Anti-Fungal Pharma (Exam 3) Flashcards
Four Major Classes
-Polyenes
-Pyrimidine
-Azoles
-Misc Agents
Nystatin: Class
Polyene
Nystatin: Indications and routes
-Treatment of superficial candida infection of mouth (thrush), oral mucosa, vagina, and skin
-Creams, powder, topical, vaginal
Nystation parental administation
TOO TOXIC
Nystatin: Adverse Reaction
-Not a lot
-Skin irritation, NVD, poor GI absorption
Amphotericin B: Class
Polyene anti-fungal
Amphotericin B: Indications
Agent of choice for most systemic mycoses
Amphotericin B: MOA
Binds to ergosterol in fungal cell membranes and causes them to become leaky and destroys cell wall of the fungus
Amphotherican B: IV Administration
-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
What other drug is amphotericin B given with
Flucytosine
Synergistic effect able to decrease amphotericin side effects
Flucytosin: Class
Pyrimidine
Flucytosine: MOA
Inhibits fungal DNA synthesis
Flucytosine: indications
-Allows for a lower dose of amphotericin B to be used
flucnonazole: class
Azoles
Azoles: MOA
Interrupts the integrity of the cell wall by interfering with the synthesis of ergosterol (component of fungi cell well)
Azoles: Indications
Used for both superficial and less serious systemic fungal infections
Azoles: Side effects
Topical: May cause redness burning or itching
Systemic: SEVERE GI upset and LIVER toxicity
Azoles: Administation
Take with food to minimize the SE, for oral separate at least 2 hours from antacids and drugs that decrease stomach acid
Fluconazole: Advantages and Disadvantages
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)
Fluconazole: Nursing implications
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
Grisfefulvin: Class
Anti-fungal
Grisfulvin: MOA
-Inhibits fungal mitosis —- binds to KERATIN
-Does not effect cell wall or membrane
Grisefulvin: Side Effects
Bone marrow suppression, rash, CNS changes, NVD, and anorexia
Grisfulvin: Indications
-Resistant dermatophyte infection of scalp, skin, and nails
