2720315
| Question | Answer |
| Fungi Types | Yeast, molds, and dimorphic Mycoses |
| Fungi -Where they are acquired -Who Gets them | Surgical, ICU, Prostheses, IV catheters, HIV Immunosuppressant, Cancer, and transplant patients |
| Traditional Fungal Diagnostic Tests | Culture |
| New Fungal Diagnostic tests (3) | 1) PCR 2) Western Blot 3) Antigen Detection |
| First Antifungal Agent available | Amphotericin B |
| Fungal Infections Subgroups (3) | 1) Superficial mycoses 2) Subcutaneous mycoses 3) Systemic mycoses |
| Superficial mycoses Tx (3) | Nystatin Terbinafine Griseofulvin |
| Subcutaneous Mycoses Tx | Amphotericin Azole Derivatives Flucytosine |
| Systemic Mycoses Tx (3) | Amphotericin Azole derivatives Flucytosine |
| Amphotericin B MOA | Polyene antifungal binds to membrane sterols (ergosterol) in fungal cell membranes, resulting in increased cell membranes, resulting in increased cell permeability, cell leakage, and death |
| Amphotericin B Adverse Effects | 1) Infusion Related Reactions: Chills, fever, HA, N/V. Premedicaiton advised w/ anti-inflammatory drugs, steroids, and antipyretics. Slow the infusion rate |
| Amphotericin B Adverse Effects | 2) Cumulative Toxicity: Nephrotoxicity is severe (80% of patients), Acute Tubular Necrosis occurs which is irreversible. There may also be Anemia, Leucopenia, and severe Potassium and Magnesium loss |
| Nystatin (General) | -Related to Amphotericin B -Topical therapy only [toxic when used systemically] |
| Nystatin -use -Available forms | -Tx for topical vaginal and oral fungal infections (Candida infection) -Available as ointments, creams, mouthwash, suppositories |
| Azole Antifungals Classes | Imidazoles Triazoles |
| Imidazoles Examples (3) | Ketoconazole Clotrimazole Miconazole |
| Imidazole -Delivery -Contraindication | -Delivery: Oral and topical -Contraindication: GI absorption of Ketoconazole does not occur in achlorhydria or when pt is receiving H2 blockers or PPI |
| Triazoles Examples (3) | Itraconazole Fluconazole Voriconazole |
| Triazoles -Delivery | -Delivery: Oral and IV |
| Triazoles Common Adverse Effects | -Common adverse effects include GI disturbances, HA, dizziness -Alopecia areata and Stevens Johnson |
| Triazole Drug levels effected | -Increased levels of Amitriptyline, Cyclosporine, Phenytoin, Warfarin -Decreased Fluconazole levels Carbamazepine, isoniazid, phenobarbital |
| Azole Derivatives and Use (4) | Itraconazole-onychomycosis Voriconazole-aspergillus, Candida Ketoconazole-Seborrheic dermatitis Clotrimazole-Topical Candida |
| Echinocandins | -Inhibit Fungal cell wall synthesis [Chitin, Beta D-Glycan] -Beta glucans are carbohydrate polymers cross-linked with other fungal cell wall components -Inhibition of Beta 1-3 glycans of the fungal cell wall |
| Echinocandins (Examples) | -Caspofungin (Cancidas) for tx of Candida and Aspergillus -Micafungin: esophageal, oropharyngeal, and invasive candidasis -Used in hemaopoietic stem cell transplantation patients Adverse effects: HA, fever, phlebitis at injection site, abnormal LFTs |
| Grisefulvin | -Deposited in keratin precursor cells of skin, hair, and nails where it disrupts microtubule function and inhibits dermatophyte growth -Induces CYP450 to reduce warfarin and Oral contraceptive concentration -Absorption enhanced w/ fatty foods |
| Terbinafine | -Synthetic allylamine used for onychomycosis -Fungicidal because it interferes w/ Ergosterol synthesis -Used for Tinea corporis and tinea cruris |
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