Source / episode info

• **Episode:**35
• **Title:**Divine Intervention Episode 35 – Antifungals and Antiparasitics.
• **Published:**2018-06-02
• Source:Episode page

One-liner

This episode covers the mechanisms and clinical uses of antifungal agents (targeting -glucan synthase or ergosterol synthesis) and antiparasitic drugs, emphasizing drug-organism pairings for tropical infections and adrenal axis side effects.

High-yield summary

• Cell Wall Synthesis Inhibitors: Echinocandins (e.g., Caspofungin) inhibit -(1,3)-glucan synthase and are used for invasive Candida species.
• Ergosterol Synthesis Inhibitors: Azoles (e.g., Fluconazole, Ketoconazole) inhibit Lanosterol 14--demethylase; Amphotericin B binds directly to ergosterol.
• Dermatophyte Infections: Systemic treatment is required for tinea capitis/onychomycosis; Terbinafine (an allylamine) is the drug of choice, while topical agents are ineffective for deep infections.
• Adrenal Axis Toxicity: Azoles (especially Ketoconazole) inhibit multiple enzymes in steroidogenesis (e.g., desmolase), leading to adrenal insufficiency and potential gynecomastia due to androgen suppression.
• Antiparasitic Pearls: Specific drugs must be paired with specific parasites: Praziquantel for Schistosoma; Nitazoxanide/Paromomycin for Cryptosporidium spp.; Ivermectin for strongyloidiasis and stercoralasis.

Learning objectives

• Differentiate the mechanisms of action and clinical uses of major antifungal classes (Azoles, Echinocandins, Polyenes).
• Identify the appropriate systemic treatment for dermatophyte infections (e.g., Tinea capitis).
• Recognize the specific drug pairings required for common tropical parasitic infections (e.g., Schistosoma, Cryptosporidium).
• Understand the metabolic side effects of azole antifungals on the adrenal steroidogenesis pathway.
• Differentiate between antifungal drugs used for superficial vs. deep/systemic fungal infections.

Board exam buzzwords