-
amphotericin B
MOA
binds to ergosterol and alters permeability
-
amphotericin B
spectrum
ADR
- BROAD (candida, aspergillus)
- but bad with toxicities: K, Mg wasting, infusion-related, nephrotoxicity --> developed lipid formulations (Ambisome, Amphotec, from Acelcet?)
-
flucytosine (5-FC)
clinical use
- COMBO therapy
- bone marrow suppression
-
Azoles
MOA
reduction of ergosterol synthesis by inhibition of fungal cyp450 --> potential drug interactions!
-
Azoles
spectrum
- cryptococcus neoforman
- dermatophytes
- Aspergillis (itra and vori conazole)
-
ketoconazole
clinical use
- not used much
- TOO MANY drug interactions!
-
itraconazole
clinical use
Adverse effect
Drug interactions
- onychomycosis - nail bed infections
- CONTRAINDICATED IN CHF
- CYP3A4 inhibitor/substrate
-
fluconazole
spectrum + pk/absorption
- Widely used
- Candida ALBICANS
- not for glabrata or krusei --> don't use if you don't know!!!
- BA excellent IV:PO
-
voriconazole
spectrum
adverse effects
disclaimer
- like itraconazole
- ASPERGILLOSIS
- visual effects (wavy lines, flashing, blurry vision)/visual hallucinations
- IV 200 MG DO NOT USE WITH CRCL <50 ML/MIN
-
echinocandins
MOA
spectrum
Adverse effects
- inhibit synthesis of 1-3 glycans of fungal cell walls
- BROAD - all candida and aspergillus
- overall extremely well tolerated
-
caspofungin (echinocandin)
clinical use
- used over ampho B
- disseminated and mucocutaneous candidal infections
- empiric antifungal therapy during febrile neutropenia
- invasive aspergillosis
-
terbinafine
clinical use
MOA
- onychomycosis
- like griseofulvin but cidal
- SQUALENE EPOXIDASE (inhibits ergosterol biosynthesis)
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