1. Quick Anti-fungals By Sarah E.

2. Anti-fungals Name the 6 categories of anti-fungals 1.Polyenes 2.-azoles 3.Synthetic allylamines 4.Anti-metabolites 5.Echinocandins 6.antibiotic

3. Anti-fungals Name a polyene – Amphotericin B Name 3 azoles – Ketoconazole (an imidazole) – Fluconazole (a triazole) – Itraconazole (a triazole) Name a synthetic allyamine – terbinafine

4. Anti-fungals Name an anti-metabolite – Flucytosine Name an echinocandin – Caspofungin Name an antibiotic – griseofulvin

5. Anti-fungals What is the mechanism of action of ampotericin B? – Breaks up cell membrane via ergosterol What is the mechanism of action of ketoconazole (and other azoles)? – Inhibits ergosterol synthesis by blocking 14-α- demethylase

6. Anti-fungals What is the mechanism of action of terbinafine? – Reduces synthesis of ergosterol by inhibiting squalene 2,3 epoxidases What is the mechanism of action of flucytosine? – Inhibits DNA synthesis via conversion to 5F-DUMP and inhibiting thymidylate synthase

7. Anti-fungals What is the mechanism of action of caspofungin? – Binds to glucan synthase complex, inhibits cell wall synthesis What is the mechanism of action of griseofulvin? – Binds host keratin, binds in fungus and their microtubules get messed up

8. Anti-fungals Which are contraindicated in patients with CHF? – Itraconazole and terbinafine Which are contraindicated in pregnancy? – Griseofulvin, fluconazole Which get into the CSF? – Fluconazole, flucytosine

9. Anti-fungals Which can’t be taken with alcohol? – Griseofulvin Which is IV only? – caspofungin Which can be used topically? – Amphotericin B, terbinafine Which inhibits patient steroid synthesis? – ketoconazole

10. Anti-fungals What is the drug of choice for coccidioides meningitis? – Fluconazole Can this drug treat aspergillus? – No What is the drug of choice for oral thrush? – Also fluconazole

11. Anti-fungals What is the drug of choice for a severe systemic infection? – Amphotericin B What is the drug of choice for non-meningeal histoplasmosis of blastomycosis? – Itraconazole

12. Anti-fungals What is the drug to use to treat systemic aspergillosis? – Amphotericin B What if the patient can’t tolerate Amphotericin B? – Give caspofungin What is the indication for griseofulvin? – Pediatric tineas

13. Anti-fungals What is the drug of choice for cryptococcal meningitis? – Combination of flucytosine and Amphotericin B What is a major adverse effect of flucytosine? – Bone marrow suppression/anemia What are the adverse effects for amphotericin B? – Cytokine release syndrome, nephrotoxicity

14. Anti-fungals Which drug’s major metabolism is done by P450? – Ketoconazole Which –azole is water soluble? – Fluconazole What is the indication for terbinafine? – Tineas, onychomycosis

15. Anti-fungals Which drug increases in serum levels when the patient is also taking cyclosporine? – Caspofungin Which drugs require low stomach pH to be absorbed? – Ketoconazole, itraconazole Which is used for preventing cryptococcal meningitis relapse in AIDs patients? – fluconazole