Echinocandins

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Echinocandins

Step2 Review

Step2 Review

Introduction to biostatistics

Types of data

Probability

Mean, median, and mode

Range, variance, and standard deviation

Standard error of the mean (Central limit theorem)

Normal distribution and z-scores

Paired t-test

Two-sample t-test

Hypothesis testing: One-tailed and two-tailed tests

One-way ANOVA

Two-way ANOVA

Repeated measures ANOVA

Correlation

Methods of regression analysis

Linear regression

Logistic regression

Spearman's rank correlation coefficient

Mann-Whitney U test

Kappa coefficient

Chi-squared test

Fisher's exact test

Kaplan-Meier survival analysis

Type I and type II errors

Sensitivity and specificity

Positive and negative predictive value

Test precision and accuracy

Incidence and prevalence

Relative and absolute risk

Odds ratio

Attributable risk (AR)

Mortality rates and case-fatality

DALY and QALY

Direct standardization

Indirect standardization

Study designs

Clinical trials

Disease causality

Selection bias

Confounding

Interaction

Prevention

Eczematous rashes: Clinical (To be retired)

Papulosquamous skin disorders: Clinical (To be retired)

Alopecia: Clinical (To be retired)

Hypersensitivity skin reactions: Clinical (To be retired)

Autoimmune bullous skin disorders: Clinical (To be retired)

Blistering skin disorders: Clinical (To be retired)

Hypopigmentation skin disorders: Clinical (To be retired)

Benign hyperpigmented skin lesions: Clinical (To be retired)

Skin cancer: Clinical (To be retired)

Immunodeficiencies: Clinical (To be retired)

Antihistamines for allergies

Glucocorticoids

Advanced cardiac life support (ACLS): Clinical (To be retired)

Supraventricular arrhythmias: Pathology review

Ventricular arrhythmias: Pathology review

Heart blocks: Pathology review

Coronary artery disease: Clinical (To be retired)

Heart failure: Clinical (To be retired)

Syncope: Clinical (To be retired)

Pericardial disease: Clinical (To be retired)

Cardiomyopathies: Clinical (To be retired)

Hypertension: Clinical (To be retired)

Hypercholesterolemia: Clinical (To be retired)

Sympatholytics: Alpha-2 agonists

Adrenergic antagonists: Presynaptic

Adrenergic antagonists: Alpha blockers

Adrenergic antagonists: Beta blockers

ACE inhibitors, ARBs and direct renin inhibitors

Thiazide and thiazide-like diuretics

Calcium channel blockers

cGMP mediated smooth muscle vasodilators

Class I antiarrhythmics: Sodium channel blockers

Class II antiarrhythmics: Beta blockers

Class III antiarrhythmics: Potassium channel blockers

Class IV antiarrhythmics: Calcium channel blockers and others

Lipid-lowering medications: Statins

Lipid-lowering medications: Fibrates

Miscellaneous lipid-lowering medications

Positive inotropic medications

Diabetes mellitus: Clinical (To be retired)

Hyperthyroidism: Clinical (To be retired)

Hypothyroidism and thyroiditis: Clinical (To be retired)

Parathyroid conditions and calcium imbalance: Clinical (To be retired)

Pituitary adenomas and pituitary hyperfunction: Clinical (To be retired)

Hypopituitarism: Clinical (To be retired)

Cushing syndrome: Clinical (To be retired)

Adrenal masses and tumors: Clinical (To be retired)

Adrenal insufficiency: Clinical (To be retired)

MEN syndromes: Clinical (To be retired)

Hyperthyroidism medications

Hypothyroidism medications

Insulins

Hypoglycemics: Insulin secretagogues

Miscellaneous hypoglycemics

Adrenal hormone synthesis inhibitors

Mineralocorticoids and mineralocorticoid antagonists

Esophageal disorders: Clinical (To be retired)

Esophagitis: Clinical (To be retired)

Gastroesophageal reflux disease (GERD): Clinical (To be retired)

Gastroparesis: Clinical (To be retired)

Malabsorption: Clinical (To be retired)

Inflammatory bowel disease: Clinical (To be retired)

Jaundice: Clinical (To be retired)

Cirrhosis: Clinical (To be retired)

Laxatives and cathartics

Antidiarrheals

Acid reducing medications

Fever of unknown origin: Clinical (To be retired)

Fat-soluble vitamin deficiency and toxicity: Pathology review

Anemia: Clinical (To be retired)

