shevyatiwari's version from 2015-04-18 04:44

Section 1

Question Answer
An AllylamineT
Ba of 90%F, 40%
Minimal hepatic metabolismF
Trade name LamisilT
Liver cirrhosis or renal impairment alters terbinafine clearance by 50%T
Comes only in 250mg tabletsF, also in granules
Metabolised by CYP2C9, 1A2, 3A4, 2C8, 2C19T
Protein binding 55%F, >99%
Detected in eccrine sweatF
Eliminating half life from stratum corneum is 1 weekF, 2-3 weeks
In the nails, accumulates at levels 10-100 times the MIC T
After completion of therapy, detected in nails for 30-36 weeksT, if 6 or 12 weeks of treatment respectively
More effective for ectothrix than endothrixF, more effective for ndothrix eg. tricophyton tonsuring cf microsporum canis as terbinafine preferentially accumulates in the hair shaft
Inhibit squalene epoxidase - > accumulation of squalene and deficiency of ergosterolT
Fungistatic and fungicidalT
FDA approved only for onychomycosisF - also for tine captious in those > 4
Used for 6-12 weeks for finger/toe nailsT
Terbinafine is less effective when candida is the cause of onychomycosisT, esp C albicans
Equal to griseofulvin in tinea capitisF, superior
Effective in tinea versicolor and facial seb dermF - azoles are better
May be useful in systemic mycosesT, require higher doses - 500-1000/day
3A4 inhibitorF, CYP2D6 inhibitor
GI S/E, dermatological manigestations, LFT abnormality up to 2 x UNL, taste abnormality are all S/ET
Hepatitis develops in 4-6 weeks with features of hepatocellular necrosis onlyF, also cholestatic injury
LFT's tend to return to normal after cessationT
Idiosyncratic hepatobiliary dysfunction is rareT
Can precipitate or exacerbate cutaneous or SLET
Depression can occurT
Category of pregnancy?B
TCA's incl doxepin, and amitriptylie do not interactF, are CYP2D6 substrates
If developing symptoms of hepatic dysfunction, should stop and have LFT's doneT, if after 6 weeks
Numerous C/IF, none significant
SSRI's, B blockers, class 1 antiarrhythmics, MOA B's, all have decreased efficacyF, are substrates for CYP2D6, and does are increased
Warfarin potentiatedT
Digoxin potentiatedF, does not alter digoxin
Cimetidine -> decreased clearance of terbinafineT, by 33%
Potentially CYP3a4 and 2c9 inhibitors increase levelsT
Fluconazole -> increased terbinafine levelsT
Rifampicin increase the clearance of terbinafineT, 100%
Caffeine's clearance is increased F, decrased
Metabolised by 2C9, 1A2, 3A4, 2C8, 2C19T

Section 2

Recent badges