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35 Cards in this Set
- Front
- Back
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What is ergosterol?
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fungal lipid; building block of fungal cell wall
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describe synthesis of ergosterol
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squalene--> lanosterol--> ergosterol
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What drug inhibits
squalene--> lanosterol? What enzyme is inhibited in this process? |
terbinafine: inh's squalene epoxidase
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What drug inhibits
lanosterol--> ergosterol? What enzyme is inhibited in this process? |
-azoles: inh demethylation
"ASSHOLES inh the finishing product" |
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Which drugs bind to ergosterol?
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Amphotericin B, Nystatin
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Difference bw the MOA of Amphotericin B and Nystatin
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AmpoTERicin B "TEARs holes in cell wall" (leak electrolytes)
NySTATin "SAT IN cell mem" to disrupt cell wall |
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Amphotericin B
MOA: uses: S/E: diminish S/E: |
MOA: AmpoTERicin B "TEARs holes in cell wall" (leak electrolytes)
uses: systemic mycosis, fungal meningitis S/E: Anemia, Nephrotox, Phlebitis, hypOtn, arrhythmias (hypOk and hypERk), SIADH "ANPHO-terrible-Beats" diminish S/E: liposomal amphotericin, hydration |
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Nystatin
MOA: uses: |
MOA: NySTATin "SAT IN cell mem" to disrupt cell wall
uses: candida on skin, mucosa |
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-Azoles
MOA: uses: S/E: |
MOA: inh lanosterol--> ergosterol
"ASSHOLES inh the finishing product" uses: systemic mycosis, cryptococcal meningitis, S/E: gynecomastia (blocks 5alpha reductase), inh P450 |
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Flucytosine
MOA: uses: S/E: |
MOA: converts to 5-fluorouracil--> inh DNA synth by inh thymidine synthase (antimetabolite)
uses: in combo with Ampotericin B for systemic mycosis S/E: n/v/d, BM suppress |
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Capsofungin
MOA: uses: tox: |
MOA: inh synth of Beta-glucan (building-block of cell WALL)
uses: invasive aspergillosis tox: GI upset, flushing "ice CAPS in ASPEn look like GLU" |
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Terbenafine
MOA: uses: tox: |
MOA: inh squalene reductase
(squalene--> lanosterol) uses: tinea, especially in nail (ie onchomycosis) "Terbenafine for Tinea" |
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Griseofulvin
MOA: uses: tox |
MOA: keratin-griseofulvin complex becomes part of skin, hair, nail; interferes w microtubule fxn
uses: inh growth of tinea infxns tox: teratogen, carcinogen, HA, confusion, inh P450 |
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Which Antifungals can be used for any systemic mycosis and fungal meningitis?
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Amphotericin B/flucytosine, -azoles
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Which can cross BBB?
Ampho-B or azoles? |
Azoles can cross BBB
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if Ampho-B cant cross BBB, how can we use it to treat fungal meningitis?
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intrathecal (into CSF) injections
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Which antifungal is too toxic for systemic use?
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Nystatin
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Rx of any topical fungal infections
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Clotrimazole, Miconazole
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dermatophyte is synonymous with
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tinea
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tinea of the nail is called
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onchomycosis
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options for rx of tinea
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terbinafine, griseofulvin
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Griseofulvan penetrates to level of
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strateum corneum
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Whats a kerion?
DOC? |
tinea capitus with superimposed bacterial infxn
DOC: griseofulvin (w abx and steroids) |
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What is Piedre?
DOC? |
little black balls on hairshaft
DOC: cut off hair |
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What is Beigeii?
DOC? |
little white balls on hairshaft
DOC: cut off hair |
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DOC for mucosal candidiasis
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nystatin, fluconazole
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DOC for tinea in nail (onchomycosis)
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terbenifine
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DOC for cryptococcal meningitis
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-azole (ketoconazole- best CNS penetration)
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Azole with best CNS penetration
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ketoconazole
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Antifungal that causes SIADH
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Amphotericin B
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Antifungal that causes arrhythmias
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Amphotericin B
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DOC for rhizor
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IMMEDIATE SURGERY!
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clues for using systemic dz (for which we give Ampho B)
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1) fever > 104
2) fungus in blood 3) lab abnormalities |
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DOC for disseminated Histoplasmosis
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Itraconazole
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DOC for tinea versicolor (4-5mm wide)
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Lotion with selegium, shampo with ketoconazole
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