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Anti-fungal drug (Subcutaneous and systemic (Amphotericin B :fire:…

- - - - Must be combined with sodium deoxycholate
      - Artificial lipids
      - Form liposome with reduced renal toxicity
  - - - IV
      - FIRST LINE OPTION FOR CANDIDEMIA :check:
      - SECOND LINE for invasive aspergillosis in people that failed amphotericin B :check:
      - Metabolised slowly by hydrolysis and N-acetylation, NOT metabolised by CYP450 enzymes
      - Increase dose with rifampicin :warning:
      - Should not be coadministered with cyclosporine :warning: due to high incidence of elevated hepatic transaminase
  - - - Itraconazole :fire:
        
        Broad spectrum FOR all systemic :check:
        
        Absorption decreased with antacids and proton pump inhibitors :warning:
        
        Metabolised by liver
        
        Inhibitor of CYP450 :warning:
        
        HEART FAILURE TAKE NOTE
        
        excreted in feces and urine
        
        Well distributed in most tissue, bone and adipose
      - Voriconazole :fire:
        
        BEST TREATMENT FOR ASPERGILLOSIS :check:
        
        Inhibitor of CYP450 :warning:
        
        Also for candida and fusarum
        
        Metabolised by liver
      - Fluconazole :fire:
        
        Clinical use
        
        Treatment for non-mould systemic fungal + Crytococcus :check:
        
        Against most fungal Meningitis :check:
        
        Single dose against vulvovaginal candidiasis
        
        No activity against MOLDS Histoplasma and blastomyces
        
        Long half life, present in breast milk and CSF (50-90% serum level)
        
        Renal clearance
        
        Inhibitor of CYP450 :warning:
        
        Headache, nausea, rash, hepatotoxicity, QT prolonged
      - Oral and IV administration
      - Teratogenic: all cat C, voriconazole cat D :warning:
  - - - Therefore commonly used with amphotericin B
- - - - Broad spectrum For all forms of Tinea (dermatophyte infection) and candidasis :check:
      - Clotrimazole :fire:
        
        FIrst choice in vulvovagnialis candidiasis :check:
        
        Small amount metabolised in liver and bile
      - Micronazole :fire:
        
        Uses TInea