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58 Cards in this Set
- Front
- Back
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Main Anti-Fungal Drug? |
Amphotericin |
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How does Amphotericin act? |
Polar & non-polar side Dissolves into fungus, leaving a hole/pore in the membrane --> Eventually funds dies |
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What contributes to predisposition of fungal infections? |
Immunosuppression Use of steroids Antibiotic use |
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2 Main Types of Fungus? |
Yeasts Filamentous Fungi |
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Types of Yeast? |
Candida spp. Cryptococcus neoformans Pityriasis versicolor Systemic Yeasts (e.g. Histoplasma capsulatum) |
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What does Candida spp. cause? |
Thrush & fungemia |
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What does Cryptococcus neoformans cause? |
Meningitis, pneumonia & fungemia |
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What does Pityriasis versicolor cause? |
Chronic skin infections |
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What do Systemic Yeasts cause? |
Pulmonary or Disseminated infections |
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Types of Filamentous Fungi? |
Aspergillus spp. Dermatophytes (e.g. Epidermophyton, Tricophyton, Microsporum) |
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What does Aspergillus cause? |
Fibrosis of the lungs (Antigen/Antibody complex III) Colonisation of lung cavity (ball of fungus) Bronchospasm (Type 1 hypersensitivity) Farmer's Lung Pulm & Occular infections Bronchopulmonary Aspergillosus Fungemia |
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What does Bronchopulmonary Aspergillosus look like? |
White patches on CXR Fungus Ball of Aspergillus on CXR |
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What do Dermatophytes cause? |
Chronic Nail & Skin infections Kerions (animal dermatophytes) |
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Names of Tri-Azole Drugs? |
Fluconazole Itraconazole Posaconazole Voriconazole |
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How Does Fluconazole work? |
Inhibits 14-alpha-demethylase enzyme Ergosterol not made for the cell membrane |
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What's Fluconazole used for? |
Fungal meningitis Candiduria |
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Risks of Fluconazole? |
Hepatotoxicity Prolonged QT interval |
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Uses of Itraconazole? |
Dermatophyte infections (Needs acid environment in stomach) |
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Risks of Itraconazole? |
Hepatotoxicity |
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Uses of Posaconazole? |
Invasive infections Used when other drugs aren't having a response |
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Uses of Voriconazole? |
Life-threatening Infections |
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Flucytosine Method? |
Prevents synthesis of fungal proteins |
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Flucytosine uses? |
Systemic yeast & fungal infections Multi-drug resistant fungal infections |
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Flucytosine Cautions? |
Elderly Blood disorders Liver problems Teratogenic - Caution in pregnancy |
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Polyene Drugs? |
Amphotericin Nystatin |
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Uses of Nystatin? |
Oropharyngeal & Oral fungal infections Given topically Toxic |
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Uses of Amphotericin? |
Active against most fungi & yeasts Systemic Fungal Infections |
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How is Amphotericin administered? |
IV Lipid formulations available when IV form is contra-indicated (poor response or toxicity) |
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Problems with Amphotericin? |
Highly protein bound Doesn't penetrate well into tissues & fluids |
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How Does Amphotericin Work? |
Binds to Ergosterol Forms pore in fungal membrane Cations leak out leading to cell death |
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Names of Echinocandins? |
Anidulafungin Caspofungin Micafungin |
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Uses of Echinocandins? |
Aspergillus & Candida infections But only Caspofungin used for Aspergillosus |
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Method of Action of Echinocandins? |
Bind to B-(1,3)-D-Glucan Synthase Glucan chain formation affected Can't resist osmotic pressure so cells lysed |
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Terbinafine Uses |
Dermatophyte & Ringworm infections |
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Terbinafine Method |
Inhibits Squalene Epoxidase Squalene not converted to Ergosterol So lack of Ergosterol & build-up of toxic products, leading to cell death |
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Terbinafine Cautions |
Psoriasis Autoimmune conditions Pregnancy Liver problems |
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Griseofulvin Method |
Inhibits fungal mitosis |
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Griseofulvin Uses |
Dermatophyte infections of skin, scalp, hair & nails |
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Griseofulvin Problems |
Contra-indicated in Systemic Lupus Erythematous & Severe Liver Disease Impaired performance in skilled tasks - e.g. driving Headaches, nausea, vomiting, diarrhoea, glossitis etc. |
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Treatment of Invasive Candidiasis - MAIN DRUG |
Echinocandin |
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What's used for Candida albicans? |
Fluconazole If there's Fluconazole resistance, Voriconazole used |
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What's used for CNS Candidiasis? |
Amphotericin |
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What's used for Refractory Cases of Invasive Candidiasis? |
IV Amphotericin + Flucytosine |
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Main Drug in Superficial Candidiasis? |
Miconazole |
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What's used for Oral/Oropharyngeal Candidiasis? |
Nystatin mouthwash |
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What's used for Vaginal Candidiasis? |
Fluconazole (Oral) Other locally acting anti-fungals |
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What's used for Candidiasis that's Fluconazole resistant? |
Itraconazole |
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Where can Aspergillosus spread to? |
Heart, Brain, Skin etc. in immunocompromised patients |
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Main drug for Aspergillosus? |
Voriconazole |
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What's used for Voriconazole resistant Aspergillosus? |
Liposomal Amphotericin |
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What's used for Aspergillosus resistant to Amphotericin & Voriconazole? |
Caspofungin/Itraconazole/Posaconazole |
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What's used for Chronic Pulm. Aspergillosus & Allergic Bronchopulmonary Aspergillosus? |
Itraconazole |
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Cryptococcal Meningitis Treatment Plan? |
IV Amphotericin + IV Flucytosine for 2 weeks Then Fluconazole (Oral) for 8 weeks (Fluconazole given as prophylaxis after treatment until immunity recovers) |
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What major disease is CM related? |
HIV Common in late-stage HIV Major cause of death in HIV patients |
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What does pigeon poo cause? |
Fungal Meningitis Histoplasmosis |
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Causal bacteria/organism of Histoplasmosis? |
Histoplasma Capsulatum (Systemic yeast) (Produced in soil when bird poo degrades) |
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What are the commonly inhaled spores? |
Coccidioides Paracoccidioides |
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Treatment of Systemic Fungal Infections (E.g. Histoplasmosis) |
Parenteral Itraconazole in patients with non-meningeal infections (e.g. Chronic Pulmonary Histoplasmosis) (Also given as prophylaxis after treatment to prevent relapse) Parenteral Amphotericin - More severe/fulminant cases |
