Anti-Fungal Pharma (Exam 3)

Question 1

Four Major Classes

Answer 1

-Polyenes

-Pyrimidine

-Azoles

-Misc Agents

Question 2

Nystatin: Class

Answer 2

Polyene

Question 3

Nystatin: Indications and routes

Answer 3

-Treatment of superficial candida infection of mouth (thrush), oral mucosa, vagina, and skin

-Creams, powder, topical, vaginal

Question 4

Nystation parental administation

Answer 4

TOO TOXIC

Question 5

Nystatin: Adverse Reaction

Answer 5

-Not a lot

-Skin irritation, NVD, poor GI absorption

Question 6

Amphotericin B: Class

Answer 6

Polyene anti-fungal

Question 7

Amphotericin B: Indications

Answer 7

Agent of choice for most systemic mycoses

Question 8

Amphotericin B: MOA

Answer 8

Binds to ergosterol in fungal cell membranes and causes them to become leaky and destroys cell wall of the fungus

Question 9

Amphotherican B: IV Administration

Answer 9

-HIGH ALERT DRUG

-Must be diluted and infused slowly

-Monitor BUN and Creatinine (kidneys)

-Patient must be on cardiac monitor with frequent vital signs

-Given every other day for several months

-Pre-treatment: with diphenhydramine, acetaminophen or aspirin may decrease infection symptoms: Fever, pain nausea and headache

Question 10

What other drug is amphotericin B given with

Answer 10

Flucytosine

Synergistic effect able to decrease amphotericin side effects

Question 11

Flucytosin: Class

Answer 11

Pyrimidine

Question 12

Flucytosine: MOA

Answer 12

Inhibits fungal DNA synthesis

Question 13

Flucytosine: indications

Answer 13

-Allows for a lower dose of amphotericin B to be used

Question 14

flucnonazole: class

Answer 14

Azoles

Question 15

Azoles: MOA

Answer 15

Interrupts the integrity of the cell wall by interfering with the synthesis of ergosterol (component of fungi cell well)

Question 16

Azoles: Indications

Answer 16

Used for both superficial and less serious systemic fungal infections

Question 17

Azoles: Side effects

Answer 17

Topical: May cause redness burning or itching

Systemic: SEVERE GI upset and LIVER toxicity

Question 18

Azoles: Administation

Answer 18

Take with food to minimize the SE, for oral separate at least 2 hours from antacids and drugs that decrease stomach acid

Question 19

Fluconazole: Advantages and Disadvantages

Answer 19

Advantages:
rapidly and completely absorbed when given orally- Able to reach bones, CNS, eyes, respiratory, and urinary tracts

Disadvantages:
Narrow specturm, MANY drug interaction (CYP450 pathway)

Question 20

Fluconazole: Nursing implications

Answer 20

Do not mix IV fluconazole with other meds

-Monitor coags for patients on warfarin

-Watch for hypoglycemia for patients with sulfonylureas

-Increase haldol and dilantin levels

Question 21

Grisfefulvin: Class

Answer 21

Anti-fungal

Question 22

Grisfulvin: MOA

Answer 22

-Inhibits fungal mitosis —- binds to KERATIN

-Does not effect cell wall or membrane

Question 23

Grisefulvin: Side Effects

Answer 23

Bone marrow suppression, rash, CNS changes, NVD, and anorexia

Question 24

Grisfulvin: Indications

Answer 24

-Resistant dermatophyte infection of scalp, skin, and nails