Term
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Definition
Amphotercin B
lipid amphotericin B
nystatin - nasty not systemic |
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Term
|
Definition
fluconazole
itraconazole
coriconazole
posaconazole |
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Term
|
Definition
penicillins for fungi - narrow spectrum
caspofungin
micafungin
anidulafungin |
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Term
| Other systemic anti-fungals |
|
Definition
flucytosine
terbinabfine
griseofulvin |
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Term
|
Definition
binds to ergosterol in the fungal cell membrane creating pores
porins increase cell permiab causing death
very broad spectrum but toxic |
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Term
|
Definition
Nephrotoxic, dos dep, not with AG's
Renal wasting of K and MG
give 1 L salin iv prior to apmho B treatment
Fever and Chills with rel of IL1, IL6 and TNF
Hypochromic, normocytic anemia w/ decr hematocrit via decreses release of erythropoietin |
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Term
|
Definition
enclosed in liposomes to be more efficasious ,
toxicity still occurs but is delayed
very expensive and still toxic, but can keep them on the drug for longer |
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Term
|
Definition
fluconazole
itraconazole
voriconazole
posaconazole
azoles inhibit CYP450 lanosterol 14a-demethylase which
PREVENTS the formation of ERGOSTEROL
Accumulation 14-methsterols INHIBIT ETC |
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Term
|
Definition
don't use ampho B after treatment with azoles b/c the azoles take away the site of action of amphotercin B
Always a worry with CYP450 inhibition |
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Term
| Are azoles static or cidal |
|
Definition
| statis, thus only ok with immunocompetent |
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Term
| Resistance mech to azoles |
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Definition
| via a mutation in binding site on demethylase - lanosterol can still bind but the azoles cannot |
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Term
| fluconazole strengths and weaknesses |
|
Definition
lacks major toxicity, excellent bioavail, and extr active against C. albicans
weak : narrow spect, only good against C. albicans
does not cover C. krusei and many C. Glab R
no aspergillus activity |
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Term
| Itraconazole strengths and weaknesses |
|
Definition
Str: active against Aspergillus
Weak: not available i.t and poor oral bioavailabiltiy, tastes bad, drug drug interactions via CYP450 inhib |
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Term
|
Definition
ext spectrum, superior to amph B to Aspergillus. Vori is DOC for asperg
covers Fusarium spp, but still need white cells
covers scedosporum
covers Candida krusei whihc is R to fluconazole |
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Term
|
Definition
IV and PO available F = 96%
can change IV to PO w/o dose adj |
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Term
|
Definition
Hepatotoxic
alt mental status, visual dist.
nephrotoxic
not effective ro C. glabrata
drug drug interactions |
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Term
|
Definition
has vori coverage plus zygomycetes
only available PO and GI abs is poor
drug inter is a problem
need for therapeutic drug monitoring |
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Term
|
Definition
inhibit the synthesis of 1,3-B-D-glucan a key component of the fungal cell wal in Candida and Aspergillus
this is diff from the azoles which attack the cell membrane |
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Term
|
Definition
| Echinocandins, replaced amph B |
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Term
|
Definition
Caspofungin
Micafungin
Anidulafuncing |
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Term
|
Definition
2nd line for aspergillosis after amphotercin B and invasive candidiasis
Rapidaly cidal against Candida even azole R ones |
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|
Term
| Caspofungin bioav and weaknesses |
|
Definition
well tolerated and few drug interactions b/c it does not aff CYP450
Expensive, no oral formulation, and limited spectrum: only covers candida, aspergillus, and Pneumocystis |
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Term
|
Definition
5-FC -> 5FU -> 5-FUMP -> FdUMP
FdUMP inhibits thymidylate synth |
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|
Term
| Used to treat cryptococcal meningitis |
|
Definition
| Flucytosine with amphotericin B |
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