Antifungal -Echinocandins.txt

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drtrouta
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198793
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Antifungal -Echinocandins.txt
Updated:
2013-02-24 11:16:32
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Antifungal Echinocandins
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Antifungal -Echinocandins.txt
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  1. What is Moa of Amphotericin B?
    binds ergosterol, cell membrane steroid of fungi
  2. What is chemistry of Amphotericin B?
    • produced by Strep nodosus
    • polyene macrolid
  3. What is the pk of Amphotericin B?
    • poor GI absorption: IV administration
    • broad spectrum, poor CSF access
  4. What are the adverse effects of Ampohtericin B?
    • immediate: reactions r/t infusion..fever, chills, muscle spasms, hypotension
    • delayed: slower reactions, renal damge (pre & post NS bolus), liver FX ABN
  5. What are the uses of Amphotericin B?
    • reduce fungal burden of nasty bugs
    • intrathhecal therapy suboptimal
    • systemic candidemia
    • aspergillus
  6. What is the Moa of Flucytosine?
    • inhibits DNA & RNA synthesis within the fungal cells
    • works in Synergism (Ampho B & Itraconazole)
  7. What is chemistry of Flucytosine?
    • pyrimidine analog
    • related to fluorouralcil (anti-neoplastic agent used in chemo)
    • potent antifungal
    • narrow spectrum of activity (neoformans, Candida)
    • used as a combo agent
  8. What is pk of Flucytosine?
    • oral, well absorbed including CSF
    • toxicity in AIDS & renal insufficiency
  9. What are the adverse effects of Flucytosine?
    • bone marrow toxicity
    • toxic enterocolitis
  10. What is the Moa of Azoles?
    reduces ergosterol synthesis by inhibition of fungal cytochrome P450 enzymes
  11. What is the chemistry of Azoles?
    • Imidazoles
    • Triazoles
  12. What is the pk of Azoles?
    variations in absorption, serum concentrations, elimination, mode of admin
  13. What are adverse effects of Azoles?
    • minor GI upset
    • liver enzyme abnormality
  14. What is the use for Azoles?
    • broad spectrum
    • treats Amphotericin resistant P boydii (fungs in soil, sewage, farm animals)
  15. Which class of Azoles causes drug reactions and why?
    Imidazoles d/t poor selectivity in reacting with CP450
  16. What is the Moa of Echinocandins?
    act on fungal wall & inhibit B-glucan
  17. What is the chemistry of Echinocandins?
    • large peptides linked to long-chain fatty acids
    • active against candida & aspergillus
  18. What are 3 types of Echinocandins?
    caspofungin, micafungin, andidulafungin
  19. What is the pk of Echinocandins?
    adjust dose if severe liver insufficiency
  20. What are adverse effects of Echinocandins?
    • minor GI & flushing
    • Micafungin can increase levels of Nifedipine (Ca2+ channel blocker)/Cyclosporin
  21. What are uses of Echinocandins?
    • Casponfungin - disseminated & mucocutaneous candida
    • Micafungin - mucocutaneous candidiasis, prophylaxis in bone marrow transplant patients
  22. What is Moa of Allylamine (Terbinafine)?
    • fungicidal - inhibits fungal enzyme epoxidase
    • interferes with ergosterol synthesis
    • highly lipophilic
  23. What is Terbinafine (Lamisil)?
    synthetic allylamine
  24. What is Terbinafine (Allylamine) used to treat?
    onychymycosis/dermatophytosis
  25. What are the adverse effects of Terbinafine (Allylamine)?
    • GI upset
    • HA
    • hepatotoxicity
  26. What baseline labs should you get before using Terbinafine?
    baseline LFT's & CC (can be 2-3'x above normal before d/c)
  27. What is the chemistry of Nystatin?
    polyene macrolide (like Ampho B)
  28. How is Nystatin adminstered?
    only topical d/t toxicity
  29. What does Nystatin treat?
    candida infections & thrush
  30. What other topical antifungals are used?
    • topical azoles
    • topical allylamines (terbinafine)
  31. What antifungal is used to treat mucocutaneous infections?
    Griseofulvin
  32. What is Griseofulvin derived from?
    penicillium
  33. What is Moa of Griseofulvin?
    unknown
  34. What is Griseofulvin used to treat?
    mucotaneous infection (dermatophytosis- skin, nail, & hair infections)

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