NUR 423 Derm Antifungals Review Questions and Correct Answers
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Course
NUR 423
Institution
NUR 423
Polyene Antifungals -Bind to sterols in the cell membrane of the fungus, causing increased membrane permeability and loss of intracellular contents
Examples: Amphotericin B Nystatin
Amphotericin B -One of the earliest effective antifungals available systemically High toxicity Also comes in topica...
NUR 423 Derm Antifungals Review
Questions and Correct Answers
Polyene Antifungals ✅-Bind to sterols in the cell membrane of the fungus, causing
increased membrane permeability and loss of intracellular contents
Examples:
Amphotericin B
Nystatin
Amphotericin B ✅-One of the earliest effective antifungals available systemically
High toxicity
Also comes in topical formulation
An amphoteric polyene macrolide
Insoluble in water, so needs to be a colloidal suspension
Poorly absorbed from the GI tract: only effective PO for infections of GI tract
90% protein bound
Has a very long half-life: slow excretion (15 days)
Selective fungicidal: binds to ergosterol in fungi cell wall
Causes leakage of intracellular ions and macromolecules, leading to cell death
Can also bind to human membrane sterols (possible cause for toxicity)
Amphotericin B (cont.) ✅Broad spectrum of action
Effective against
Candida
Cryptococcus
Histoplasma capsulatum
Blastomyces dermatidis
Coccidiodes
Aspergillus
Being highly effective, may be used initially for serious fungal infection (then switched
to an azole)
Topical uses: corneal ulcers, keratitis, joints, bladder irrigation
Also for paronychia, intertrigo (yeast)
Side effects (topical): yellow staining, mild irritation
Side effects (systemic): fever, chills, muscle spasm, vomiting, headache, hypotension
*Over time renal damage (must monitor renal function regularly)*
Nystatin ✅Polyene macrolide
Too toxic for parenteral use but widely used topically
Available in cream, ointment, suppositories, oral suspension
Not absorbed to any significant degree through GI tract, skin, or MM
, Active against Candida: oropharyngeal, vaginal, intertriginous, paronynchia
Side effects (oral): bad taste, mild nausea, diarrhea, vomiting
No or limited topical irritation or hypersensitivity reactions
Triazole Antifungals ✅Reduce ergosterol synthesis by inhibition of fungal cytochrome
P450
Less active against human cyt P450 than fungal cyt P450
*Topical is appropriate for treatment of tinea pedis & corporis*
Azole Antifungals ✅All display broad activity including
Candida
C. neoformans
Blastomycosis
Coccidioidomycosis
Histoplasmosis
Dermatophytes
Side effects: minor GI upset (common)
Can cause drug-induced hepatitis, elevated liver enzymes
Major cyt P450 interactions
*Most commonly used in clinical practice*
Topical ketoconazole
PO itraconazole
PO fluconazole
Topical clotrimazole, miconazole, econazole
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