Microcytic anemia: Pathology review

Non-hemolytic normocytic anemia: Pathology review

Intrinsic hemolytic normocytic anemia: Pathology review

Extrinsic hemolytic normocytic anemia: Pathology review

Macrocytic anemia: Pathology review

Heme synthesis disorders: Pathology review

Leukemia: Clinical (To be retired)

Lymphoma: Clinical (To be retired)

Thrombocytopenia: Clinical (To be retired)

Bleeding disorders: Clinical (To be retired)

Thrombophilia: Clinical (To be retired)

Myeloproliferative neoplasms: Clinical (To be retired)

Plasma cell disorders: Clinical (To be retired)

Blood products and transfusion: Clinical (To be retired)

Anticoagulants: Heparin

Anticoagulants: Warfarin

Anticoagulants: Direct factor inhibitors

Antiplatelet medications

Thrombolytics

Hematopoietic medications

Ribonucleotide reductase inhibitors

Topoisomerase inhibitors

Platinum containing medications

Anti-tumor antibiotics

Microtubule inhibitors

DNA alkylating medications

Monoclonal antibodies

Antimetabolites for cancer treatment

Infective endocarditis: Clinical (To be retired)

Pneumonia: Clinical (To be retired)

Tuberculosis: Pathology review

Diarrhea: Clinical (To be retired)

Viral hepatitis: Clinical (To be retired)

Urinary tract infections: Clinical (To be retired)

Meningitis, encephalitis and brain abscesses: Clinical (To be retired)

Bites and stings: Clinical (To be retired)

Protein synthesis inhibitors: Aminoglycosides

Antimetabolites: Sulfonamides and trimethoprim

Antituberculosis medications

Miscellaneous cell wall synthesis inhibitors

Protein synthesis inhibitors: Tetracyclines

Cell wall synthesis inhibitors: Penicillins

Miscellaneous protein synthesis inhibitors

Cell wall synthesis inhibitors: Cephalosporins

DNA synthesis inhibitors: Metronidazole

DNA synthesis inhibitors: Fluoroquinolones

Integrase and entry inhibitors

Nucleoside reverse transcriptase inhibitors (NRTIs)

Protease inhibitors

Hepatitis medications

Non-nucleoside reverse transcriptase inhibitors (NNRTIs)

Neuraminidase inhibitors

Herpesvirus medications

Azoles

Echinocandins

Miscellaneous antifungal medications

Anthelmintic medications

Antimalarials

Anti-mite and louse medications

Hypernatremia: Clinical (To be retired)

Hyponatremia: Clinical (To be retired)

Hyperkalemia: Clinical (To be retired)

Hypokalemia: Clinical (To be retired)

Metabolic and respiratory acidosis: Clinical (To be retired)

Metabolic and respiratory alkalosis: Clinical (To be retired)

Toxidromes: Clinical (To be retired)

Medication overdoses and toxicities: Pathology review

Acute kidney injury: Clinical (To be retired)

Chronic kidney disease: Clinical (To be retired)

Nephritic and nephrotic syndromes: Clinical (To be retired)

Renal tubular defects: Pathology review

Renal tubular acidosis: Pathology review

Osmotic diuretics

Carbonic anhydrase inhibitors

Loop diuretics

Potassium sparing diuretics

Stroke: Clinical (To be retired)

Seizures: Clinical (To be retired)

Headaches: Clinical (To be retired)

Hyperkinetic movement disorders: Clinical (To be retired)

Hypokinetic movement disorders: Clinical (To be retired)

Muscle weakness: Clinical (To be retired)

Disorders of consciousness: Clinical (To be retired)

Spinal cord disorders: Pathology review

Sympathomimetics: Direct agonists

Muscarinic antagonists

Cholinomimetics: Direct agonists

Cholinomimetics: Indirect agonists (anticholinesterases)

Anticonvulsants and anxiolytics: Barbiturates

Anticonvulsants and anxiolytics: Benzodiazepines

Nonbenzodiazepine anticonvulsants

Migraine medications

Anti-parkinson medications

Medications for neurodegenerative diseases

Asthma: Clinical (To be retired)

Chronic obstructive pulmonary disease (COPD): Clinical (To be retired)

Diffuse parenchymal lung disease: Clinical (To be retired)

Venous thromboembolism: Clinical (To be retired)

Acute respiratory distress syndrome: Clinical (To be retired)

Pleural effusion: Clinical (To be retired)

Pneumothorax: Clinical (To be retired)

Lung cancer: Clinical (To be retired)

Bronchodilators: Beta 2-agonists and muscarinic antagonists

Bronchodilators: Leukotriene antagonists and methylxanthines

Joint pain: Clinical (To be retired)

