Treatment of fungal infections Flashcards Preview

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Flashcards in Treatment of fungal infections Deck (36)
1

Vaginal Candida (single oral dose)
- Also for Candida in urinary tract and oropharynx

Fluconazole

2

creams/suppositories for vaginal candidiasis
- Toxicity of topical preps.: burning, itching, irritation

Miconazole

3

Mechanism for Miconazole

inhibit sterol 14α-sterol demethylase
fungistatic

4

Miconazole is used for:

Oral or vaginal candidiasis
not nails available topically
mech like fluconazole

5

Toxicity of Miconazole

allergic/irritation reactions
- Oral form toxicity: may cause abnormal liver function tests (15%),

6

Use of Itraconazole

- Oropharyngeal and esophageal candidiasis

7

Almost exclusively for Candida of skin, mucous membranes, G.I. tract, vaginal infections
- Mechanism similar to amphotericin B

Nystatin

8

Mech of Nystatin

Nystatin (lika amphoB)
binds ergosterol

9

Side effects of Nystatin

tastses NASTY and GI

10

Amphotericin B
(does it work for dermatophytes?)

topical formulation for cutaneous or mucosal
Candida -
not effective against dermatophytes

11

For fungal eye infections, e.g. conjunctivitis, keratitis, blepharitis
• especially those caused by Fusarium, Cephalosporium, Aspergillus

Natamycin

12

Natamycin must be used in conjuction with

appropriate surgical measures

13

Toxicity caused by Natamycin

conjunctival chemosis and hyperemia, allergic in nature

14

Mech of Natamycin

lipophilic and binds ergosterol

15

type of Dermpatophytic infections:

(Trichophyton, Epidermophyton, Microsporum)

16

Terbinafine (Lamisil):

topical, for dermatophytes

17

Use: this lacquer is the only topical Rx for fungal nail infections

Ciclopirox
(ciclops only has nails... everyint e

18

Ciclopirox mechanism

possibly inhibits metal-dependent enZ by chelating metal ions

19

Tolnaftate

-tx dermapthophytes (not Candida); no significant absorption,
few toxic reactions; thought to inhibit fungal ergosterol synthesis

20

Mech of Tolnaftate

inhibit fungal ergosterol synthesis

21

Terbinafine

12 week therapy for nail infections~ shorter then other dermatophyte infections
superior to grisefulvin for nail infections

22

Mech of Terbinafine
squaline for 12 weeks and 2x6 = 12

inhibits fungal squalene epoxidase; non-competitively; lotsa squalene damages fungal cell membranes; fungicidal

23

blocks fungal squalene epoxidase
accumulation of squaline damages cell membrane~~ fungicidal

Terbinafine

24

Terbinafine;
administration:
Metabolism/excretion:

oral, well absorbed; remains in skin 12 weeks after therapy stopped
metabolites excreted in urine

25

Terbinafine toxicity

inhibits CYP2D6
diarheaa

26

For stuborn infections of skin, hair, nails, that are beyond the scope of topical
therapy

Griseofulvin

27

Recommended therapy for children, esp. for tinea capitis

Griseofulvin

28

Tx length with Griseofulvin

Long-term treatment (6–12 months) esp. for nail infections; clinical relapse will
occur if long-term treatment not completed

29

Mech of Griseofulvin
(micortubles~ metaphase)

slowly deposited into skin, hair, nails; interferes with microtubule
function/mitotic spindle/mitosis; arrests fungi in metaphase of mitosis.

30

only for Epidermophyton, Microsporum, Trichophyton (dermatophytic) infections of skin, hair, nails; not justified for skin infections which respond to topical agents

Griseofulvin
(microtubles, metaphase)

31

Is Griseofluvin Fungistatic or fungicidal?

Both Fungistatic or fungicidal, dependent on fungal metabolic rate

32

Administration of Griseofulvin

Oral with high fat foods
use wth others when tx tenia pedis

33

Toxicities of Griseofulvin

Dont use if porphyria and advanced liver disease;
monitoring of hepatic, renal, and hematopoietic systems recommended - Increased metabolism of other drugs (e.g. oral contraceptives, warfarin,
others)
- caution: penicillin allergies

34

Contraindicated in those with porphyria and advanced liver disease; periodic
monitoring of hepatic, renal, and hematopoietic systems recommended - Increased metabolism of other drugs (e.g. oral contraceptives, warfarin,
others)
- caution: penicillin allergies

Griseofulvin

35

3-month therapy for toenail infections

Itraconazole

36

Itraconazole

Discontinue if signs of liver dysfunction appear Inhibits metabolism of many drugs,
Nausea, vomiting, rash, diarrhea, headache, edema