Caspofungin

Tx: Invasive Aspergillosis, refractory candidiasis

Ax: Echinocandin - Inhibits 1,3-β glucan synth.

interferes with cell wall synth.

SE: Phlebitis, GI distress, hypersensitivity w/ immuno supp. drugs

Ms: IV only, well-tolerated

Amphotericin B

Tx: systemic fungal infections, drug of choice for cryptococcal meningitis

Ax: Polyene - binds ergosterol and forms a pore in the membrane

SE: aka "Amphoterrible," Immediate infusion rxn: fever/chills, nausea, ↓BP, nephrotoxic (80%), arrhythmias

t½=15 days

Terbinafine

Tx: Dermatophytes, Tinea unguium (nails fungus), Tinea cruris (jock itch), Tinea pedis (athlete's foot)

Ax: Allylamine - inhibits squalene epoxidase, interferes w/ ergoterol synth. (↓memb. integrity)

squalene buildup→toxic

SE: Avoid if preg/nursing and in liver/kidney pts

Fluconazole

Intraconazole

Tx: both - candida, Cryptococcus

Fluconazole: superficial + systemic, (not a Tx for asprigillosis)  Intraconazole: broad spectrum, histo, blasto, nail infx, aspergillosis

Ax: Azoles -

inhibits Ianosterol-14a demethylase (P450), interfere w/ ergosterol synth. (↓memb. integrity)

SE: Intraconazole - NOT for pts with CHF

Inhibits human CYP3A4, only Fluconazole-CNS

Flucytosine

Tx: Systemic fungal infx (esp. candida, & crypto.)

use in combo w/ amphotericin B for

cryptococcal meningitis

Ax: cytosine nucleoside analog, fungal cytosine deaminase converts it to 5-Fluorouracil 

"suicide substrate"→inhibits DNA/RNA synth.

SE: BM suppression

Griseofulvin

Tx: Dermatophytes: skin, hair, nails

"ringworm": Microsporum, Epidermophyton, Trichophyton

Ax: binds microtubules, inhibits mitosis→get mutinucleated cells

SE: must monitor blood weekly 1st month,

temporary headaches (15%)

teratogentic, carcinogenic at high doses in

animal studies

Pentamindine

Tx: NOT first line Tx, alternative for pneumocystis pneumonia 

Ax: Unknown

SE: Nephrotoxicity (25%), fatal arrhythmia, heart failure, hypoglycemia, hepatitis

Ms: IM or Slow IV infusion, inhaled (less toxic), Tissue only (no CNS)

TMP-SMX

Tx: Pneumocystis pneumonia, various antiBac.

Ax: Antifolate therapy, inhibits DHPS and DHFR,

prevents production of THF, ↓Thymine & DNA synth 

SE: more pronounced in AIDs: rash, hepatitis, neutropenia, azotemia, thrombocytopenia,

Ms: refer to UTI antibiotics for more info