Anti-Infective Drugs Flashcards by Kelsey Klipfel

Anti-infective agent: Any drug/agent effective against some type of pathogens; umbrella term
All have Sim Goal: Reduce population/amount of invading organisms to allow immune response to eliminate rest - why infections problematic in immunocompromised: anti-infectives aid to own immune sys so if not properly working drugs to treat organisms not as effective so is prob for these pats and want them to avoid infections in first place because drugs only help so much; reduce amount invading organism

Anti-infectives overview

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Immune compromised problematic

All have Sim Goal: Reduce population/amount of invading organisms to allow immune response to eliminate rest - why infections problematic in immunocompromised: anti-infectives aid to own immune sys so if not properly working drugs to treat organisms not as effective so is prob for these pats and want them to avoid infections in first place because drugs only help so much; reduce amount invading organism

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Drugs cause toxicity due to client status
Immune system cannot fight remaining pathogens

Immune compromised problematic

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Occurs with any anti-infectives
Develops through mutation from organ - resistance occurs; when things mutate treatments not helpful or fight as well as once did - problematic because might run out of treatment options; prevention of resistance imp
Accelerated by/occur by sev diff things:
Prevention
Lot resistance already occurring - prob if new ones not created to fight infections

Anti-infective resistance

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Inappropriate prescribing (e.g., antibiotic for virus) - taking med for something not have so allows for more resistance of organism
Ineffective dosing - not prescribe long-enough duration to adequately kill bacteria; if happens that gives bacterium more opportunity to mutate and change (sees antibiotic but not killed all way and learns how to evade it)
Widespread use - using lot anti-infectives in lot diff pops; overusing it in diff pops and more used more likely evade treatment options and get around them

Accelerated by/occur by sev diff things:

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Appropriate prescribing - imp for HCP be educated on best anti-infective for organism grown
Adequate dosing (maintain therapeutic level) - makes sure organism effectively erradicated
Patient education: vital educate take prescription as prescribed; complete entire prescription; vital that educate patients on this; take for entire duration regardless if feel better/symps away; if end too early allows come back and more risk for resistance and mutation; do not share meds with others

Prevention

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Goal: Cause bacterial cell death without causing damage to host cells - hard; kill bacteria without causing probs to other host cells; will have some AE as a result
Treat bacterial infections
Mechanism of Action (MOA)
Big concept: All antibiotics cause cell death of bacteria if effective

Antibiotics

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Interfere with biosynthesis of pathogen cell wall (penicillin)
Prevent pathogen growth and reproduction division (sulfonamides)
Interfere with steps involved in protein synthesis (aminoglycosides)
Interfere with DNA synthesis in cell (fluoroquinolones)
Alter permeability of cell membrane - leak essentials (antifungal, antiprotozoal, and some antibiotics)

Mechanism of Action (MOA) - antibiotics

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Effective for a wide variety of bacteria
Treat wide variety of bacteria
Based on best guess; used first in treatment - cover lot diff types organisms; not know what causing certain thing give these and feel confident start kill off some organism
Used in sepsis protocol - really sick because infections in bloodstream and need take action quickly; get cultures and once come back change course treatment based on organisms growing - where narrow-spectrum antibiotics come into play

Broad-spectrum antibiotics

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Selective group of bacteria
Based on results of C&S - see which antibiotics bacteria sensitive to
Better in that help decrease resistance - not using something that treats number things

Narrow-spectrum antibiotics

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Two or more drugs intitially and as infections improve d/c antibitoics over time depending on pat
May need multiple antibiotics

Combination therapy

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Identify pathogen
Drug (antibiotic) most effective against pathogen involved - C&S (diff ways to get - to determine which drug most effective)
Drug that will cause least AE/complications for client
Consider patient allergy profile - past history; allergies? Comorbidities - sig renal disease - need ones less toxic

HCP considers factors:

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GI effects
Skin effects
Hypersensitivity reactions - allergic rxns
Superinfections/secondary infections

