Rhubarb (Rheum palmatum) also contains several different O-glycosides and cascarosides safe alavert 10mg allergy treatment brand crossword. A pink or violet colour in the base layer indicates the presence of anthraquinones in the plant sample buy alavert 10 mg allergy shots user reviews. Biosynthesis of anthraquinone glycosides In higher plants order discount alavert allergy medicine red eyes, anthraquinones are biosynthesized either via acylpolyma- lonate (as in the plants of the families Polygonaceae and Rhamnaceae) or via shikimic acid pathways (as in the plants of the families Rubiaceae and Gesneriaceae) as presented in the following biosynthetic schemes. There are two major classes of isoprenoid glycosides: saponins and cardiac glycosides. Usually, the sugar is attached at C-3 in saponins, because in most sapogenins there is a hydroxyl group at C-3. Steroidal saponins are used in the commercial production of sex hormones for clinical use. Most aglycones of triterpenoidal saponins are pentacyclic compounds derived from one of the three basic structural classes represented by a-amyrin, b-amyrin and lupeol. Most crude drugs containing triterpenoid saponins are usually used as expectorants. Three major sources of triterpenoidal glycosides along with their uses are summarized below. Plants Botanical names (Family) Main constituents Uses Liquorice root Glycyrrhiza Glycyrrhizinic acid In addition to expectorant glabra (Fabaceae) derivatives action, it is also used as a ﬂavouring agent. Quillaia bark Quillaja Several complex Tincture of this plant is saponaria (Rosaceae) triterpenoidal saponins, used as an emulsifying e. Ginseng Panax ginseng Ginsenosides As a tonic, and to (Araliaceae) promote the feeling of well being. Their effect is speciﬁ- cally on myocardial contraction and atrioventricular conduction. The aglycones of cardiac glycosides are steroids with a side-chain containing an unsaturated lactone ring, either ﬁve membered g-lactone (called carde- nolides) or six membered d-lactone (called bufadienolides). The sugars present in these glycosides are mainly digitoxose, cymarose, digitalose, rhamnose and sarmentose. Liliaceae, Ranunculaceae, Apocynaceae and Scrophulariaceae are the major sources of these glycosides. Among the cardiac glycosides isolated to date, digitoxin and digoxin, isolated from Digitalis purpurea and Digitalis lanata, respec- tively, are the two most important cardiotonics. Both these cardiac glycosides are cardenolides, and the sugar present is the 2-deoxysugar digitoxose. The sugar part possibly is responsible for binding the glycoside to heart muscle, and the aglycone moiety has the desired effect on heart muscle once bound. It has been found that the lactone ring is essential for the pharmacological action. In large doses these glycosides lead to cardiac arrest and can be fatal, but at lower doses these glycosides are used in the treatment of congestive heart failure. For example, harpago- side, an active constituent of Harpagophytum procumbens, is an iridoid glycoside. Lamiaceae (especially genera Phlomis, Stachys and Eremostachys), Gentianaceae, Valerianaceae and Oleaceae, are good sources of these glycosides. Changes in functionalities at various other carbons in iridoid and secoiridoid skeletons are also found in nature, as shown below. Devil’s claw (Harpagophytum procumbens) Harpagophytum procum- bens is native to South Africa, Namibia and Madagascar, and traditionally used in the treatment of osteoarthritis, rheumatoid arthritis, indigestion and low back pain. However, this plant is said to have oxytocic properties and should be avoided in pregnancy. In addition, due to its reﬂex effect on the digestive system, it should be avoided in patients with gastric or duodenal ulcers. Picrorhiza (Picrorhiza kurroa) Picrorhiza kurroa is a small perennial herb that grows in hilly parts of India, particularly in the Himalayas between 3000 and 5000 m. The bitter rhizomes of this plant have been used for thousands of years in Ayurvedic traditional medicine to treat indigestion, dyspepsia, constipation, liver dysfunction, bronchial problems and fever. It is, in combination with various metals, useful in the treatment of acute viral hepatitis. Oleuropein, a secoiridoid glycoside Fraxinus excelsior (ash tree), Olea europaea (olive tree) and Ligustrum obtusifolium from the family Oleaceae are the major sources of oleuropein. According to the isoprene rule proposed by Leo- pold Ruzicka, terpenoids arise from head-to-tail joining of isoprene units. For example, myrcene is a simple 10-carbon-containing terpenoid formed from the head- to-tail union of two isoprene units as follows. Tail Isoprene unit 1 2 4 2 4 1 3 3 Isoprene unit Myrcene Head Terpenoids are found in all parts of higher plants and occur in mosses, liverworts, algae and lichens. These compounds are particularly important as ﬂavouring agents in pharmaceutical, confectionery and perfume products. However, a number of monoterpenes show various types of bioactivity and are used