antifungal

6

Class: Nystatin

Polyene macrolide
Antifungal

7

Class: Caspofungin

Echinocandin
Antifungal

8

Class: Micafungin

Echinocandin
Antifungal

9

Class: Anidulafungin

Echinocandin
Antifungal

10

Use: Nystatin

Skin infections - Candida
Usually topical preparations

11

MOA: Triazoles

Impede ergosterol synthesis through direct inhibition of the cytochrome P450 dependent enzyme 14-alpha-sterol-demethylase.

Ergosterol is an essential molecule of the fungal cell membrane. Inhibition of this stops fungal growth.

12

Spectrum: Flunazole

Some candida;
Cryptococcus;
Endemic Mycoses (ie Histoplasmosis, Coccidiomycosis)

13

Spectrum: Voriconazole, Itraconazole

Fluconazole spectrum PLUS
Aspergillus, broader Candida coverage

14

Spectrum: Posaconazole

Voriconazole, Itraconazole spectrum PLUS Fusarium, Mucorales

15

Adverse effects: Triazoles

Liver enzyme abnormalities
GI side effects

16

What adverse effect is specific to Voriconazole?

Visual disturbances

17

What triazole has the lowest drug interaction profile?

Fluconazole
**Triazoles have crossover with mammalian CYP450 system**

18

Use: Fluconazole

Susceptible candidiasis;
Severe thrush/exophageal candidiasis;
Secondary treatment of (and prophylaxis of) cryptococcal meningitis

19

Use: Itaconazole

Secondary treatment and prophylaxis of systemic histoplasmosis

20

Use: Voriconazole

Invasive aspergillosis

21

Use: Posaconazole

Prophylaxis of aspergillosis/candidiasis in immunocompromised patients

22

MOA: Amphotericin B

Pores are formed in the fungal cell membrane, allowing leakage of K+ and Mg+

23

Spectrum: Amphotericin B

Broad spectrum: Candida spp, Aspergillus spp. Zygomyces spp., Hystoplasma, Cryptococcus

24

Use: Amphotericin B

Life-threatening invasive fungal infections; broad antifungal spectrum; (occasionally used with flucytosine in immunocompromised hosts)

25

Adverse effects: Amphotericin B

Nephrotoxocity;
Poor overall tolerability;

Chronic: fall in renal function (may only be partially reversible); K+ Mg+ wasting; renal tubular acidosis

26

Use: Echinocandins

• Candida infections
• Refractory aspergillus infection
• Esophageal candidiasis
• Empiric antifungal therapy for febrile neutropenic patients

**IV formulation only**

27

MOA: Nystatin

Pores are formed in the fungal cell membrane, allowing leakage of K+ and Mg+

28

Adverse effects: Echinocandins

Liver toxicity possible, requires monitoring;

29

MOA: Echinocandins

Inhibit synthesis of Beta(1,3)-D-glucan, an essential component of the fungal cell wall

30

MOA: Flucytosine

Prodrug converted by fungal enzyme to analog inhibitor of pyrimidine nucleotide synthesis

31

Use: Flucytosine

Cryptococcal meningitis;
Often in combination therapy;
Oral only

32

Spectrum: Flucytosine

Crytpococcus, some Candida spp

33

Adverse effects: Flucytosine

Bone marrow issues - low WBCS;
Liver toxicity;
GI issues

**Follow with blood levels**

34

Class: Efinazonazole solution

Azole / Cell membrane synthesis inhibitor

35

MOA: Efinazonazole solution

Inhibit ergosterol synthesis by inhibiting lanosterol demethylase

36

Use: Efinazonazole solution

Candida; Tinea
ie toe fungus

37

Adverse effects: Efinazonazole

Application site dermatitis, pain