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Updated: Oct 1 2019

Anti-Fungals

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  • 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
      • 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
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