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Antifungals

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bomehubo's version from 2016-11-18 16:03

Section 1

Question Answer
antifungals - name the classespolyenes, azoles
antifungal therapy pitfalls1. delay in starting treatment 2. limited activity of availabe antifungal agents 3. fungal "burden" 4. host immune dysfxn 5. physiologic status of host
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Section 2

Question Answer
Polyenes - mechanismintercalate into sterol cell membrane; causing leaking of cytoplasmic contents
Polyenes - drugsamphotericin B; nystatin
Polyenes - clinical indicationsaspergillosis; histoplasmosis; blastomycosis
Polyenes:ADE - most seriousnephrotoxicity > virtually every pt develops some decrease in CrCl; direct renal tubular toxin; mostly reversible azotemia (may take months)
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Section 3

Question Answer
Azoles - mechanisminhibits enzyme in cell membrane steroid synthesis pathway
Azoles - drugsketo- flu- itra- vori- posa- canazole
Azoles - special propertiesfungistatic; oral and IV preps
Azoles - interactionsnumerous drug interactions; metabolized by CYP450; inhibitors
Azoles - enzyme it inhibits14-alpha-demethylase
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Section 4

Question Answer
Allylamines - mechanismreversible, non-competitive inhibitors of squalene epoxidase leading to decrease amounts of lanosterol and ultimately ergosterol
Allylamines -clinical utilitylimited to topical tx of dermatophyte infections
Allylamines - drugsnaftifine, terbinafine, tolnaftate
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Section 5

Question Answer
Nucleoside analogues - mechanismconverted to triphosphate form and incorporation with subsequent miscoding of RNA & DNA synthesis
Nucleoside analogues - analogue of what?flucytosine (5-FC) - cytosine analogue
Nucleoside analogues - special noteno indication for monotherapy; rapidly emerging resistance
Nucleoside analogues - AEpotent myelosuppressive
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Section 6

Question Answer
Echinocandins - mechanisminhibition of glucan synthase (cell wall)
Echinocandins - drugsmicofungin; caspofungin
Echinocandins - activity against what? no activity for what?excellent coverage for aspergillus and candida. No activity for cryptococcus.
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