Page 654 - TNFlipTest

ID54 Infectious Diseases
Table 34. Antifungals (continued)
Antifungals
Mechanism of Action
All azoles: inhibit ergosterol synthesis and thereby
alter fungal cell membrane permeability
Toronto Notes 2019
Class and Drugs
TRIAZOLES
fluconazole (Diflucan®)
itraconazole (Sporanox®)
voriconazole (Vfend®)
posaconazole (Posanol®, Noxafil®)
ALLYLAMINES
terbinafine (Lamisil®)
ECHINOCANDINS
caspofungin micafungin anidulafungin
Coverage
Candida infections (mucosal and invasive)
Cryptococcal meningitis (step- down therapy)
Sporotrichosis Onychomycoses Endemic mycoses:
Histoplasmosis Blastomycosis Coccidioidomycosis
Aspergillosis Candidiasis
Candidiasis Aspergillosis Mucormycosis
Dermatomycoses Onychomycoses
Refractory aspergillosis, candidemia (azole-resistant)
Inhibits enzyme needed for ergosterol synthesis
Inhibits 1-3 β-D-glucan synthesis (needed for fungal cell wall)
Griseofulvin
Adverse Effects
Elevated liver enzymes GI nonspecific
Elevated liver enzymes Rash GI nonspecific HTN Hyperkalemia Peripheral edema
Visual disturbance (30%) Hepatotoxicity
Cutaneous photosensitivity Cutaneous squamous cell carcinoma with long-term
use in immunosuppressed patients Prolonged QT Periostitis Neurologic toxicity
Elevated liver enzymes Headache
Prolonged QT
Rash, local irritation GI nonspecific, transaminitis
Hepatotoxicity Infusion and injection site reactions
Flucytosine
Protein synthesis
Pyrimidines
14-α-dimethylase
Contraindications
Cross-sensitivity with other azoles unknown
Cross-sensitivity with other azoles unknown
Severe ventricular dysfunction
Cross-sensitivity with other azoles unknown
May avoid or alter doses if co- administered with other CYP3A4 substrates, rifampin, carbamazepine, long-acting barbiturates, ritonavir, efavirenz, sirolimus, rifabutin, ergot alkaloids
Coadministration of cisapride, ergot alkaloids, pimozide, quinidine, or sirolimus
Active liver disease
Cell wall
Cytoplasmic cell membrane
Nucleus
Microtubule
Echinocandins: Caspofungin
Mitochondrion
Nucleic Acids Ergosterol
Azoles:
Fluconazole, Itraconazole, Ketoconazole, Miconazole Morpholines Terbinafine Tolnaftate
Figure 21. Mechanism of action of antifungals
Precursors
Squalene
Lanosterol
Terbinafine
Polyenes: Amphotericin Nystatin
© Stefanie Spano 2012