in medicinal preparations. For example, camphor is used in liniments against rheumatic pain, menthol is used in ointments and liniments as a remedy against itching, bitter-orange peel is used as an aromatic bitter tonic and as a remedy for poor appetite and thymol and carvacrol are used in bactericidal preparations. Types of monoterpene Monoterpenes occur in plants in various structural forms; some are cyclic while the others are acyclic. They also contain various types of functional group, and depending on their functional groups they can be classiﬁed as simple hydrocarbons, alcohols, ketones, aldehydes, acids or phenols. The following table lists just a few of these sources, and their major monoterpene components. Source Major monoterpenes Common name Botanical name (Family) Black pepper Piper nigrum (Piperaceae) a- and b-pinene, phellandrene Peppermint leaf Mentha piperita (Lamiaceae) Menthol, menthone Oil of rose Rosa centifolia (Rosaceae) Geraniol, citronellol, linalool Cardamom Elettaria cardamomum a-terpineol, a-terpinene (Zingiberaceae) Rosemary Rosmarinus ofﬁcinalis Borneol, cineole, camphene (Lamiaceae) Bitter orange Citrus aurantium (Rutaceae) (þ)-limonene, geranial Camphor Cinnamomum camphora (þ)-camphor (Lauraceae) Caraway Carum carvi (Apiaceae) (þ)-carvone, (þ)-limonene Thyme Thymus vulgaris (Lamiaceae) Thymol, carvacrol 6. Farnesylpyrophosphate can cyclize by various cyclase enzymes in various ways, leading to the production of a variety of sesquiterpenes. For example, (À)-a-bisabolol and its derivatives have potent anti-inﬂammatory and spasmolytic proper- ties, and artemisinin is an antimalarial drug. The following table lists just a few of these sources, and their major sesquiterpene components. Source Major sesquiterpenes Common name Botanical name (Family) German chamomile Matricaria recutita (Asteraceae) Àa-bisabolol and its derivatives Feverfew Tanacetum parthenium Farnesene, germacrene D, (Asteraceae) parthenolide Qinghao Artemisia annua (Asteraceae) Artemisinin and its derivatives Holy thistle Cnicus benedictus (Asteraceae) Cnicin Cinnamon Cinnamomum zeylanicum b-caryophyllene (Lauraceae) Cloves Syzygium aromaticum b-caryophyllene (Myrtaceae) Hop Humulus lupulus (Cannabaceae) Humulene Wormseed Artemisia cinia (Asteraceae) a-santonin Valerian Valeriana ofﬁcinalis Valeranone (Valerianaceae) Juniper berries Juniperus communis a-cadinene (Cupressaceae) Curcuma or Cucuma longa Curcumenone, curcumabranol turmeric (Zingiberaceae) A, curcumabranol B, b-elemene, curzerenone 6. One of the simplest and most signiﬁcant of the diterpenes is phytol, a reduced form of geranylgeraniol, which constitutes the lipophilic side-chain of the chlorophylls. Vitamin A is also a 20-carbon-containing compound, and can be regarded as a diterpene. Among the medicinally important diterpenes, paclitaxel, isolated from Taxus brevifolia (family Taxaceae), is one of the most successful anticancer drugs of modern time. The following table presents just a few of these sources, and their major diterpenoidal components.
However buy discount alavert 10 mg online allergy shots johns hopkins, the salicylate level should certainly be measured; in this case it was not raised order alavert 10 mg with visa allergy shots preventive care. In the absence of drowsiness at this time order alavert online pills allergy symptoms in july, it is not necessary to consider temazepam any further. Paracetamol overdose causes hepatic and renal damage, and can lead to death from acute liver failure. The severity of paracetamol poisoning is dose related with a dose of 15 g being serious in most patients. Patients with pre-existing liver disease and those with a high alcohol intake may be susceptible to smaller overdoses. It is often the first test to become abnormal when there is liver damage from paracetamol overdose. There are few symptoms in the first 24 h except perhaps nausea, vomiting and abdominal dis- comfort. Acute liver failure may develop between days 3 and 5, and renal failure occurs in about 25 per cent of patients with severe hepatic damage. The earlier this is used the better but it is certainly still worth- while 16 h after the ingestion. In this case a level of paracetamol of 64 mg/L confirmed that treatment was appropriate and that the risk of severe liver damage was high. Further advice can always be obtained by ringing one of the national poisons information ser- vices. The electrolyte, renal and liver function tests and the clotting studies should be monitored carefully over the first few days, and referral to a liver unit considered if there is marked liver dysfunction. Patients with fulminant hepatic failure are considered for urgent liver transplantation. The other areas that need to be addressed in this case are the mental state and the safety and care of the son and any other children. She should be seen by a psychiatrist or other appropriately trained health worker. The question of any possible risk to the baby should be evaluated before she returns home. On