Topic
Review Topic
0
0
Introduction
  • Drugs (all systemic unless otherwise noted)
    • amphotericin B
    • nystatin
      • topical formulation only
    • terbinafine
      • topical or systemic
    • echinocandins
      • anidulafungin
      • caspofungin
      • micafungin
    • azoles
      • topical formulations (too toxic for systemic use)
        • clotrimazole
        • miconazole
        • econazole
      • systemic
        • itraconazole
        • fluconazole
        • isavuconazole
        • ketoconazole (can also be topical)
        • voriconazole
    • griseofulvin
    • flucytosine
    • selenium sulfide
      • topical formulation only
  • Clinical use
    • fungal infections
 
Anti-Fungal Medications
Drug Mechanism of Action
Adverse Effects of Systemic Treatment
Indications
Amphotericin B
  • Binds to ergosterol in the membrane that is unique to fungi, forming membrane pores through which electrolytes and other cell contents leak 
  • Can be fungistatic or fungicidal
  • Fevers, chills, and flu-like reaction
  • Renal toxicity
    • hydrate
    • supplement potassium and magnesium
  • Arrhythmias
  • Anemia
  • IV phlebitis
  • Systemic mycoses
    • Cryptococcus
    • Blastomyces
    • Coccidioides
    • Histoplasma
    • Candida
    • Mucor
Nystatin
  • Binds to ergosterol
  • Can be fungistatic or fungicidal
  • Topical formulation only
    • adverse effects are too toxic for systemic use
  • Oral candidiasis
  • Topical yeast infection
    • diaper rash
    • vaginal candidiasis
    • intertrigo
Terbinafine
  • Inhibits squalene epoxidase, an enzyme in fungi that is key in lanosterol synthesis
  • Fungicidal
  • Gastrointestinal upset
  • Liver toxicity (rarely, can cause fulminant liver failure requiring liver transplant)
  • Taste disturbance
  • Widespread dermatophyte infections
  • Onychomycosis
Echinocandins
  • Disrupts cell wall synthesis by inhibiting beta-glucan synthesis
  • Can be fungistatic or fungicidal
  • Gastrointestinal upset
  • Flushing
    • mediated by histamine
  • Aspergillosis
  • Candida
Azoles
  • Inhibits 14-alpha-demethylase, which is key in ergosterol synthesis in fungi
  • Fungistatic
  • Anti-androgen effects via inhibiting testosterone synthesis
    • gynecomastia (in particular, with ketoconazole)
  • Inhibits cytochrome P450
  • Local mycoses
  • Mild systemic mycoses
  • Specific indications
    • fluconazole
      • chronic suppression of Cryptococcus in immunosuppressed patients
    • itraconazole
      • Blastomyces
      • Coccidioides
      • Histoplasma
    • voriconazole
      • Aspergillus
      • Candida
    • isavuconazole
      • Aspergillus
      • Mucor
Griseofulvin
  • Disrupts mitosis via microtubule dysfunction
  • Especially targets keratin-containing tissues such as nails
  • Fungistatic
  • Teratogenic
  • Disulfiram-like reaction
  • Neurologic symptoms
    • confusion
    • headaches
  • Induces cytochrome P450
  • Superficial infections
  • Dermatophytes
    • inhibits growth
Flucytosine
  • Converted by fungal enzyme cytosine deaminase to 5-fluorouracil, which then inhibits nucleic acid synthesis
  • Can be fungistatic or fungicidal
  • Bone marrow suppression
  • Systemic mycoses
    • Cryptococcus
Selenium sulfide
  • Disrupts mitosis, resulting in decreased turnover of epidermal cells and decreased flaking
  • Also has mild antibacterial and antifungal activity
-
  • Seborrheic dermatitis
  • Pityriasis versicolor
 

Please rate topic.

Average 5.0 of 1 Ratings

Thank you for rating! Please vote below and help us build the most advanced adaptive learning platform in medicine

The complexity of this topic is appropriate for?
How important is this topic for board examinations?
How important is this topic for clinical practice?
Topic COMMENTS (0)
Private Note