| Drug Class/Agents | Mechanism | Clinical Use | Adverse Effects |
|---|---|---|---|
| Polyenes (Amphotericin B, Nystatin) | Binds ergosterol, forms membrane pores, leaks electrolytes (K+, Mg2+) | Ampho B: Serious systemic mycoses (Cryptococcus, Blastomyces, Coccidioides, Histoplasma, Candida, Mucor). Nystatin: Topical only ("Swish and swallow") for oral candidiasis, diaper rash. | Ampho B: Nephrotoxicity (dose-dependent), "Shake and bake" (fever/chills), Arrhythmias, Anemia, IV phlebitis, Hypotension. Nystatin: Toxic if IV. |
| Azoles (Fluconazole, Itraconazole, Voriconazole, Ketoconazole, Clotrimazole) | Inhibits 14-alpha-demethylase (P450 enzyme), preventing Lanosterol -> Ergosterol conversion. | Fluconazole: Cryptococcal meningitis, Candida. Itraconazole: Dimorphic fungi (Blastomyces, Coccidioides, Histoplasma). Voriconazole: Invasive Aspergillus. Topical: Tinea/Vaginal yeast. | Hepatotoxicity, P450 Inhibition, Gynecomastia (Ketoconazole), QT prolongation. Voriconazole: Visual disturbances (blurry/flashes). |
| Echinocandins (Caspofungin, Micafungin) | Inhibits cell wall synthesis (Beta-glucan). | Invasive Aspergillus, Invasive Candida. | Flushing (histamine release), GI upset. |
| Flucytosine | Inhibits DNA/RNA biosynthesis (converted to 5-FU by cytosine deaminase). | Cryptococcal meningitis (w/ Ampho B). | Bone marrow suppression (Anemia, Leukopenia, Thrombocytopenia). |
| Terbinafine | Inhibits Squalene epoxidase. | Dermatophytes (Onychomycosis). | Hepatotoxicity, Taste disturbance. |
| Griseofulvin | Interferes with microtubules (mitosis). Deposits in keratin. | Superficial dermatophytes (Ringworm). | Teratogenic, Carcinogenic, P450 Inducer, Disulfiram-like reaction. |
| Drug | Mechanism | Clinical Use | Adverse Effects |
|---|---|---|---|
| Benzimidazoles (Mebendazole, Albendazole) | Inhibits microtubule synthesis (beta-tubulin); impairs glucose uptake. | Nematodes (Ascaris, Hookworm, Pinworm), Cestodes (Neurocysticercosis). | Teratogenic. GI distress. |
| Praziquantel | Increases membrane permeability to Calcium (spasms/paralysis). | Trematodes (Schistosoma, Clonorchis), Cestodes (Taenia). | Contraindicated in Ocular Cysticercosis. |
| Pyrantel Pamoate | Depolarizing neuromuscular blocker (Nicotinic receptors). | Enterobius, Ascaris, Hookworms. | GI distress. |
| Ivermectin | Binds glutamate-gated Chloride channels (Hyperpolarization). | River Blindness (Onchocerca), Strongyloides. | Mazzotti reaction (fever/rash from dying worms). |
| Diethylcarbamazine | Immobilizes microfilariae, alters surface structure. | Lymphatic Filariasis, Loa Loa. | Mazzotti-like reaction. |