PharmWk2ThursNotes.docx - Antifungals Candida...

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Antifungals Candida Albicans -caused by antibiotic therapy, antineoplastic, immunosuppressants -may result in overgrowth and systemic infections -growth in mouth; called thrush or oral candidiasis -common in newborns -vaginal candidiasis common in pregnancy, women with diabetes mellitus, women taking contraceptives Antifungal Drugs -systemic; amphotericin B, caspofungin, fluconazole, ketoconazole, etc. -topical; clotrimazole, miconazole, nystatin -broken down into select prototypes based on chem structure -Polyenes: amphotericin B and nystatin -Imidazoles: ketoconazole -Triazoles: fluconazole, itraconazole, voriconazole -Echinocandins: caspofungin, micafungin -Drugs that are listed individually, not by chemical structure: -Griseofulvin, flucytosine Clotrimazole (Lotrimin) -binds w/ fungal cell membrane wall to inhibit it’s growth Polyenes: Amphotericin B & nystatin MOA: -binds to sterol in cell membrane lining -result: fungal cell death -do not bind to human cell membrane or kill human cells -this is a drug of choice for sever systemic fungal infections Adverse Effects: -fever, chills, cardiac dysrhythmias, nausea/gi upset, renal toxicity, headache, malaise, hypotension, tingling, numbness in hands and feet, lowered potassium and magnesium levels -main concerns: renal toxicity, neurotoxicity; seizures/paresthesia -to reduce severity: antipyretic (acetaminophen), antihistamines, antiemetics, corticosteroids -use IV infusion pumps & most distal veins possible Imidazoles & Triazoles: ketoconazole, fluconazole, metronidazole MOA: -inhibit fungal cell cytochrome enzymes, resulting in cell membrane leaking -lead to altered cell membrane

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