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抗黴菌局部外用: Propionic acid、Caprylic acid、Triacetin、Undecylenic acid香港腳: Salicylic acid孕婦: Amphotericin B偕同: Flucytosine (5-FC)+Amphotericin B(-azole)抑菌抑制C-14α-steroldemethylase (阻斷細胞膜麥角固醇Ergosterol形成)有畸胎性/孕婦noCYP450 inhibitor一、imidazole1.)Ketoconazole: 需要酸、no BBB、可治療庫欣氏症/汗斑/髮癬、制酸劑/Amphotericin B no、會男性女乳症二、Triazole1.)Fluconazole: 不用酸、可BBB、念珠菌/隱球菌首選/骨髓移殖預防、腎差藥調劑量2.)Itraconazole (衍生Posaconazole): 需要酸、灰指甲(間歇療法)/麴菌、膠囊/溶液、腎差可、會CHF3.)Voriconazole: Fluconazole衍生、侵襲性麴菌首選、白黴菌/腎差no、會視力障礙4.)Posaconazole: 接合菌/白黴菌(唯一)(Echinocandin)1.)Caspofungin: 抑制細胞壁合成(β1,3-D-glucan)、麴菌/念珠菌、肝毒(+cyclosporine)(Allylamine)殺菌1.)Terbinafine: 抑制squalene epoxidase(抑制ergosterol)、皮癬/灰指甲、療程長(可+Griseofulvin)、副作用: SJS、惡血質、味覺/視力障礙、肝毒(Benzofurane)1.)Griseofulvin: 抑制微管/有絲分裂、高脂肪佳(口服)、皮膚和指甲、CYP450 inducer副作用: porphyria紫質症no、disulfiram戒酒藥反應(Polyene)和ergosterol結合、改變通透性(電解質K+流失)、專一性1.)Nystatin: 口腔念珠菌(PO)2.)Amphotericin B: 全身性感染(IV)、不可加食鹽水NS、肝腎差/孕婦可用副作用: 腎毒性、Cytokine風暴(輸注)、低血鉀、血栓(可用heparin)、類感冒(用clonidine、dexamethasone、meperidine、tramal)交互作用: 可並用Flucytosine、不並用Ketoconazole(會沒有ergosterol)(核酸抑制劑)1.)Flucytosine (5-FC): 轉成5-FdUMP抑制胸苷酸合酶(T)、嚴重/新型隱球菌副作用: 骨髓抑制、孕婦no
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