Hey doctors! In this video, I review all of the Antifungals and associated pharmacology tested on Step 1. There’s time at the end to screen shot the final diagram.
Hey everyone welcome to my channel this video is gonna be on what i like to call the abcs of the antifungals so i’m gonna be drawing out in diagram form all of their names relative admin mechanisms of action side effects and major uses for all the drugs that are tested on step one hopefully this video will put it all together for you guys and make it much easier
For you guys to recollect on test day so without further ado let’s get started so first to get started we’re gonna go through our abcs a b amphotericin b and cosmo function ds for our subcategory of our derm drugs ee for everything else f for flu cytosine and gene for griseofulvin and now to break into routes of admin our first two goes together because they are
The two that are given iv only and the b and amphotericin me remember stands for no bbb it cannot cross the blood-brain barrier however you can use it during meningitis intrathecally because remember the barrier is already breached by inflammation at that point now our derm drugs are usually given topically of course everything else is given by mouth so everything
But below this line that i’m about to draw is given by mouth and everything above it is usually not and now to round out the rest of the drugs in the list just remember the mnemonic nerds can make kinky freaks for and i started cloture miss all my con us all ketoconazole and shook on us all so the two major drug categories and the insider member are to benefit
And the a souls and just remember to bring a fin comes first turbans go on your head way above your and now let’s go over a mechanism of action so our first three go together and flow because both london and i staten because those all work at the level of the salt law you’ll notice you can line up where i have the drugs pleased with the structure of the cell
That i’m drawing on the right so let’s go over what makes up a fungal cell wall the first component is the phospholipid bilayer which remember unlike mammalian cells contains our go sterile instead of cholesterol and this is what anthony and i statin binds you disrupting the integrity of the cell wall the next component we have is chitin which is a popular protein
Which provides structural support to the cell next we have beta glucan which refers to the beta 1 3 and 1 6 linkages that are found on the cell surface it’s important to remember this because casto funds in the g all highlighted in green because it specifically binds to beta glucan unlike the other two which generally just behind 200 sterile and for completions
Sake the last component are the menos proteins which do vary among fungal species and now we move to the inside of my diagram as well as inside the cell for the mechanisms of terbinafine and the a souls in the ergo sterols and this is pathway starting with the conversion of squalene to leno sterile and then leno sterile – ergo cyril so remember line up where the
Drugs are with my diagram terbinafine comes first turban goes on your head it inhibits the first enzyme which is squalene epoque today’s and the easels inhibit the second enzyme in the pathway which is 14 alpha team appleson delays which is a sip for 50 mitochondrial enzyme and therefore the major drug side effect is that they are sipped 450 inhibitors next up we
Have with cytosine sometimes also referred to as five floral cytosine that works at the level of dna synthesis by inhibiting cytosine deaminase ultimately inhibiting the hydrolysis of cytosine to uracil and the permanent salvage pathway and finally we have grizz so cosy evolvin is transported in the into the cell via energy mediated transport and binds to tubulin
Ultimately inhibiting microtubules and mitosis i just think of a grizzy wiry grizzly bear yes that’s a bear in order to remember this that grizzly evolving works at the level of microtubules and now on some major uses for the first c we use them for our really serious systemic mycoses so aspergillus blastomycosis coccidioides candida histoplasma and mucormycosis
Just a little reminder you can use intrathecally for meningitis now for the side effects of an fo b i remember the mnemonic sharpen s4 shake-and-bake meaning fever and chills hypotension arrhythmia and anemia a red rash phlebitis electrolyte imbalance and nephrotoxicity now that electrolyte imbalance can be hypo or hyper cle mia which bleeds into your arrhythmia
Risk and also means that your patients on to jackson will have the toxicity risk cosmo dungeon is mainly used for canada and aspergillus and its side effect profile is very similar to an fo b but the two that should stand out are the f for flushing and g for gi upset and that’s why i’m calling those two letters in for red and now onto good ol nystatin we all know
It’s used for candida it can be used for aspergillus but that’s not heavily tested at all what is heavily tested are these side effects so i’m bolding and underlying it twice never give it iv due to the risk of nephrotoxicity i’m also going to highlight the s as a side effect because it’s one of the two drugs on our list that has the risk of steven johnson syndrome
Now remember candida is its main use oral for oral thrush in a mouthwash form and for diaper rash in a topical form now in terms of terbinafine and the easels in general they’re used for demand if it’s funky like taniya and oneko mycoses or yellow now with clotrimazole mic on us all being used topically and terbinafine being used by mouth ketoconazole and flu
Connoisseur the exception so keitel can be used more serious mycoses at blasto and canada and histoplasma however they love to test its random use which is hyper cortisol near aka patients with cushing’s syndrome or cushing’s disease ketoconazole can inhibit cook the cholesterol sidechain cleavage enzyme 17 alpha hydroxylase 1720 lahey’s and beta hydroxylase for
A fukken assault it’s random you know they love to test is for cryptococcal meningitis so typically an aids patient and suspected or confirmed cups of kaka meningitis one of your first line drugs is buchanan’s all because it can cross the bbb next up is flu cytosine and i like to think of flu cytosine as sort of a fluke in that it’s always used in conjunction with
Another drug namely amphotericin b and this is done to achieve synergy in the case of serious systemic mycoses in a patient who is not responding to iv amphotericin b therapy now the downside of this is that it does increase the risk of toxicity in both drugs namely flu cytosine whose major side effect is milo suppression however this therapy is usually life-saving
And finally for grizz now its major users are the same as to benefit and the easels and then it’s used for des mattifies and tania’s they don’t care about that what they do care about is its side effects so remember the mnemonic griseofulvin is a 450 inducer this is one of the few times in forum where you’ll have two drugs on the same list where one is an inhibitor
One is an inducer this is an inducer so it’s gonna have your die soul from like reactions and will lower the efficacy of your oc piece the other side effect so that it is photo toxic so it’s contraindicated with patients with porphyria and it’s the second term on the list that has the risk of steven johnson syndrome the final final thing to remember is that this
Greasy grizzly bear you should take raziel fill them with food in order to avoid gi upset okay doctors that is it for this video we made it to the end i’m gonna leave my diagram up the screen so that you guys can either take a screenshot of it or just read watch the video and study it on your own either way thank you so much for watching please make sure you like
And subscribe to my channel but more importantly leave me a comment down below let me know how you’re studying is going what other types of videos you guys would find helpful do make sure to check out my next one it’ll be on all the microbio behind the fungi that are tested as well as all of the mycotic diseases but until then just remember guys have faith in
Yourself we are following in the footsteps of thousands that have come before us and if they can do it we can do
Transcribed from video
Easy Antifungals Pharmacology | Azoles, Amphotericin B, Terbinafine, Nystatin, Griseofulvin… By Slay Step 1
