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Antifungals (Three very important types (Azoles inhibit the enzyme that…
Antifungals
Three very important types
Polyenes
bind to ergosterol in the fungal cell membrane
Amphotericin B
qualities
lots of side effects
nephrotoxicity
infusion-related: chills, fever, low-back pain
makes pores
very broad (covers most disease causing fungi)
IV (unusual: inhaled for airway infection)
used for
mucormycosis
endemic fungi treatment
Nystatin
topical
prophylaxis of
oral candidiasis
(zero oral uptake, safe to swallow)
candida vaginitis
Azoles
inhibit the enzyme that converts lanosterol to ergosterol
fluconazole
non-invasive, skin/mucosal candidiasis
prophylaxis for immunocompromised
(e.g. stem cell transplant)
oral and IV
voriconazole
invasive aspergillosis
side effects: liver toxicity, interactions, hallucinations, periostitis
oral and IV
posaconazole
prophylaxis for immunocompromised
(e.g. stem cell transplant)
itraconazole
secondary treatment of endemic fungi to prevent recurrence
Echinocandins
inhibit the synthesis of glucan in the cell wall
caspofungin
anidulafungin
micafungin
(all very similar)
invasive candida or candidemia
attack fungal cell wall
few adverse effects
Two not as important types
Allylamines
terbinafine
dermatophytosis
well tolerated
Others
5-fluocytosine
cyrptococcal meningitis
use in combination with
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main activity is against Cryptococcus