Rheumatoid arthritis: Clinical (To be retired)

Seronegative arthritis: Clinical (To be retired)

Systemic lupus erythematosus (SLE): Clinical (To be retired)

Sjogren syndrome: Clinical (To be retired)

Inflammatory myopathies: Clinical (To be retired)

Vasculitis: Clinical (To be retired)

Acetaminophen (Paracetamol)

Non-steroidal anti-inflammatory drugs

Opioid agonists, mixed agonist-antagonists and partial agonists

Antigout medications

Osteoporosis medications

Pregnancy

Routine prenatal care: Clinical (To be retired)

Hypertensive disorders of pregnancy: Clinical (To be retired)

Antepartum hemorrhage: Clinical (To be retired)

Premature rupture of membranes: Clinical (To be retired)

Stages of labor

Abnormal labor: Clinical (To be retired)

Vaginal versus cesarean delivery: Clinical (To be retired)

Postpartum hemorrhage: Clinical (To be retired)

Gestational trophoblastic disease: Clinical (To be retired)

Breastfeeding

Abdominal pain: Clinical (To be retired)

Puberty and Tanner staging

Amenorrhea: Clinical (To be retired)

Contraception: Clinical (To be retired)

Virilization: Clinical (To be retired)

Infertility: Clinical (To be retired)

Vulvovaginitis: Clinical (To be retired)

Sexually transmitted infections: Clinical (To be retired)

Menopause

Abnormal uterine bleeding: Clinical (To be retired)

Ovarian cysts, cancer, and other adnexal masses: Clinical (To be retired)

Endometrial hyperplasia and cancer: Clinical (To be retired)

Cervical cancer: Clinical (To be retired)

Vaginal cancer: Clinical (To be retired)

Vulvar cancer: Clinical (To be retired)

Estrogens and antiestrogens

Progestins and antiprogestins

Androgens and antiandrogens

Aromatase inhibitors

Uterine stimulants and relaxants

Newborn management: Clinical (To be retired)

Neonatal ICU conditions: Clinical (To be retired)

Congenital TORCH infections: Pathology review

Neonatal jaundice: Clinical (To be retired)

Perinatal infections: Clinical (To be retired)

Congenital disorders: Clinical (To be retired)

Congenital heart defects: Clinical (To be retired)

Autosomal trisomies: Pathology review

Miscellaneous genetic disorders: Pathology review

Disorders of carbohydrate metabolism: Pathology review

Disorders of fatty acid metabolism: Pathology review

Glycogen storage disorders: Pathology review

Lysosomal storage disorders: Pathology review

Mood disorders: Clinical (To be retired)

Anxiety disorders: Clinical (To be retired)

Schizophrenia spectrum disorders: Clinical (To be retired)

Dissociative disorders: Clinical (To be retired)

Eating disorders: Clinical (To be retired)

Obsessive compulsive disorders: Clinical (To be retired)

Trauma- and stressor-related disorders: Clinical (To be retired)

Disruptive, impulse-control and conduct disorders: Clinical (To be retired)

Personality disorders: Clinical (To be retired)

Sleep disorders: Clinical (To be retired)

Somatic symptom disorders: Clinical (To be retired)

Sexual dysfunctions: Clinical (To be retired)

Paraphilic disorders: Clinical (To be retired)

Substance misuse and addiction: Clinical (To be retired)

Drug misuse, intoxication and withdrawal: Hallucinogens: Pathology review

Psychiatric emergencies: Pathology review

Preoperative evaluation: Clinical (To be retired)

Postoperative evaluation: Clinical (To be retired)

General anesthetics

Local anesthetics

Neuromuscular blockers

Esophageal surgical conditions: Clinical (To be retired)

Gastrointestinal bleeding: Clinical (To be retired)

Peptic ulcers and stomach cancer: Clinical (To be retired)

Appendicitis: Clinical (To be retired)

Diverticular disease: Clinical (To be retired)

Hernias: Clinical (To be retired)

Bowel obstruction: Clinical (To be retired)

Colorectal cancer: Clinical (To be retired)

Abdominal trauma: Clinical (To be retired)

Anal conditions: Clinical (To be retired)

Gallbladder disorders: Clinical (To be retired)

Pancreatitis: Clinical (To be retired)

Breast cancer: Clinical (To be retired)

Benign breast conditions: Pathology review

Anatomy clinical correlates: Anterior and posterior abdominal wall

Anatomy clinical correlates: Breast

Valvular heart disease: Clinical (To be retired)

Chest trauma: Clinical (To be retired)

