Quick Anti- fungals

1. Quick Anti-fungals By Sarah E.

2. Anti-fungals • Name the 6 categories of anti-fungals • Polyenes • -azoles • Synthetic allylamines • Anti-metabolites • Echinocandins • antibiotic

3. Anti-fungals • Name a polyene • Amphotericin B • Name 3 azoles • Ketoconazole (an imidazole) • Fluconazole (a triazole) • Itraconazole (a triazole) • Name a synthetic allyamine • terbinafine

4. Anti-fungals • Name an anti-metabolite • Flucytosine • Name an echinocandin • Caspofungin • Name an antibiotic • griseofulvin

5. Anti-fungals • What is the mechanism of action of ampotericin B? • Breaks up cell membrane via ergosterol • What is the mechanism of action of ketoconazole (and other azoles)? • Inhibits ergosterol synthesis by blocking 14-α-demethylase

6. Anti-fungals • What is the mechanism of action of terbinafine? • Reduces synthesis of ergosterol by inhibiting squalene 2,3 epoxidases • What is the mechanism of action of flucytosine? • Inhibits DNA synthesis via conversion to 5F-DUMP and inhibiting thymidylate synthase

7. Anti-fungals • What is the mechanism of action of caspofungin? • Binds to glucan synthase complex, inhibits cell wall synthesis • What is the mechanism of action of griseofulvin? • Binds host keratin, binds in fungus and their microtubules get messed up

8. Anti-fungals • Which are contraindicated in patients with CHF? • Itraconazole and terbinafine • Which are contraindicated in pregnancy? • Griseofulvin, fluconazole • Which get into the CSF? • Fluconazole, flucytosine

9. Anti-fungals • Which can’t be taken with alcohol? • Griseofulvin • Which is IV only? • caspofungin • Which can be used topically? • Amphotericin B, terbinafine • Which inhibits patient steroid synthesis? • ketoconazole

10. Anti-fungals • What is the drug of choice for coccidioides meningitis? • Fluconazole • Can this drug treat aspergillus? • No • What is the drug of choice for oral thrush? • Also fluconazole

11. Anti-fungals • What is the drug of choice for a severe systemic infection? • Amphotericin B • What is the drug of choice for non-meningeal histoplasmosis of blastomycosis? • Itraconazole

12. Anti-fungals • What is the drug to use to treat systemic aspergillosis? • Amphotericin B • What if the patient can’t tolerate Amphotericin B? • Give caspofungin • What is the indication for griseofulvin? • Pediatric tineas

13. Anti-fungals • What is the drug of choice for cryptococcal meningitis? • Combination of flucytosine and Amphotericin B • What is a major adverse effect of flucytosine? • Bone marrow suppression/anemia • What are the adverse effects for amphotericin B? • Cytokine release syndrome, nephrotoxicity

14. Anti-fungals • Which drug’s major metabolism is done by P450? • Ketoconazole • Which –azole is water soluble? • Fluconazole • What is the indication for terbinafine? • Tineas, onychomycosis

15. Anti-fungals • Which drug increases in serum levels when the patient is also taking cyclosporine? • Caspofungin • Which drugs require low stomach pH to be absorbed? • Ketoconazole, itraconazole • Which is used for preventing cryptococcal meningitis relapse in AIDs patients? • fluconazole