direct questioning she states that she has lost 8 kg in weight over the past year although she says her appetite is good. This is a disorder usually of teenagers or young adults char- acterized by severe weight loss, a disorder of body image (the patient perceiving themself as being fat despite being objectively thin) and amenorrhoea (or, in men loss of libido or potency). Often sufferers from this condition work in a profession where personal image is very important, e. Some patients exhibit the bulimic behaviour of recurrent bouts of overeating and self-induced vomiting. The skin is dry with growth of lanugo hair over the neck, cheeks and limbs as in this woman. Severe physical complications include proximal myopathy, cardiomyopathy and peripheral neuropathy. A number of interrelated mechanisms cause the metabolic alkalosis in this patient. The vom- iting causes a net loss of hydrogen and chloride ions, causing alkalosis and hypochloraemia. The loss of fluid by vomiting leads to a contracted plasma volume with consequent second- ary hyperaldosteronism to conserve sodium and water, but with renal loss of potassium, due to its secretion in preference to sodium and the fact that fewer hydrogen ions are available for secretion by the renal tubules. These events combine to give the typical picture of an alkalosis with low chloride and raised bicarbonate in the blood, and urine which contains excess potassium and very little chloride. This patient should be referred to a unit with a special interest in eating disorders. Other serious physical illnesses should be excluded with the appropriate investigations. Often such patients are admitted for several weeks in an attempt to make them gain weight. Supportive psychotherapy tackles the patient’s disordered perception of their body image. This developed suddenly a week previously after carrying a heavy suitcase at the airport. She has had increasing problems with back pain over the past 10 years, and her family have commented on how stooped her posture has become. She takes courses of oral corticosteroids, and use steroid inhalers on a regular basis. She has a moon-face, abdominal striae and a number of bruises on her arms and thighs. The loss of height is typical, and is usually noted more by others than the patient. This can occur spontaneously or in association with a recognized stress such as carrying a heavy load. Examination confirms loss of trunk height, thoracic kyphosis and proxim- ity of the ribs to the iliac crest. The differential diagnoses of osteoporosis • Multiple myeloma • Metastatic carcinoma, particularly from the prostate, breast, bronchus, thyroid and kidney • Osteomalacia • Hyperparathyroidism • Steroid therapy or Cushing’s syndrome This patient has several risk factors for osteoporosis. Thirdly she has been on oral and inhaled corticosteroids for her asthma for years. She has no clinical evidence of thyrotoxicosis or hypopituitarism which can cause osteoporosis. This woman should have blood tests to exclude myeloma, cancer and metabolic bone dis- ease. Collapse of the vertebral body will manifest as irregular anterior wedging affecting some vertebrae and not others (L1 and L4). She should have her dose of corticosteroids reduced to the minimum required to control her asthmatic symptoms, using the inhaled routes as far as possible. She should be started on calcium and vitamin D supplements and a bisphosphonate to try to reduce her bone loss. Oestrogen-based hormone replacement therapy is only used for symptoms associated with the menopause because of the increased incidence of thromboembolism and endometrial carcinoma. She has had an irregular bowel habit with periods of increased bowel actions up to four times a day and periods of constipation. Opening her bowels tends to relieve the pain which has been present in both iliac fossae at different times. She thinks that her pains are made worse after eat- ing citrus fruits and after some vegetables and wheat.
Negative attitudes included beliefs that ‘it kills spontaneity’ best purchase for alavert allergy symptoms gagging, ‘it’s too much trouble to use’ and that there are possible side eﬀects 10mg alavert overnight delivery allergy medicine and pregnancy. In addition buy alavert master card allergy medicine on sale, carrying contraceptives around is often believed to be associated with being promiscuous (e. This research assumes that certain aspects of individuals are consistent over time and research has reported associations between the following types of personality: s conservatism and sex role have been shown to be negatively related to contraceptive use (e. Interpersonal factors Research highlights a role for characteristics of the following signiﬁcant others: 1 Partner: facets of the relationship may inﬂuence contraception use including duration of relationship, intimacy, type of relationship (e. They included interpersonal and situational factors as a means to place the individual’s cognitions within the context of the relationship