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23 Cards in this Set

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Topical Antifungals: Azoles (Clotrimazole), Polyenes (Amphotericin B), Other (Tolnaftate)
No adverse effects
Nystatin (mycostatin)
oral candidiasis

few adverse effects
Clotrimazole (mycelex)
oral candidiasis

rare adverse effects
Griesofulvin (grifulvin)
dermatophytes

treat 12-18 months
Terbinafine (Lamisil)
dermatophytes

loss of apetite, dyspepsia, nausea, vomiting, diarrhea, skin rxn, hepatotoxic
Amphotericin B
1st line for everything EXCEPT PCP and dermatophytes
(sporothrix, cocci, histo, blasto, candida, crypto, aspergillus)

"shake & bake" (prostaglandins, cytokines - NOT HISTAMINE!!), anemia, renal toxicity/acidosis, thrombophlebitis
Amphotericin B lipid complex (ABLC, Abelcet)
Liposomal Amphotericin B (AmBisome)
Aspergillus (if Ampho intolerant); crypto meningitis

less nephrotoxicity than regular Amphotericin B
Ketoconazole (Imidazole) PO
2nd line: Blastomyces

fungistatic; hepatic effects, lower testosterone/cortisol, nausea, rash
Fluconazole (triazole) PO/IV
1st line: vaginal candidiasis
2nd line: crypto, cocci

alopecia, nausea, rash
Voriconazole (triazole) PO/IV
1st line: aspergillosis
2nd line: candida, histo

altered mental status, visual alterations, nausea, rash, expensive
Itraconazole (triazole) PO/IV
1st line: blasto, sporothrix
2nd line: aspergillosis, candida, cocci/paracocci, histo

nausea, rare, need H+ for absorb
Posaconazole
broad spectrum (especially mucorales, cocci)
Ravuconazole
less spectrum than posaconizole, long half life
5-flourocytosine (5-FC, ancoban)
5-FC + Amphotericin B for crypto meningitis
fewer relapsed with candida UTI

adjust dose with renal insufficiency; nausea, vomit, rash, diarrhea, hepatic insufficiency, bloody diarrhea
Echinocandins (caspofungin, micafungin, anidulafungin)
Candida (esp resistant ones), Aspergillus, dimorphic fungi, PCP cyst phase

fungicidal; rare adverse effects
Aspergillosis
1st line: Amphotericin B (liposomal), Voriconazole, Caspofungin
2nd line: Itraconazole
Blastomycosis
1st line: Itraconazole
2nd line: Ketoconazole
Amphotericin B for life threatening
Candidiasis: Urinary
1st line:Amphoteriicn B, Fluconazole
2nd line: 5-FC, Caspofungin
Candidiasis: systemic, organs
Echnocandins, Amphotericin B
2nd line: voriconazole, itraconizole
Cryptococcosis
Amphotericin B +/- 5-FC, fluconazole
2nd line: Fluconazole + 5-FC
Echinocandins have NO activity
Coccidioidomycosis
1st: Amphotericin B
2nd: Itraconazole, Fluconazole, Voriconazole, Posaconazole
Histoplasmosis
1st: Amphotericin B
2nd: Itraconazole, Voriconazole
Sporotrichosis
1st: Itraconazole
2nd: SSKI for cutaneous, terbinafine