Antifungal Drugs

Terbinafine (prototype)

MOA: inhibits squalene enzyme

Dermatophyte infections and onychomycosis (nail infections)

ADR:

• GI effects, liver issues

*Check liver tests

Fluconazole (prototype)

Used for candidiasis, cryptococcus, and coccidioidomycosis

MOA:

• inhibits the synthesis of ergosterol in fungal cell membranes

ADR:

• SJS/ TENS

• QT Prolongation

• Hypokalemia

• Liver Toxicity: STRONGLY inhibits CYP450

*test AST and ALT

*always attempt to use topically first

Nystatin (prototype)

Used for vaginal, oral, and cutaneous candida; local

MOA:

• causes leaks in cell membranes

ADR:

• GI upset

*shake before administering liquid, comes in suspension

Amphotericin B (prototype)

Used for invasive/ systemic infections; BIG GUN

MOA:

• creates pores in cell membrane, causing death

ADR:

• Nephrotoxicity

• infusion reactions

• hypokalemia

• cardiotoxicity

*monitor creatine, BUN, potassium, and magnesium levels

Caspofungin (prototype)

Used for systemic/ invasive infections

MOA:

• inhibits B-1,3-D-glucan synthesis in cell wall

ADR:

• flu-like symptoms; infusion reactions