and the broader social world. These variables can be applied individually or alternatively incorporated into models. In particular, social cognition models emphasize cognitions about the individual’s social world, particularly their normative beliefs. However, whether asking an individual about the relationship really accesses the interaction between two people is questionable. For example, is the belief that ‘I decided to go on the pill because I had talked it over with my partner’ a statement describing the interaction between two individuals, or is it one individual’s cognitions about that interaction? Although sometimes ignored, this research is also relevant to other sexually transmitted diseases. Since then, health education programmes have changed in their approach to preventing the spread of the virus. For example, early campaigns emphasized monogamy or at least cutting down on the number of sexual partners. Campaigns also promoted non- penetrative sex and suggested alternative ways to enjoy a sexual relationship. As a result, research has examined the prerequisites to safer sex and condom use in an attempt to develop successful health promotion campaigns. Richard and van der Pligt (1991) examined condom use among a group of Dutch teenagers and report that 50 per cent of those with multiple partners were consistent condom users. It reported that 16 per cent of these used condoms on their own, 13 per cent had used condoms while on the pill, 2 per cent had used condoms in combination with spermicide and 3 per cent had used condoms together with a diaphragm. Overall only 30 per cent of their sample had ever used condoms, while 70 per cent had not. Fife-Schaw and Breakwell (1992) undertook an overview of the literature on condom use among young people and found that between 24 per cent and 58 per cent of 16- to 24-year-olds had used a condom during their most recent sexual encounter. In terms of their condom use with their current partner, 25 per cent reported always using a condom with their current male partner, 12 per cent reported always using a condom with their current female partner, 27 per cent reported some- times/never using a condom with their male partner and 38 per cent reported some- times/never using a condom with their female partner. In terms of their non-current partner, 30 per cent had had unprotected sex with a man and 34 per cent had had unprotected sex with a woman. Bisexuals are believed to present a bridge between the homosexual and heterosexual populations and these data suggest that their frequency of condom use is low. They reported that over the one-year follow-up, condom use during vaginal intercourse with prostitutes/clients was high and remained high, condom use with private partners was low and remained low, but that both men and women reduced their number of sexual partners by 50 per cent. The results from the General Household Survey (1993) provided some further insights into changes in condom use in Britain from 1983 to 1991 (see Figure 8. These data indicate an overall increase in condom use as the usual form of contraception, which is particularly apparent in the younger age groups. However, since this time there has been an increase in rectal gonorrhoea and clinical experience, cross-sectional and longitudinal Fig. These data suggest that many individuals do report using condoms, although not always on a regular basis. Therefore, although the health promotion messages may be reaching many individuals, many others are not complying with their recommendations. Predicting condom use Simple models using knowledge only have been used to examine condom use. These models are similar to those used to predict other health-related behaviours, including contraceptive use for pregnancy avoidance, and illustrate varying attempts to understand cognitions in the context of the relationship and the broader social context. Rosenstock 1966; Becker and Rosenstock 1987) (see Chapter 2) and has been used to predict condom use. They reported that the components of the model were not good predictors and only perceived susceptibility was related to condom use. This suggests that condom use is a habitual behaviour and that placing current condom use into the context of time and habits may be the way to assess this behaviour. This presents the problem of a ceiling eﬀect with only small diﬀerences in ratings of this variable. Abraham and Sheeran (1993) suggest that social skills may be better predictors of safe sex. These models address the problem of how beliefs are turned into action using the ‘behavioural intentions’ component. In addition, they attempt to address the problem of placing beliefs within a context by an emphasis on social cognitions (the normative beliefs component). In a recent study of condom use, the best predictors appeared to be a combination of normative beliefs involving peers, friends, siblings, previous partners, parents and the general public. This suggests that although cognitions may play a role in predicting