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59 Cards in this Set
- Front
- Back
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what is an important note about dosing with funal infections?
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They require prolonged treatment
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Which type of fungal infection is more lifethreatening?
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Systemic! It's in your body!!
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What is utilized for SEVERE infections
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Amphotercin B
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What azoles are orally effective?
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Itraconazole, fluconazole
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MOA: polyenes
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Bind ergosterol in fungus and make pores inducing death
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MOA: Azoles
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Block ergosterol synthesis by inhibiting demethylation of lanosterol
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name the polyenes
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Amphotericin B and Nystatin
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MOA: 5-flucytosine
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converted into 5-fu and inhibits DNA synthesis
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MOA: Griseofulvin
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Binds microtubles and then the cell can't GROW
g for Grow |
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allylamines MOA
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Block ergosterol by inhibits squalene eposixase...
"All....it's a SQUirl" |
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echinoCANdins MOA
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inhibit beta gluCAN synthesis and cell wall integrity
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Indications for nystatin
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Only use orally/topically....otherwise too toxic
candida infections, ex. Trush |
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Indications for amphotercin B
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B for Broad spectrum, only use for severe infections
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Which anti-fungal has activity against all the fungi?
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Amphotericin B (B for broad spectrum)
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Adverse effects of amphotericin B?
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Nephrotox
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How does Amphotericin B cause nephrotox?
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Constriction afferent arterioles and renal damage by membrane permeability disruption
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What should you watch for ACUTELY in giving amphotericin B?
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Cytokine storm; NV, fever, chills, hypotension
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How do we minimize the occurance of a cytokine storm?
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Give acetaminophen, Ibuprofen, benadryl and lots of water!
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why do we have lipid formulations of amphotericin B?
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To decrease nephrotoc
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What is Flucytosine effective against?
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Aspergillus, candida, cryptococcus
Not preferred for any of them |
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How is Flucytosine used?
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In combo with amphotericin B for systemic candidiasis and crytopoccal meningitis
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What are the adverse effects associated with flucytosine?
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BMD
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MOA: griseofulvin
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Inhibit microtubles to prevent growth
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Indication for griseofulvin
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Tinea infections
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How long would a patient be given griseofulvin in a fungal nail infection?
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Months
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How is griseofulvin given?
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Orally, does not work topically
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Adverse effects of griseofulvin
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hepatotoxicity, teratogenic
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If given with warfarin, girseofulvin may.....
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increase the metabolism due to CYP3A4 induction
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Terbinafine is the DOC for
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Tinea infections, onychomycosis
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MOA: terbinafine
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Inhibit squalene epoxidase to cause squalene accumulation and toxicity
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toxicity with Terbinafine
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Hepatoxicity and neutropenia
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In comparision to griseofulvin, terbinafine.....
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Is shorter, more effective, and better tolerated UINLESS the infection is tinea capititis
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Indication for azoles
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Systemic fungal infections
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MOA: Azoles
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inhibits P450 to decrease ergosterol and make leaky membranes
"Azoles will poke Ahole in the fungus" |
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What is a unique side effect of Azoles at high dosages?
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decreased testosterone and cortisol
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clinical indication for Ketoconazole
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Keto treats tine Corporis and Capitis
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PK of Ketoconazole
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food needed to process
decreasing stomach acid (antacid, H2 blocker, PPI_ interferes with absorption |
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Adverse effects of ketoconazole
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Decreases steroid synthesis leading to testosterone issues and hepatotoxicity
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Drug interactions with ketoconazole
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are due to P450 inhibition
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which is used more fluconazle or ketoconozole? why?
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fluconazole, less activity on P450 and less toxicity
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adverse effect with Voriconazole
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Vision disturbance (vori=vision)
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DOC for invasive aspergilliosis?
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Voriconazole
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what drug class does caspogungin belong to?
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echinocandins
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MOA caspofungin
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inhibits glucan synthesis for the cell wall
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bugs caspogungin works against
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candida and aspergillus
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main clinical use of caspofungin
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salvage therapy in invasive aspergillosis
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treat moderate systemic candidiasis with -____
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itraconazole
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Treat severe crytococcosis and candidiasis with
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amphotericin B + flucytosine
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treat mild blastomycosis with
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itra, flucon -azoles if mild/moderate
Amphotericin B if severe |
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treat histoplamosis with ______ (do you remember where this is prevelant?)
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itraconazole, add amphotericin B if severe
Ohio and Mississippi river valley's |
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treat coccidiomycosis with
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itra or fluconazole
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Treat paracoccidiomycosis with
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itra or ketoconazole
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Treat mucormycosis with
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AmP. B
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How do you treat a superficial dermatophyte infection?
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topical azole
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How do you treat tinea corporis and capitis?
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oral/topical azole
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how do you treat tinea unguium?
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terbinafine or griseofulvin
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superficial candidiasis is treated with......
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topical azole
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what is miconzole used to treat?
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vaginal candidiasis
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T or F, topical antifungals can be used for tinea unguinum
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False
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