Saturday, July 3, 2010

I'm on a zole!

Today we start on antimicrobials, beginning with antifungals.
The basic function of of azoles is to stop the conversion of lanosterol into ergosterol, which interferes with the membrane and prevents reproduction making it fungistatic.
Four main azoles: ketoconazole, not used all that much any more since it can be quite toxic, fluconazole, used for CNS infections such as meningitis as it enters the cerebrospinal fluid, itraconazle, usually used for dermatophytes, and miconazole, usually for GIT infections.
Aphoterecin puts holes in the membrane and lets all the potassium leak out, but can cause renal impairment. Nystatin is much the same but is not absorbed from the GIT.
Griseofulvin cleaves microtubules and echinocandins render ergosterol ineffective and lyse the cell walls.
Flucytosine (I know runny nose is a symptom of rhinovirus not influenza but shhhh, it helps me remember) is taken up by both human and fungal cells, but only fungal cells convert it into a toxin, although resistance develops quite quickly so it is usually used in concert with other antifungals.
Turbinafine is a drug absorbed with great affinity for keratin and adipose tissue, it fills the cell wall with squaline and destroys it. In 10% of patients it has side effects.

I'm leaving for QC in a matter of hours, I'll probably have internet while I'm away but I doubt I'll be doing much for this, I rather hope I won't have time. When I get back we'll cover the rest of the antimicrobials.

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