condom use, this essentially interactive behaviour is probably best understood within the context of both the relationship and the broader social world, highlighting the important role of social cognitions in the form of normative beliefs. The role of self-efﬁcacy The concept of self-eﬃcacy (Bandura 1977) has been incorporated into many models of behaviour. In terms of condom use, self-eﬃcacy can refer to factors such as conﬁdence in buying condoms, conﬁdence in using condoms or conﬁdence in suggesting that condoms are used. In addition, this model may be particularly relevant to condom use as it emphasizes time and habit. For example, whereas Fisher (1984) reported an association between intentions and actual behaviour, Abraham et al. However, such studies have used very diﬀerent popula- tions (homosexual, heterosexual, adolescents, adults). Perhaps models of condom use should be constructed to ﬁt the cognitive sets of diﬀerent populations; attempts to develop one model for everyone may ignore the multitude of diﬀerent cognitions held by diﬀerent individuals within diﬀerent groups. Models that emphasize cognitions and information processing intrinsically regard behaviour as the result of information processing – an individualistic approach to behaviour. In particular, early models tended to focus on representations of an individual’s risks without taking into account their interactions with the outside world. However, recent social cognition models have attempted to remedy this situation by emphasizing cognitions about the indi- vidual’s social world (the normative beliefs) and by including elements of emotion (the behaviour becomes less rational). Furthermore, the models predict that high levels of susceptibility will relate to less risk-taking behaviour (e. In attempts to include an analysis of the place of this behaviour (the relationship), variables such as peer norms, partner norms and partner support have been added. However, these variables are still accessed by asking one individual about their beliefs about the relationship. Perceptions of susceptibility, sex as an interaction between individuals and the broader social context will now be dealt with in more detail.
Pyrazinamide and its metabolites are excreted via the kidney order alavert 10mg mastercard allergy forecast west bend wi, and renal fail- Adverse effects ure necessitates dose reduction buy generic alavert from india allergy shots immunotherapy. Use Testing of colour vision and visual fields should precede Streptomycin is an aminoglycoside antibiotic discount 10 mg alavert with mastercard allergy shots vs oral drops. It has a wide initiation of high-dose treatment, and the patient should spectrum of antibacterial activity, but is primarily used to treat be regularly assessed for visual disturbances; mycobacterial infections. It is only administered parenterally • rashes, pruritus and joint pains; (intramuscularly). Therapeutic drug monitoring of trough • nausea and abdominal pain; plasma concentrations allows dosage optimization. Thiacetazone Oral Gastro-intestinal, rash, vertigo The major side effects are eighth nerve toxicity (vestibulotoxicity and conjunctivitis more than deafness), nephrotoxicity and, less commonly, allergic Capreomycina i. If the organisms are still sensitive to the Oral absorption is minimal and it is given intramuscularly. They are helpful when patients are established Mycobacterium tuberculosis infection on therapy, and the reduced number of tablets should aid com- M. Her being localized to skin or nerve) or lepromatous (a general- chest x-ray shows patchy right upper lobe consolidation and ized bacteraemic disease that effects many organs, analogous her sputum is positive for acid-fast bacilli. The main drugs used to treat leprosy obtained three sputum samples, she is started, while in hos- are dapsone, rifampicin and clofazimine. She is taking the low-dose oestrogen cycline, clarithromycin (see Chapter 43) and thalidomide. Dapsone (4,4-diaminodiphenyl sulphone) is a bacteriostatic How could this outcome have been avoided? Control Pharmacokinetics and prevention of tuberculosis in the United Kingdom: code of practice 2000. Management of 1/2 opportunist mycobacterial infections: Subcommittee of the Joint lized in the liver, partly by N-acetylation, with only 10–20% of Tuberculosis Committee of the British Thoracic Society. Chemotherapy and management of tuberculosis in the United Drug interactions Kingdom: recommendations 1998. In addition, potent immunosuppres- Griseofulvin inhibits Caspofungin inhibits sive and cytotoxic therapies produce patients with seriously cell division and synthesis of glucan impaired immune defences, in whom fungi that are non- and disrupts cell wall reproduction of pathogenic to healthy individuals become pathogenic and fungal cells cause disease. Fluconazole – oral Itraconazole or voriconazole oral Caspofungin if failing azole therapy Aspergillus Amphotericin B i. Its indications are limited to cutaneous/mucocutaneous and