Anti-Fungal Pharmacology

Question 1

What are the 4 major classes of anti-fungals

Answer 1

polyenes
pyrimidine
azoles
misc agents

Question 2

2 polyenes meds

Answer 2

nystatin (Mycostatin)

Amphotericin B

Question 3

1 pyrimidine med

Answer 3

flucytosine (Ancobon)

Question 4

1 Azole Med

Answer 4

fluconazole (Diflucan)

Question 5

1 Misc. Agent Med

Answer 5

grisefulvin (Fulvicin)

Question 6

Nystatin (mycostatin) Class?

Answer 6

Polyene

Question 7

Indications for Nystatin

Answer 7

Treatment of superficial candida infections of mouth (thrush), oral mucosa, vagina, and ski

Question 8

S/E for Nystatin

Answer 8

not a lot, mild skin irritation; N/V/D when taken orally, poor GI absorption \

Question 9

Nystatin is avaliable to administer in what ways?

Answer 9

Available in MANY formulations creams, powder, topical, vaginal

Question 10

Nursing consideration for Nystatin

Answer 10

TOO TOXIC for parental admini

Question 11

Amphotericin B class?

Answer 11

Polyene anti-fungal

Question 12

Amphotericin B indications?

Answer 12

agent of choice for most systemic mycoses

Question 13

Amphotericin B MOA

Answer 13

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

Question 14

Amphotericin B Routes

Answer 14

PO or parental (usually IV)

Question 15

T/F Amphotericin B is not a high alert drug

Answer 15

False

Question 16

Nursing considerations for Amphotericin b: IV administration

Answer 16

• Must be diluted and infused SLOWLY
• Monitor BUN and creatinine

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 infusion symptoms: fever, pain, nausea, and h/a

Synergistic effect when given with flucytosine

Question 17

flucytosine (ancobon) class?

Answer 17

Pyrimidine

Question 18

flucytosine (ancobon) MOA

Answer 18

Inhibits fungal DNA synthesis

Question 19

flucytosine (ancobon) Indications

Answer 19

: allows for a lower dose of amphotericin B to be used

Helps decrease SE related to amphotericin

Question 20

fluconazole (Diflucan) class

Answer 20

Azoles

Question 21

Azoles MOA

Answer 21

interrupts the integrity of the cell wall by interfering with the synthesis of ergosterol

Question 22

Azoles Indications

Answer 22

used for BOTH superficial and less serious systemic fungal infections

Question 23

S/E of Azoles

Answer 23

topica = may cause redness burning itching

Systemic = SEVERE GI upset (n/v/d), LIVER toxicity

Question 24

Administration of Azoles

Answer 24

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

Question 25

Fluconazole advantages

Answer 25

rapidly and completely absorbed when given orally– able to reach bones, CNS, eyes, respiratory, and urinary tracts

Much less toxic than amphotericin with fewer SE

Question 26

Fluconazole Disadvantages

Answer 26

narrow spectrum, MANY drug interactions (CYP450 pathway)

Question 27

Nursing implications for Fluconazole

Answer 27

do not mix IV fluconazole with other meds

Monitor coags for patients on warfarin

Watch for hypoglycemia for patients with sulfonylureas

Increases Haldol and Dilantin levels

Question 28

Grisefulvin/Fulvivin MOA

Answer 28

inhibits fungal mitosis binds to KERATIN

Does not affect the cell wall or membrane

Question 29

S/E of Grisefulvin/Fulvivin

Answer 29

bone marrow suppression, rash, CNS changes, N/V/D, anorexia

Question 30

Indications of Grisefulvin/Fulvivin

Answer 30

resistant DERMATOPHYTE infection of scalp, skin, and nails