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Echinocandins and Squalene Epoxidase Inhibitor (Terbinafine) – Antifungals

by Pravin Shukle, MD
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    We have a new class of drugs, the prototypical drug of which is griseofulvin. Now it is not active topically. It actually an orally ingested agent for skin infections. So that's sometimes kind of confusing to a lot of medical students. It's a skin drug but it's not used topically. It's distributed to the stratum corneum where it binds to various proteins. It should not be used in patients with porphyria because you can actually precipitate a porphyria crisis with this agent. In terms of how it works, it actually inhibits microtubule formation in the dermatophytes. It's a fungistatic so it's absorbed into fungal cells through an active transporter. The toxicity of this agent includes, headache and GI distress, fever, rash and flushing from the histamine release that you sometimes get. Now the other thing that's really important with this agent is that it will interfere with warfarin levels. So be careful of your warfarin dosing in your INR's when you start this medication. Terbinafine is available both in oral and in topical forms. Like griseofulvin it is distributed to the stratum corneum where it binds to various proteins. It's actually much more effective then griseofulvin. And we see it all the time used in fungal infections. In terms of how it works, it inhibits squalene epoxidase. It accumulates, there's an accumulation of squalene and this interferes with ergosterol synthesis. And this is actually a fungicidal activity. Toxicity once again same as the other ones. Headache, GI distress, fever, rash and flushing from histamine release. And once again this drug also will interfere with warfarin dosing and levels. ...

    About the Lecture

    The lecture Echinocandins and Squalene Epoxidase Inhibitor (Terbinafine) – Antifungals by Pravin Shukle, MD is from the course Antimicrobial Pharmacology. It contains the following chapters:

    • Echinocandins
    • Terbinafine

    Included Quiz Questions

    1. It is used topically.
    2. It may cause flushing from histamine release.
    3. It inhibits microtubule formation.
    4. It may precipitate a porphyria attack in susceptible patients.
    5. It is used for skin infections
    1. Distribution to the stratum corneum
    2. Fungicidal activity
    3. Ergosterol synthesis inhibition
    4. Available topically
    5. Fungistatic activity

    Author of lecture Echinocandins and Squalene Epoxidase Inhibitor (Terbinafine) – Antifungals

     Pravin Shukle, MD

    Pravin Shukle, MD


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