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Flashcards in Systemic Pharmacology Deck (72)
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1

Examples of Oral Antifungals

Griseofulvin
Terbinafine (Lamisil)
Itraconazole (Sporonox)

2

What do oral antifungals treat?

Scalp & nail fungal disorders

3

Medications to Treat Scalp Fungal Infections

1st: Griseofulvin
2nd: Terbinafine (Lamisil)

4

Medications to Treat Nail Fungal Infections

1st: Terbinafine (Lamisil)
2nd: itraconazole (Sporanox)

5

MOA of Griseofulvin

Inhibits fungal cell division
Binds to keratin making it resistant to fungal invasion

6

Administration of Griseofulvin

Take with a fatty meal: increases absorption, lessens GI upset

7

Distribution of Griseofulvin

Deposited in the keratin layer of skin, hair, & nails
Concentrates in liver, fat, & skeletal muscles

8

Where is griseofulvin metabolized?

Hepatically

9

2 Formulations of Griseofulvin

Microsize
Ultramicrosize

10

Contraindications with Griseofulvin

Liver failure
Porphyria
Pregnancy (Cat. X)
Caution with penicillin allergy
Breast feeding

11

SE of Griseofulvin

Photosensitivity
SJS
Toxic epidermal necrolysis
Erythema multiforme
Jaundice
Elevated liver enzymes
Granulocytopenia
Dizziness
Headache
Fatigue
N/V
Drug induced lupus like syndrome

12

Drug Interactions with Griseofulvin

Multiple
Warfarin
Oral contraceptives
Alcohol
Barbiturates
Cyclosporine

13

Monitoring with Griseofulvin

LFTs: liver failure
CBC: granulocytopenia
Renal function tests

14

MOA of Terbinafine (Lamisil)

Creates ergesterol deficiency within the fungal cell wall leading to cell death

15

Distribution of Terbinafine (Lamisil)

Sebum & skin

16

How is terbinafine (Lamisil) metabolized?

Hepatically

17

Drug Reactions with Terbinafine (Lamisil)

Many
Inhibit CYP450 enzymes

18

Terbinafine (Lamisil) SE

Headache
Diarrhea
Elevated liver enzymes

19

Monitoring for Terbinafine (Lamisil)

AST/ALT prior to initiation
CBC
Assess taste/smell disturbances

20

What is terbinafine used for?

Treat tinea capitis, and onychomycosis

21

Reasons to Treat Onychomycosis

Cosmetic reasons
DM & onychomycosis
Hx of lower extremity cellulitis & ipsilateral onychomycosis
Pain/discomfort secondary to infection

22

Black Box Warning for Itraconazole (Sporanox)

Negative inotropic effects have been observed following IV administration
Discontinue or reassess if S/S of HF occur during treatment

23

Contradictions for Itraconazole (Sporanox)

Ventricular dysfunction
CHF
Pregnancy
Concomitant use of other CYP450 drugs

24

How is itraconazole (Sporanox) metabolized?

Hepatically

25

Drug Interactions with Itraconazole (Sporanox)

PPIs
Anxiolytics
Pain medications
Antiplatelet agents
Antihypertensives
Statins

26

Itraconazole (Sporanox) SE

Nausea
Diarrhea
Edema
Headache
Rash
Abnormal LFTs
Heart failure
Arrhythmia
Hearing loss
Many others

27

Monitoring with Itraconazole (Sporanox)

Baseline LFTs
Monthly LFTs
Serum contraindications

28

5-Alpha-Reductase Inhibitor Medication for Fungal Infections

Finasteride (Propecia)

29

MOA of Finasteride (Propecia)

Inhibits the conversion of testosterone to dihydrotestosterone

30

What is finasteride (Propecia) first line for?

Androgenic alopecia in men