amphotericin B black box warning - answer✔highly toxic. only to be used in setting of life
threatening infections (infusion reaction and renal damage occur in many patients)
amphotericin B uses - answer✔-Drug of choice for most systemic mycoses
-Before ampho B, systemic fungal infections were usually fatal
Amphotericin B MOA - answer✔-Binds ergosterol (unique to fungi); forms membrane pores that
allow leakage of electrolytes.
-Amphotericin "tears" holes in the fungal membrane by forming pores
Amphotericin B adverse effects - answer✔-Infusion reactions (caused by release of
proinflammatory cytokines - symptoms begin 1-3 hours after start of infusion and last for about 1
hour. pre-treat with diphenhydramine + acetaminophen, IV meperidine or dantrolene can be
given if rigors occur, hydrocortisone can be given with caution)
-Nephrotoxicity (likely if total dose exceeds 4g, avoid concurrent use of other nephrotoxic drugs
ex aminoglycosides and cyclosporines, monitor serum creatinine every 3-4 days and reduce
dosage of greater than 3.5 mg/dL)
-Hypokalemia (results from damage to kidneys, may need K+ supplements, monitor serum K+
levels)
Bone marrow suppression (anemia, monitor Hct)
Itraconazole side effects - answer✔-cardiosuppression (transient decrease in ventricular ejection
fraction) *BBW: should not be used in patient with heart failure or other indications of
ventricular dysfunction*
-liver damage (can inhibit drug-metabolizing enzymes)
-GI effects (N, V, D)
Fuconazole - answer✔Fungistatic
inhibits the synthesis of ergosterol and disrupts the fungal cell membrane
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