Introduction Drugs (all systemic unless otherwise noted) amphotericin B nystatin topical formulation only terbinafine topical or systemic echinocandins anidulafungin caspofungin micafungin azoles topical formulations (too toxic for systemic use) clotrimazole miconazole econazole systemic itraconazole fluconazole isavuconazole ketoconazole (can also be topical) voriconazole griseofulvin flucytosine selenium sulfide topical formulation only Clinical use fungal infections Anti-Fungal Medications Drug Mechanism of Action Adverse Effects of Systemic Treatment Indications Amphotericin B Binds to ergosterol in the membrane that is unique to fungi, forming membrane pores through which electrolytes and other cell content leak Can be fungistatic or fungicidal Fevers, chills, and flu-like reaction Renal toxicity hydrate supplement potassium and magnesium Arrhythmias Anemia IV phlebitis Systemic mycoses Cryptococcus Blastomyces Coccidioides Histoplasma Candida Mucor Nystatin Binds to ergosterol Can be fungistatic or fungicidal Topical formulation only adverse effects are too toxic for systemic use Oral candidiasis Topical yeast infection diaper rash vaginal candidiasis intertrigo Terbinafine Inhibits squalene epoxidase, an enzyme in fungi that is key in lanosterol synthesis Fungicidal Gastrointestinal upset Liver toxicity (rarely, can cause fulminant liver failure requiring liver transplant) Taste disturbance Widespread dermatophyte infections Onychomycosis Echinocandins Disrupts cell wall synthesis by inhibiting beta-glucan synthesis Can be fungistatic or fungicidal Gastrointestinal upset Flushing mediated by histamine Aspergillosis Candida Azoles Inhibits 14-alpha-demethylase, which is key in ergosterol synthesis in fungi Fungistatic Anti-androgen effects via inhibiting testosterone synthesis gynecomastia (in particular, ketoconazole) Inhibits cytochrome P450 Local mycoses Mild systemic mycoses Specific indications fluconazole chronic suppression of Cryptococcus in immunosuppressed patients itraconazole Blastomyces Coccidioides Histoplasma voriconazole Aspergillus Candida isavuconazole Aspergillus Mucor Griseofulvin Disrupts mitosis via microtubule dysfunction Especially targets keratin-containing tissues such as nails Fungistatic Teratogenic Disulfiram-like reaction Neurologic symptoms confusion headaches Induces cytochrome P450 Superficial infections Dermatophytes inhibits growth Flucytosine Converted by fungal enzyme cytosine deaminase to 5-fluorouracil, which then inhibits nucleic acid synthesis Can be fungistatic or fungicidal Bone marrow suppression Systemic mycoses Cryptococcus Selenium sulfide Disrupts mitosis, resulting in decreased turnover of epidermal cells and decreased flaking Also has mild antibacterial and antifungal activity - Seborrheic dermatitis Pityriasis versicolor
QUESTIONS 1 of 1 1 Previous Next Lab Values Blood Hematologic Cerebrospinal Sweat, Urine, and BMI Blood, Plasma, Serum Reference Range ALT 8-20 U/L Amylase, serum 25-125 U/L AST 8-20 U/L Bilirubin, serum (adult) Total // Direct 0.1-1.0 mg/dL // 0.0-0.3 mg/dL Calcium, serum (Ca2+) 8.4-10.2 mg/dL Cholesterol, serum Rec: < 200 mg/dL Cortisol, serum 0800 h: 5-23 μg/dL //1600 h: 3-15 μg/dL 2000 h: ≤ 50% of 0800 h Creatine kinase, serum Male: 25-90 U/LFemale: 10-70 U/L Creatinine, serum 0.6-1.2 mg/dL Electrolytes, serum Sodium (Na+) 136-145 mEq/L Chloride (Cl-) 95-105 mEq/L Potassium (K+) 3.5-5.0 mEq/L Bicarbonate (HCO3-) 22-28 mEq/L Magnesium (Mg2+) 1.5-2.0 mEq/L Estriol, total, serum (in pregnancy) 24-28 wks // 32-36 wks 30-170 ng/mL // 60-280 ng/mL 28-32 wk // 36-40 wks 40-220 ng/mL // 80-350 ng/mL Ferritin, serum Male: 15-200 ng/mLFemale: 12-150 ng/mL Follicle-stimulating hormone, serum/plasma Male: 4-25 mIU/mL Female: premenopause: 4-30 mIU/mL midcycle peak: 10-90 mIU/mL postmenopause: 40-250 pH 7.35-7.45 PCO2 33-45 mmHg PO2 75-105 