Updated: 1/10/2022

Anti-Fungals

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  • 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
      • vIV 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
      • 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
      • Oral candidiasis
      •  Topical yeast infection:
      • diaper rash
      • vaginal candidiasis
      • intertrigo
      • Echinocandins
      • Disrupts cell wall synthesis by inhibiting beta-glucan synthesis
      •  Can be fungistatic or fungicidal
      • Gastrointestinal upset
      •  Flushing:
      • mediated by histamine
      • Widespread dermatophyte infections
      •  Onychomycosis
      • 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

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