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Amphotericin B
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Caspofungin
Fluconazole
Flucytosine
Griseofulvin
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This patient who presents with fungal meningitis (given the India ink-stained organisms suggesting Cryptococcus neoformans) who then develops hypokalemia and hypomagnesemia after administration of a specific medication was most likely given amphotericin B. Amphotericin B is an antifungal medication that functions by binding to the fungal lipid component ergosterol. This leads to the formation of pores in fungal membranes that results in the extravasation of cytosolic contents. Amphotericin B can be used in the treatment of almost all fungal infections but is often reserved for the most severe infections because it has many potentially life-threatening side effects. Side effects include nephrotoxicity, intravenous phlebitis, anemia, cardiac arrhythmia, fevers, chills, and metabolic abnormalities such as hypokalemia and hypomagnesemia. Patients should be adequately hydrated and supplemented with potassium and magnesium in order to mitigate these side effects. Ochieng et. al studied the effect of amphotericin B in the treatment of HIV-positive patients with cryptococcal meningitis. They found that 93% of these patients developed hypokalaemia and 80% had hypomagnesemia. Incorrect Answers: Answer 2: Caspofungin is an echinocandin that disrupts fungal cell wall synthesis by inhibiting beta-glucan synthesis. Major side effects of this drug class include gastrointestinal upset and flushing. Answer 3: Fluconazole is an azole that inhibits 14-alpha-demethylase, which is key in fungal ergosterol synthesis. Major side effects of this drug class include gynecomastia and inhibition of cytochrome P450 enzymes. Answer 4: Flucytosine is an antifungal agent that is converted by the fungal enzyme cytosine deaminase to 5-fluorouracil, which then inhibits nucleic acid synthesis. The major side effect of this drug is bone marrow suppression. Answer 5: Griseofulvin is an antifungal agent that disrupts fungal cell mitosis by inducing microtubule dysfunction. Major side effects of this drug class include confusion, headaches, and a disulfiram-like effect in response to alcohol consumption. Bullet Summary: Side effects of amphotericin B include nephrotoxicity, intravenous phlebitis, anemia, cardiac arrhythmia, fevers, chills, and metabolic abnormalities such as hypokalemia and hypomagnesemia.
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