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32 Cards in this Set

  • Front
  • Back

Names of polyenes antifungals

Amphotericin B


Nystatin

Mechanism of action of anti fungal agents?

Inhibit ergosterol (replaces cholesterol functions) synthesis.

Special pharmacokinetics of amphotericin B?

Binds strongly to tissues - long plasma half-life of 15 days. Hence not good use systemically

Mode of administration of amphotericin B?

Oral and IV

MOA of nystatin?

Pessary

Spectrum of activity of Amphotericin B?

Gold standard for all anti fungal agents - Broad

Uses of Polyenes?

Amphotericn B - Invasive aspergillosis, histoplasmosis, Systemic candidiasis (ABC)


Nystatin - Vaginal Candidiasis

Adverse effects of Amphotericin B?

- Infusion reaction ("shake and bake" syndrome) Precaution - use a small test dose, slow infusion of final dose over 2-4hrs


- Thrombophlebitis


- Nephrotoxicity

Name 2 azoles

Imidazoles - Clotrimazole, Miconazole (ICM)


Triazoles - Itraco, fluco, vorico-nazoles

How are azoles administered?

Imidazoles- Topical preparations (cream, lotion, powder, pessary)


Triazoles - Oral

Which drug is a useful alternative to amphotericin B for treating systemic fungal infections?

Imidazoles

Adverse effects of imidazole and triazoles?

Imidazoles: Mild side effects


Triazoles


- cause GIT disturbance and mild rash, S-J syndrome occasionally occurs.

Voriconazole is contraindicated with what?

Foetal toxicity - avoid use in pregnancy

Flucytosine mechanism of action?

Disrupt synthesis of fungal RNA and dna

Echinocandin example?

Caspofungin

Mechanism of caspofungin?

Inhibit synthesis of gluten -> disrupt fungal cell wall and causes cell death

How to administer echinocandins?

Parenteral (IV)

Spectrum of activity for flucytosine and caspofungin?

Both Narrow.


When do you use echinocandins (caspofungin?)

Salvage therapy in patients with invasive aspergillosis (failed response to amphotericin B)

When do you use Flucytosine?

During systemic yeast infections (Systemic Candidiasis and Cryptococcal meningitis) and give orally. Combine with Amphotericin B.

How to administer flucytosine?

Orally.

Adverse effects of flucytosine?

1. Bone marrow suppression


2. Hepatotoxicity

Drugs to take note when using caspofungin?

CYP450 inducers like rifampicin, carbamazepine can reduce plasma levels of caspofungin, hence requiring higher dose.

What to note when taking terbinafine (topical)?

Can cause dry skin. These can be avoided by not using >4 weeks.

What subgroup is flucystine under?

Pyramidine analogues.

Name an antiprotozoal agent?

Metronidazole

Mechanism of action of metronidazole?

Interferes with nucleic acid synthesis

Mode of administration of metronidazole?

Orally (rapid and complete absorption)

Distribution of metronidazole?

Distribution: penetrates well into body tissues and fluids, breast milk, saliva, CSF, vaginal and seminal fluids.

Spectrum of activity for metronidazole?

Protozoans and anaerobic bacteria (eg. Clostridium difficile)

Adverse effects of metronidazole?

1. MOST COMMON - bitter metallic taste, dry mouth, N/V



2. COMMON - GIT-related, diarrhoea, vomiting.


CNS-related: insomnia, vertigo


Precautions while taking metronidazole?

Avoid in pregnant patients.