Anti fungal agents

Amphotericin B

Uses

broad-spectrum anti-fungal agent used to treat systemic mycotic infections caused by Cryptococcus, Coccidioides, Aspergillus, Blastomyces, Candida, Histoplasma,and Mucor.

MOA

binds to ergosterol and alters permeability of the fungal cell membrane killing cell

SIDE EFFECTS

• Infusion-related reaction (fever, chills, muscle spasms, headache)

• nephrotoxicity

• hypotension

• anemia;

• arrhythmias (caused by electrolyte imbalance)

Nystatin

Uses

broad-spectrum anti-fungal agent used topically to treat oral and cutaneous candidiasis

MOA

binds to ergosterol and alters permeability of the fungal cell membrane killing cell

SIDE EFFECTS

Oral

• GI upset

• Stomach pain, cramps, or bloating

• Mouth irritation, sensitivity, or an unpleasant/metallic taste

topical

• Skin irritation, burning, or itching

• Redness, crusting, or peeling skin

• Contact dermatitis

LIFE THREATENING

• difficulty breathing or swallowing

• Swelling of the face, lips, tongue, or throat

• Severe rash, hives, or itching

• SJS

Fluconazole

Uses

treats systemic fungal infections(especially cryptococcal meningitis and sepsis from Candida). It is also used to treat blastomycosis, coccidiomycosis, andhistoplasmosis

MOA

inhibit the formation of ergosterol, by inhibiting P-450 enzymes

Side effects

• GI upset

• abnormal liver enzymes

• Rash

• DO NOT USE IN PREGNANT WOMEN

Contradictions

INTERACTS WITH 100S OF DRUGS

Blood Thinners & Antiplatelets [1, 2]

• Interacting Drugs: Warfarin (Coumadin), apixaban (Eliquis), rivaroxaban (Xarelto).

• Interaction Risk: Fluconazole can significantly increase the levels of these drugs, greatly elevating your risk of internal or major bleeding. [1, 2, 3, 4]

Heart & Blood Pressure Medications

• Interacting Drugs: Amiodarone, quinidine, calcium channel blockers (amlodipine, nifedipine, verapamil).

• Interaction Risk: Certain combinations can increase the risk of a serious and potentially fatal heart rhythm condition known as QT prolongation. [1, 2, 3, 4]

Cholesterol-Lowering Drugs (Statins) [1]

• Interacting Drugs: Simvastatin (Zocor), atorvastatin (Lipitor), lovastatin.

• Interaction Risk: Fluconazole can prevent the body from metabolizing statins, leading to dangerous muscle pain and a severe condition called rhabdomyolysis

Diabetes Medications

• Interacting Drugs: Sulfonylureas such as glyburide, glipizide, and glimepiride.

• Interaction Risk: Fluconazole can increase the potency of these drugs, which may lead to dangerously low blood sugar (hypoglycemia

Micafungin

Uses

invasive candidiasis or aspergillosis. Treats esophageal candidiasis and candidemia

MOA

inhibits the beta-1,3-D-glucan synthase enzyme, used for fungal cell wall

Side effects

• infusion reactions

• neutropenia

CONTRADICTIONS

• Patients under age 18 years

• Pregnancy and breast - feeding

• Liver dysfunction

• Renal disease
  

Flucytosine

Uses

used in combination with other anti-fungal agents (often amphotericin B) for treatment of systemic mycotic infections and fungal meningitis caused by Cryptococcus and Candida species

MOA

inhibiting fungal DNA and RNA synthesis

side effects

• Bone marrow suppression

• hepatotoxicity.

Ketoconazole

Uses

broad-spectrum anti-fungal agent in the treatment of Blastomycosis, Coccidioides, Histoplasmosis, Aspergillus, Mucor, and Candida infections

MOA

inhibit the formation of ergosterol

side effects

Hormone synthesis inhibition (which leads to decreased libido, gynecomastia, and menstrual irregularities—this is especially seen in ketoconazole)

GI upset

Griseofulvin

Uses

an oral anti-fungal agent used in the treatment of topical dermatophytic infections caused by Epidermophyton, Microsporum, and Trichophyton

MOA

interferes with microtubule function in fungal cells in keratin-rich tissues (e.g., skin, nails, and hair)

Side effects

• Headaches

• confusion

• GI upset

• allergic reaction

• hepatitis