Anatomy clinical correlates: Thoracic wall

Anatomy clinical correlates: Heart

Anatomy clinical correlates: Pleura and lungs

Anatomy clinical correlates: Mediastinum

Dizziness and vertigo: Clinical (To be retired)

Thyroid nodules and thyroid cancer: Clinical (To be retired)

Neck trauma: Clinical (To be retired)

Nasal, oral and pharyngeal diseases: Pathology review

Traumatic brain injury: Clinical (To be retired)

Brain tumors: Clinical (To be retired)

Lower back pain: Clinical (To be retired)

Eye conditions: Refractive errors, lens disorders and glaucoma: Pathology review

Eye conditions: Retinal disorders: Pathology review

Eye conditions: Inflammation, infections and trauma: Pathology review

Anatomy clinical correlates: Clavicle and shoulder

Anatomy clinical correlates: Axilla

Anatomy clinical correlates: Arm, elbow and forearm

Anatomy clinical correlates: Wrist and hand

Anatomy clinical correlates: Median, ulnar and radial nerves

Burns: Clinical (To be retired)

Prostate disorders and cancer: Pathology review

Testicular tumors: Pathology review

Kidney stones: Clinical (To be retired)

Renal cysts and cancer: Clinical (To be retired)

Urinary incontinence: Pathology review

PDE5 inhibitors

Peripheral vascular disease: Clinical (To be retired)

Leg ulcers: Clinical (To be retired)

Aortic aneurysms and dissections: Clinical (To be retired)

Assessments

Echinocandins

Flashcards

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Flashcards

Echinocandins

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External References

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2016

Anidulafungin p. 195, 197

Transcript

Contributors

Ursula Florjanczyk, MScBMC

Evan Debevec-McKenney

Echinocandins are a novel class of medications used to treat mycoses, or fungal infections.

Mycoses can be localized skin infections, or develop into systemic infections in immunodeficient patients.

Antifungals work either through fungistatic action, meaning that they inhibit fungal growth, or through fungicidal action, meaning they kill the fungi.

Now, most fungi have a protective cell wall made of different carbohydrate molecules.

Some fungal species have beta glucans which are polysaccharide polymers that are cross linked with other carbohydrate molecules to make a strong fungal cell wall.

Beta glucans are produced by an enzyme on the cell membrane called beta-1,3-D-glucan synthase.

This enzyme is not found in human cells which makes it a good target for antifungal medications.

Now, echinocandins are a type of medication that noncompetitively bind to and inhibit beta-1,3-D-glucan synthase.

This weakens the cell wall and prevents it from being repaired.

The cell wall gradually deforms more and more until it ruptures, causing the cell to die.

Echinocandins are only available via IV since they are not well absorbed through the GI tract.

Medications in this class include anidulafungin, micafungin, and caspofungin.

They are only effective against fungal species that have beta-1,3-D-glucan synthase, but it’s extremely rare for these organisms to have resistance to these medications.

Because of this, echinocandins are often used to treat fungal infections that are resistant to the more common antifungal medications like amphotericin-B and the “azole” medications like fluconazole.

Echinocandins are used to treat mucocutaneous candidiasis, which affect the skin, nails, and oral mucosa, or disseminated candidiasis, where the infection spreads to multiple organ systems through the blood, causing endocarditis, endophthalmitis, and osteomyelitis.

Summary

Echinocandins are a class of antifungals, mainly used to treat infections caused by candida species and aspergillus species. They work by disrupting the formation of the fungal cell wall, leading to cell death. They inhibit eta-1,3-D-glucan synthase, an enzyme necessary for the synthesis of major fungal cell components known as Beta glucans. Echinocandins are generally well-tolerated and have a low risk of serious adverse effects.

The most common side effects are facial flushing, nausea, vomiting, and skin rash. Rare but serious side effects include anaphylaxis (a life-threatening allergic reaction) and Stevens-Johnson syndrome (a severe skin reaction).

Sources

  1. "Katzung & Trevor's Pharmacology Examination and Board Review,12th Edition" McGraw-Hill Education / Medical (2018)
  2. "Rang and Dale's Pharmacology" Elsevier (2019)
  3. "Goodman and Gilman's The Pharmacological Basis of Therapeutics, 13th Edition" McGraw-Hill Education / Medical (2017)
  4. "Echinocandins--new antifungal agents" Rev Med Chir Soc Med Nat Iasi (2014)
  5. "Echinocandins in antifungal pharmacotherapy" Journal of Pharmacy and Pharmacology (2017)
  6. "Clinical hepatotoxicity associated with antifungal agents" Expert Opinion on Drug Safety (2016)
Elsevier

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