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20 Cards in this Set
- Front
- Back
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fungal infection sites
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superficial- skin, mucous membranes, hair, nails
subcutaneous- dermis, subcutaneous tissue, bone systemic- internal organs -most difficult to treat |
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Amphotericin B
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binds to ergosterol--> disrupts membrane and causes cell death
spectrum: candida, histoplasma, cryptococcus, coccidioides, aspergillus, blastomyces IV, topical- for cutaneous candida, intrathecal for fungal meningitis U: DOC for aspergillus, candida, cryptococcus, histoplasma, mucormycoses AD: fever, chills, hypotension, RENAL IMPAIRMENT- renal tubular acidosis, hypochromic normocytic anemia- due to decrease in EPO, intrathecal causes seizures and neurological symptoms now: lipid formulations to reduce nephrotoxicity |
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Flucytosine
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Inhibits thymidylate synthetase- no dTMP, also no protein synthesis
-taken in via cytosine permease fungistatic U: only in combination therapy: flucytosine + amphotericin B= cryptococcal meningitis flucytosine + itraconazole= chromoblastomycosis ORAL AD: marrow anemia, leukopenia, thrombocytopenia, toxis enterocolitis |
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Azoles: general
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inhibit 14α-sterol demethylase- reduces ergosterol synthesis
2 types: imidazoles and triazoles -imidazoles are less specific therefore greater adverse effects keto, flu, itra= oral for dermatophytoses -pulse or intermittant dosing topical azoles against candida and pityrosporum -clotrimazole, miconazole |
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Ketoconazole
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IMIDAZOLE
stong inhibitor of CYP3A4 best absorbed at low pH AD: propensity for mammalian CYP's, can decrease testosterone, hepatic toxicity U: chronic mucocutaneous candidiasis, dermatophytes |
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Fluconazole
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TRIAZOLE
inhibitor of CYP2C9, CYP3A4; can increase levels of phenytoin, warfarin, zidovudine oral, IV renal excretion DOC candidiasis, coccidioides, cryptococcal meningitis NOT effective on aspergillus, or other filamentous fungi |
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Itraconazole
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TRIAZOLE
inhibits CYP3A4 absorption in acidic pH U: blastomyces, sporothrix, histoplasma, aspergillus, dermatophytes, onychomycosis NOT effective on zygomycetes |
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Voriconazole
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TRIAZOLE
inhibits CYP2C19, CYP2C9, CYP3A4 IV, oral U: invasive aspergillus, some candida, fusarium NOT zygomycetes AD: rash, elevated liver enzymes, visual disturbances- blurring, brightness, and color |
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Posaconazole
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TRIAZOLE
inhibits CYP3A4 spectrum like other azoles but also zygomycetes (ex. mucor) oral suspension with fatty meal |
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Echinocandins
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cyclic peptide linked to long chain fatty acid
inhibit synthesis of β(1,3)-D-glucans in the fungal cell wall- disruption in cell wall-->death |
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Caspofungin
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Echinocandin
U: disseminated and mucocutaneous candida infections, aspergillus if amphoteracin B doesn't work. AD: Gi, flushings, elevated liver enzymes if given with cyclosporine |
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Micafungin
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Echinocandin
U: mucocutaneous candidiasis and prophylaxis of candida AD: GI, flushings, increases levels of nifedipine, cyclosporine, sirolimus |
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Anidulafungin
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Echinocandin
U: esophageal and invasive candida AD: GI, flushings, may cause histamine release with IV |
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Griseofulvin
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Interacts with microtubules and inhibits mitosis
-fungistatic absorbed with fatty foods must be administered 2-6 weeks for nail and hair infections U: dematophytoses of skin, hair, nails AD: allergies, mental confusion, photosensitivity, may enhance coumarin metabolism |
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Terbinafine
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inhibits squalene epoxidase---> no lanosterol
-fungicidal oral U: onychomycosis, topically for tinea cruris, corporis AD: GI, rash, headache, taste |
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Nystatin
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inhibits ergosterol--> cell death
topical use U: candida-oropharyngeal, vaginal, intertriginous AD: rare |
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Naftifine
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inhibits squalene epoxidase--> no lanosterol
U: tinea cruris, corporis topical |
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Butenafine
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inhibits squalene epoxidase
U: dermatophytoses |
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Tolnaftate
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U dermatophytoses
not effective against candida |
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Ciclopirox olamaine
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inhibits uptake of precursors of macromolecules
-fungal membrane U: dermatophytes, candida, P. orbiculare |
