; LEARNING OBJECTIVE
; At the end of lecture students should be bale to know about, ; Echinocandins,
; Terbinafine ,
; Are the newest class of anti fungal agents eg Capsofungin. ; Chemically they are large cyclic peptides linked to a long-
chain fatty acid.
; They are active against Candida and Aspargillus. ; MODE OF ACTION
; Echinocandins act by inhibiting the synthesis of beta glucan
of the fungal cell wall resulting in disruption of fungal cell wall
and cell death.
; They are available in only intravenous formulations, water
soluble and highly protein bound.
; The half life of Capsofingin is 9-11 hours and of Micafungin
is 11-15 hours.
; The metabolites are excreted by the kidneys and
; Dosage adjustments are required only in severe hepatic
; Clinical uses
; Capsofungin is currently licensed for
; Disseninated and mucocutaneous candida infection.
; Empiric antifungal therapy during febrile neutropenia. ; As salvage therapy in invasive Aspergillosis. ; Adverse effects
; Minor gastrointestinal side effects and flushing reported
; Drug interaction combination of Caspofungin and
Cyclosporine should be avoided.
; DRUGS FOR CUTANEOUS MYCOTIC INFECTIONS
; Fungi that cause superficial skin infection are called
; It is primarily fungicidal.
; It is the drug of choice for treating dermatophytosis and
; MODE OF ACTION
; It inhibits fungal squalene epoxidase there by decreasing the
synthesis of ergosterol.
; Secondly accumulation of toxic amounts of squalene results
in the death of the fungal cells.
; Given orally, bioavailability is only 40% due to first pass
; 99% plasma protein bound.
; It is deposited in the skin nail and fat.
; Terbinafine accumulates in the breast milk should not be
given to nursing mothers.
; Prolong terminal half life of 200 to 400 hours. ; Extensively metabolized in the liver and excreted in the urine.
; ADVERSE EFFECTS
; Gastrointestinal disturbance, headache and rash. ; Taste and visual disturbances and transient increase in
serum liver enzyme levels have been reported. Rarely may
cause hepatotoxicity and neutropenia.
; It is fungistatic.
; It accumulates in newly synthesized keratin containing
; MODE OF ACTION
; It causes disruption of the mitotic spindle and inhibition of
; It is given orally and absorbed adequately from G I tract. ; Griseofulvin induces cytochrome P 450 activity. ; It may exacerbate intermittent porphyria.
; Polyene antibiotic.
; It has only topical use. never used parenterally. ; As an oral agent (swish and swallow). It is used for oral
; Excretion in feaces is only quantitative.
; MICONAZOLE AND CLOTRIMAZOLE
; Are topically active drugs.
; M.O.A AND ANTI FUNGAL SPECTRUM
; Are same as ketoconazole
; Miconazole is a potent inhibitor of Warfarrin metabolism. ; Azole and Nystatin are used in vulvar candidiasis ; THANKYOU