Antifungals

Front 1

Most important for serious fungal infections

Back 1

Amphotericin B

Front 2

Mainstays of treatment for fungal infections?

Back 2

oral azoles (Itraconacole and Fluconazole) if severe start on Amp B then switch to azoles after a couple weeks

Front 3

Amphotericin B, Nystatin MOA

Back 3

binds to ergosterol, creates pores in membrane, and causes the membranes to become leaky

Front 4

Nystatin use

Back 4

Oral thrush (Candida sp) oral or topical use only too toxic for systemic use

Front 5

Amphotericin B use

Back 5

severe, invasive fungal infections. Systemic use reserved for sevre, life-threatening infections

Front 6

Amphotericin B adverse effects

Back 6

Nephrotoxicity, cytokine storm (can slow infusion to avoid this), aka as Shake and Bake drug because of cytokine storm

Front 7

Amphotericin B administration

Back 7

IV, intrathecal for meningitis

Front 8

Amp B lipid formulatoins will

Back 8

decrease side effects like the really bad nephrotoxicity and they are less expensive

Front 9

Flucytosine uses

Back 9

systemic candidiasis, cryptococcal meningitis never used alone used in combination with Amp B esp. if have CNS involvement

Front 10

Flucytosine MOA

Back 10

enters cell, hit by cytosin deaminase then acts like fluoquinolol by decreasing dUMP to TMP

Front 11

Flucytosine adverse effects

Back 11

BMD, GI mucositis same as 5-fluoroquinolon

Front 12

Griseofulvin uses

Back 12

skin, scal, nail infections DOC for tinea capitis

Front 13

Griseofulvin MOA

Back 13

deposits in keratin producing cells so new hair or nails grow and they are fungal free but takes months to clear

Front 14

Griseofulvin administration

Back 14

only given orally (not effective topically)

Front 15

Griseofulvin adverse effects

Back 15

Hepatotoxicity, teratogenic, potent CYP3A4 inducer so lot of DDIs

Front 16

Terbinafine MOA

Back 16

increases squalene which is toxic for the fungus so it dies

Front 17

Terbinafine uses

Back 17

DOC for Dermatophytoses (tinea infections e.g. athletes foot, jock itch), Onychomycosis (nail infections)

Front 18

Terbinafine adverse effects

Back 18

rare but causes hepatotoxicity and neuropenia

Front 19

Ketoconazole Fluconazole Itraconazole Voriconazole MOA

Back 19

inhibits cytochrome P450 which decreases the production of Ergosterol and creates a leaky membrane so don't use with Amp B because Amp B will not have anything to work on

Front 20

Ketoconazole Fluconazole Itraconazole Voriconazole side effects

Back 20

DDIs (C450 inhibitor), hormonal deficiencies more problems and lower efficacy with Ketoconazole than the others because it is an older drug

Front 21

Ketoconazole uses

Back 21

tinea corporis and capitis (topical), not used for systemic infections

Front 22

Ketoconazole PK

Back 22

Antacids, H2 blockers and proton pump inhibitors interfere with absorption

Front 23

Ketoconazole adverse effects

Back 23

persistent adrenal insuficiency, gynecomastia, impotence, decreased libido, menstrual abnormalities, and hepatoxicity

Front 24

Fluconazole uses

Back 24

several systemic fungal infections, least effect of all azoles on P450 so less DDIs and little to no endocrine effects, elminated by kidneys

Front 25

Voriconazole adverse effects

Back 25

visual disturbances (blurring and changes in color vision)

Front 26

Voricanzole use

Back 26

invasive aspergillosis

Front 27

Caspofungin MOA

Back 27

Impairs cell wall production via inhibition of beta-1,3-D-glucan systhesis

Front 28

Caspofungin uses

Back 28

Candida and aspergillus (resistant or refactory infections), used as salvage therapy for invasive aspergillus when Amp B and Voriconazole have failed or pt can't take them