intestinal infections, Uses especially those caused by Candida species. Little or no nystatin Amphotericin is invaluable in treating life-threatening sys- is absorbed systemically from the oropharynx or gastrointest- temic fungal infections, but has considerable toxicity. Patients often prefer topical amphotericin B mycosis), Histoplasma capsulatum (which causes histoplasmo- because nystatin has a bitter taste. Cutaneous infections are sis), Cryptococcus neoformans (which causes cryptococcosis), treated with ointment and vaginitis is treated by suppositories. Coccidioides immitis (which causes coccidioidomycosis) and Sporotrichum schenckii (which causes sporotrichosis). Amphotericin is insoluble in water, but can Nystatin can cause nausea and diarrhoea when large doses be complexed to bile salts to give an unstable colloid which can are administered orally. Amphotericin B is normally given as an intravenous infusion given over four to six hours. Key points Several liposomal or lipid/colloidal complex amphotericin preparations have now been formulated, and are less toxic (par- Polyene antifungal drugs ticularly less nephrotoxic), but more expensive than the stand- • Wide spectrum of antifungal activity, fungicidal; makes ard formulation. Topical amphotericin lozenges or suspension are • Amphotericin is used intravenously for deep-seated and used for oral or pharyngeal candidiasis. Mechanism of action • Intravenous amphotericin is toxic, causing fever, chills, hypotension during infusion, nephrotoxicity, electrolyte Amphotericin is a polyene macrolide with a hydroxylated abnormalities and transient bone marrow suppression. The lipophilic amphotericin is reduced by using the liposomal/ surface has a higher affinity for fungal sterols than for choles- lipid/micellar formulations. They are used topically and are • reversible nephrotoxicity; this is dose dependent and active both against dermatophytes and yeasts (e. It results from vasoconstriction and Some imidazoles are also used systemically, although they tubular damage leading to acute renal impairment have limited efficacy and significant toxicity. Mechanism of action of azoles (imidazoles and • tubular cationic losses, causing hypokalaemia and triazoles) hypomagnesaemia; • normochromic normocytic anaemia due to temporary Imidazoles competitively inhibit lanosterol 14-α-demethylase marrow suppression is common. This disrupts the acyl chains of fungal membrane phos- Poor gastro-intestinal absorption necessitates intravenous pholipids, increasing membrane fluidity and causing administration for systemic infections. Amphotericin distrib- membrane leakage and dysfunction of membrane-bound utes very unevenly throughout the body. The t1/2 is occurs due to mutations in the gene encoding for lanosterol 18–24 hours. Breast milk concentrations are inhibits testosterone and cortisol synthesis) and because it similar to those in plasma and fluconazole should not be used interacts adversely with many drugs. The use and properties of more commonly used imidazoles Pharmacokinetics are listed in Table 45. Fluconazole is well absorbed after oral administration and is widely distributed throughout the body. Triazole drugs fluconazole mean elimination t is 30 hours in patients with 1/2 work by the same mechanism as imidazoles but have a wider normal renal function. However, Aspergillus species nel blockers, ciclosporin, docetaxel and, importantly, war- are resistant and resistant Candida species are problematic in farin. Fluconazole is used clinically will increase during concomitant treatment with fluconazole. It is administered orally or Itraconazole and voriconazole are available as oral and par- intravenously as a once daily dose. Oral bioavailability is good for both Adverse effects agents, but intravenous use is indicated for severe fungal infec- tions. The antifungal spectrum is similar to that of fluconazole Adverse effects include: and is broad. The mean itraconazole t1/2 is 30–40 hours and • hepatitis (rarely, hepatic failure). Induces its own infections metabolism Miconazole Oral Candida (topical therapy for Oral gel, four times daily Nausea and Systemic absorption is ringworm, Candida and pityriasis 2% cream or powder vomiting, rashes. Mechanism of action Key points Echinocandins are non-competitive inhibitors of 1,3-β-D glucan Azole antifungal drugs synthase, an enzyme necessary for synthesis of a glucose poly- mer crucial to the structure and integrity of the cell walls of • Relatively wide spectrum of antifungal activity, fungistatic, but fungicidal with higher concentrations. Fungal cells unable to synthesize this polysaccha- • Impair ergosterol biosynthesis by inhibiting ride cannot maintain their shape and lack adequate rigidity to lanosterol 14-alpha-demethylase (fungal cytochrome resist osmotic pressure, which results in fungal cell lysis. Glucan also appears essential for fungal cell growth and divi- • Available as intravenous, oral and topical formulations.
M. Asaru. Case Western Reserve University.