Flashcards in Fungal Deck (26)
Examples of azoles?
Mechanisim of action of azoles?
inhibit ergosterol synthesis via inhibiton of CYP 450 enzyme
Ergosterol is a vital part of the cell membrane
Indications for fluconazole?
Candida Albicans infection
- not good for non-albicans candida
Indications for Itraconazole?
Indications for Voriconazole?
All candida species and aspergillous
Indications for Posiconazole
Candida (all species)
Zygomycosis (mucor etc.)
Cautions in use of azoles?
Lots of drug interactions
Caution in renal impairment
Example of a polyene anti-fungal?
Mechanism of action of amphotericin B
Binds to sterols in cell membrane and increases membrane permeability and pore formation
Indications for amphotericin B
Cryptococcus (first line for cryptococcal meningitis)
Candida - particularly C. Glabrata and C. Krusei
Side effects of amphotericin B
Distal type 1 RTA
*Note - liposomal preparation decreases drug toxicity
Mechanism of echinocandins?
inhibits synthesis of glucan in cell wall thereby inhibiting cell wall synthesis
Example of echinocandin?
Indications for echinocandins?
Mechanism of action of Flucytosine?
inhibitor of fungal DNA synthesis
Indications for flucytosine?
What are some side effects of flucytosine?
Bone marrow suppression
Treatment of crytpococcal meningitis?
Amphotericin B and flucytosine for 6 weeks - crosses BBB
Followed by fluconazole maintaince
Risk factors for systemic candidiasis?
loss of gut integrity (particularly upper abdomen)
prolonged neutropenia (chemotherapy/immunosuppression)
central lines, TPN
Clinical manifestations of disseminated candida?
eye lesions - white exudates on retina
skin lesions - papules or pustules with an erythematous base
abscesses in liver, spleen, kidney, lungs, brain
Treatment of disseminated candida?
Fluconazole if not C.glabrata or krusei and not severely unwell
Otherwise Voriconazole, Caspofungin, amphotericin B
What is galactomannan assay?
a component of the cell wall of aspergillous that can be measured in serum
What is the first line treatment for disseminated aspergillous?
What is the treatment for aspergillioma?
Risk factors for mucor infection?
poorly controlled diabetes
iron chelating therapy (desferrioxamine)