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19 Cards in this Set
- Front
- Back
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yeasts
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repro budding, cryptococcus (immunodef), candida
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molds
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repro spores, aspergillus
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dimorphic
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yeast in body, mold at room temp, histoplasma
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polyene
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bind ergosterol in mem --> cytotoxic spores, fungicidal, poorly abs (no po), highly distributed, no cns penetration (but 1st line for cryptococcal meningitis), conc dep
***ae "amphoterrible" nephrotox (atn, attenuate w/ saline bolus before/after), electrolyte wasting (k, mg), infusion-related rxn (rigor, prophylactic diphenhydramine/acetaminophen) amphotericin b, nystatin (only topical) |
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amB
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amphotericin b, polyene, broad spectrum (candida EXCEPT c. lusitianiae, cryptococcus neoformans, dimorphic fungi, molds), considerable ae, conventional prep amBd (deoxycholate)
lipid formations better ae: abcd (colloidal dispersion, worse infusion rxn, not used), ablc (lipid complex, no benefit), lamb (liposomal, best ae but most expensive), less efficacy so more conc needed |
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nystatin
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polyene, topical only
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echinocandins
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inh b-1,3,-glucan synthase, good v candida (weak c. parapsiilosis), aspergillus, bad v cryptococcus, molds, fungicidal v yeast, pseudostatic v mold (abn hyphae growth), very low ae, poor ba (iv only), well distributed, no renal elim, conc dep
ae <3% infusion rxn, hepatotox uncommon, phlebitis, expensive caspofungin (di w/ cyclosporin?), micafungin, anidulafungin (metab plasma, still hepatotox) |
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caspofungin
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echinocandin, possible di w/ cyclosporin
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micafungin
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echinocandin
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anidulafungin
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echinocandin
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azoles
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inh fungal cyt p450 (dec ergosterol form), all po, widely distributed, hepatic metab, time-dep, fungicidal v mold, fungistatic v yeast
ae hepatotox, rash di human cyt p450 fluconazole, itraconazole, voriconazole, posaconazole, ketoconazole |
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fluconazole
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iv/po, renal excretion, best tolerated azole, few ae, di cyp2c9/19 NOT 3a4
use candidiasis (tx, prophylaxis) good v yeast, cryptococcus, some dimorphic res c. glabrata "glide" (sdd), c. krusei "cruise" (all res), aspergillus, molds, prophylaxis selects for res |
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itraconazole
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po: capsule (poor ba, needs acid), solution (better ba, less tolerated)
reformation of fluconazole, add act v mold, good v aspergillus (dematiaceous mold, dimorphic), candida/cryptococcus (sdd glabrata), use dimorphic, onychomycosis ae neg inotropy lots of di |
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voriconazole
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iv (not sol so use w/ cyclodextrin, nephrotox), po, well abs, hepatic metab, non-linear kinetics
modified fluconazole, very broad, 1st line aspergillosis, candidiasis, better v krusei good v yeast (candida, cryptococcus), mold (aspergillus, fusarium, scedosporium, dematiaceous mold, endemic fungi) ae visual effects (dose related), heaptotox (inc bilirubin), visual hallucination lots of di |
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posaconazole
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prophylaxis mold, only po w/ high fat meal, good v yeast (candida, cryptococcus), mold (aspergillus, zygomycetes)
lots of di |
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ketoconazole
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poor po abs, topical shampoo for dandruff
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5-fc
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flucytosine, antimetabolite, deaminate w/in fungus to 5-fu (fluorouracil), replaces uracil, high ba, widely distributed (incl cns), renal excrete (tox)
use w/ amB for cryptococcal meningitis, good v candida, cryptococcus neoformans, less act kruseii, some act aspergillus/molds ae at peak dose, bone marrow supp, gi intolerance, rash, hepatotox |
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terbinafine
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lamisil, allyamine, inh squalene epoxidase (inh ergosterol synth), po, 40% ba 1st pass, conc nail/fat/skin, liver metab, renal excrete (non-linear elim)
only use onychomycosis ae hepatotox, neutropenia, sjs topical for dermatophytes (trychophyton) good v candida/aspergillus (not used) |
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griseofulvin
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inh fungal mitosis (inh mt), act on mt, po, long hl, good v dermatophyte
ae cns ha |