mmHg Glucose, serum Fasting: 70-110 mg/dL2-h postprandial:<120 mg/dL Growth hormone - arginine stimulation Fasting: <5 ng/mLProvocative stimuli: > 7ng/mL Immunoglobulins, serum IgA 76-390 mg/dL IgE 0-380 IU/mL IgG 650-1500 mg/dL IgM 40-345 mg/dL Iron 50-170 μg/dL Lactate dehydrogenase, serum 45-90 U/L Luteinizing hormone, serum/plasma Male: 6-23 mIU/mL Female: follicular phase: 5-30 mIU/mL midcycle: 75-150 mIU/mL postmenopause 30-200 mIU/mL Osmolality, serum 275-295 mOsmol/kd H2O Parathyroid hormone, serume, N-terminal 230-630 pg/mL Phosphatase (alkaline), serum (p-NPP at 30° C) 20-70 U/L Phosphorus (inorganic), serum 3.0-4.5 mg/dL Prolactin, serum (hPRL) < 20 ng/mL Proteins, serum Total (recumbent) 6.0-7.8 g/dL Albumin 3.5-5.5 g/dL Globulin 2.3-3.5 g/dL Thyroid-stimulating hormone, serum or plasma .5-5.0 μU/mL Thyroidal iodine (123I) uptake 8%-30% of administered dose/24h Thyroxine (T4), serum 5-12 μg/dL Triglycerides, serum 35-160 mg/dL Triiodothyronine (T3), serum (RIA) 115-190 ng/dL Triiodothyronine (T3) resin uptake 25%-35% Urea nitrogen, serum 7-18 mg/dL Uric acid, serum 3.0-8.2 mg/dL Hematologic Reference Range Bleeding time 2-7 minutes Erythrocyte count Male: 4.3-5.9 million/mm3Female: 3.5-5.5 million mm3 Erythrocyte sedimentation rate (Westergren) Male: 0-15 mm/hFemale: 0-20 mm/h Hematocrit Male: 41%-53%Female: 36%-46% Hemoglobin A1c ≤ 6 % Hemoglobin, blood Male: 13.5-17.5 g/dLFemale: 12.0-16.0 g/dL Hemoglobin, plasma 1-4 mg/dL Leukocyte count and differential Leukocyte count 4,500-11,000/mm3 Segmented neutrophils 54%-62% Bands 3%-5% Eosinophils 1%-3% Basophils 0%-0.75% Lymphocytes 25%-33% Monocytes 3%-7% Mean corpuscular hemoglobin 25.4-34.6 pg/cell Mean corpuscular hemoglobin concentration 31%-36% Hb/cell Mean corpuscular volume 80-100 μm3 Partial thromboplastin time (activated) 25-40 seconds Platelet count 150,000-400,000/mm3 Prothrombin time 11-15 seconds Reticulocyte count 0.5%-1.5% of red cells Thrombin time < 2 seconds deviation from control Volume Plasma Male: 25-43 mL/kgFemale: 28-45 mL/kg Red cell Male: 20-36 mL/kgFemale: 19-31 mL/kg Cerebrospinal Fluid Reference Range Cell count 0-5/mm3 Chloride 118-132 mEq/L Gamma globulin 3%-12% total proteins Glucose 40-70 mg/dL Pressure 70-180 mm H2O Proteins, total < 40 mg/dL Sweat Reference Range Chloride 0-35 mmol/L Urine Calcium 100-300 mg/24 h Chloride Varies with intake Creatinine clearance Male: 97-137 mL/minFemale: 88-128 mL/min Estriol, total (in pregnancy) 30 wks 6-18 mg/24 h 35 wks 9-28 mg/24 h 40 wks 13-42 mg/24 h 17-Hydroxycorticosteroids Male: 3.0-10.0 mg/24 hFemale: 2.0-8.0 mg/24 h 17-Ketosteroids, total Male: 8-20 mg/24 hFemale: 6-15 mg/24 h Osmolality 50-1400 mOsmol/kg H2O Oxalate 8-40 μg/mL Potassium Varies with diet Proteins, total < 150 mg/24 h Sodium Varies with diet Uric acid Varies with diet Body Mass Index (BMI) Adult: 19-25 kg/m2 Calculator ( ) xy AC 7 8 9 ÷ 4 5 6 × 1 2 3 - 0 . = + You have 100% on this question. Just skip this one for now. Take This Question Anyway (M1.MC.15.75) A 57-year-old florist presents to his family physician with nodular lesions on his right hand and forearm. He explains that he got pricked by a rose thorn on his right "pointer finger" where the first lesions appeared, and the other lesions then began to appear in an ascending manner. The physician prescribed a medication and warned him of gynecomastia as a side effect if taken for long periods of time. Which of the following is the mechanism of action of the medication? Review Topic | Tested Concept QID: 106869 Type & Select Correct Answer 1 Inhibits ergosterol synthesis 61% (95/157) 2 Binds to ergosterol, forming destructive pores in cell membrane 17% (27/157) 3 Inhibits squalene epoxidase 11% (18/157) 4 Inhibits formation of beta glucan 3% (5/157) 5 Disrupts microtubule function 6% (10/157) L 1 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 1