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29 Cards in this Set
- Front
- Back
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name 2 drugs that are POLYENES
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-ampB
- Nystatin |
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moa of polyenes?
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interacts with ERGOSTEROL and forms pores in fungal membranes
- resistant bugs have low levels of ergosterol in their cell membranes |
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spectrum of ampB ?
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WIDE FUNGICIDAL spectrum
- DOC for --> apergillus, candida, cryptococcus, histo, mucor, sporothrix |
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ampB + flucytosine = synergism for which fungi?
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candidiasis and crypto
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nyastatin is used in what manner?
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topically for localized candidal infections
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pk of ampB?
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slow iv infusion
- poor cns penetration - LONG HALF LIFE >2 weeks |
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side fx of ampB ?
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INFUSION related
- f, chills, muscle rigor and hypotension due to histamine release **make sure to do a TEST DOSE |
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how do u alleviate ampB side fx related to infusion?
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pretreat w/ NSAIDS, antihistamines, meperidine or adrenal steroids
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dose depende side fx of ampB are?
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- nephro --> dcrsd gfr, K , Mg2+, erythropoietin secretion (anemia)
- tubular acidosis |
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how do u protect against these dose related side fx?
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na+ loading
- liposomal ampB - add flucytosine so u can dcrse dose of ampB |
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moa of AZOLES?
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KETO/FLUCO/ITRACONAZOLE
- interfere w/ ergosterol synth via inhibition of conversion of lanosterol --> ergosterol |
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what enzyme is responsbile for the conversion of lanosterol --> ergosterol?
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14-alpha-demethylase
- its a fungal P450 enzyme |
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uses of keto?
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coDOC for --> paracoccidiodes
- backup for blasto/histoplasma - used oraly for mucocutaneous candidiasis or dermatophytoses |
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Fluconazole? cns penetrance?
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fluconazole DOES penetrate the CNS...can b used for suppression and prophylaxis in cryptococcal meningitis
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fluconazole is doc for?
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esophageal / invasive candidiasis / coccidiomycoses
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blastomyces and sporotrichoses have which fungal drug for their DOC?
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itraconazole
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what stomach medications do u not want to take while taking keto?
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antacids
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which drug has a better absorption w/ food intake?
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itraconazole
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keto/itra inhibit which enzyme in the liver?
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p450 inhibitors
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side fx of azoles?
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- dcrse steroid synth
- dcrse cortisol / testerone synth --> dcrsd libido , gynecomastia and menstrual changes |
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make sure u do which test when using azoles?
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LFTS!
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moa of flucytosine?
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activated by fungal cytosine deaminase to 5-FU --> inhibits thymidilate synthase --> causes a THYMINELESS cell DEATH
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flucytosine is used w/ what other drug for rx of severe candidal / cryptococcal infxns?
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ampB
- csf entrance :) - bmd |
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what type of fungal infections is GRISEOFULVIN active against?
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dermatophytoses
- deposits in newly formed keratin and disrupts microtubule structure |
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side fx of griseofulvin?
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ha, thrush, peripheral neuritis and phototoxic
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if a patient has a history of porphyria, do u avoid griseofulvin?
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yes
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moa of Terbinafine?
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inhibits squalene epoxidase
- which decreases ergosterol synth and causes the cell to kill itself |
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terbinafine is good for only one group of fungal infections? which are they?
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dermatophytoses
- better than griseofulvin in the rx of onchomycoses |
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side fx of terbinafine?
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gi distress, HEPATOTOXIC
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