Antibiotics: Common Adverse Effects

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Nausea, vomiting, diarrhea (n/v/d) - pretty common on some degree for lot pats; monitor pat for these and decide severity

GI effects (Antibiotics: Common Adverse Effects)

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Developing a Rash, hives (hypersensitivity rxn); monitor for both of these

Skin effects (Antibiotics: Common Adverse Effects)

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Most commonly occur with very first dose; sometimes also during second dose; first and second dose most crucial for monitoring for severe rxn - but can happen at any time; taken many times risk for rxn much lower; first time watch closer
May be immediate, with next exposure, or delayed allergic (48+ hours out)
Severe cases, anaphylaxis can occur
Cross-sensitivity between classifications of antibiotics (e.g., penicillins & cephalosporins) possible - 2 diff classes and if allergic to 1 likely allergic to other higher; 10% not okay but imp know - imp to monitor closely esp if never taken
Determine what client experienced - true allergy or expected adverse effect - assess rxn; imp have correct: want make sure have availability as many antibiotics classifications as possible to treat appropriately

Hypersensitivity reactions - allergic rxns (Antibiotics: Common Adverse Effects)

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EX: C. diff, yeast infections

Superinfections/secondary infections (Antibiotics: Common Adverse Effects)

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Cause:
Clinical manifestations vary:
Examples:

superinfections/secondary infections

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Occur because Host flora suppressed by antibiotics; Pathogenic microorganisms multiply
More likely occur with certain antibiotics than others
Opportunistic—suppressed immune system - immunocompressed more higher risk

Cause: (superinfections/secondary infections)

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Diarrhea/cramping, painful urination, abnormal vaginal discharge, rash…

Clinical manifestations vary:(superinfections/secondary infections)

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Clostridium difficile (C. diff) overgrowth
Candida albicans (oral or vaginal yeast)
C.diff and yeast infections more common/imp monitor for

Examples: (superinfections/secondary infections)

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Toxicities more likely occur with IV because more potent; if on multiple IV antibiotics risk increases; order toxicities most to least prevalent
Acute kidney injury
Neurotoxicity
Liver toxicity

Potential toxicities with antibiotics (order of probability)

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Most likely suffer from renal toxicity; when on IV antibiotics look at creatinine and BUN on reg basis to make sure kidney func not declining; not showing kidney injury; monitor urine output closely
CM: Decrease urine output, protein in urine, elevated creatinine and BUN; decreased GFR
Prevention renal toxicity: adequate hydration; do that: diluting antibiotic; not effecting the effectiveness of antibiotic - helps dilute it out; not as toxic on kidneys or hard renal tubules - may give IV fluids; outpat - stay adequately hydrated

Acute kidney injury

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More likely occur for IV antibiotics
Nothing to prevent this
CM: headache, dizziness, confusion, seizures, loss of hearing (ototoxicity), vision damage

Neurotoxicity

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CM: Hepatitis (jaundice, elevated liver function tests (LFTs)) Least likely to occur on antibiotics

Liver toxicity

Monitor them closely for allergic reaction (most likely give antibiotic first time taken it - more likely allergic rxns occur with them) and superinfections Ensure adequate hydration and nutritional status

Children - Antibiotics across the lifespan

Instructions to take all medication as directed or prescribed/do not save or share meds Females on birth control pill-use additional protection against pregnancy - antibiotics make birth control less effective; if have a female of child-bearing age imp to assess and ask if taking oral contraceptives to prevent pregnancy and know less effective when on antibiotics and use alternate protection and use for up to 7 days after

Adults - Antibiotics across the lifespan

Most antibiotics contraindicated; risk vs. benefit Gen Most category C Penicillin: category B Should be avoided if possible; HCP makes decision on antibiotics appropriate, trimester, etc

Pregnancy - Antibiotics across the lifespan

Higher risk for toxicity (reduced liver, kidney function) - risk for renal toxicity because may have some decline kidney func and more risk for toxicity of med because kidneys not working up to speed

Older adult - Antibiotics across the lifespan

Prior to administration: When administering antibiotics things to keep in mind depending on route (2 most common listed and most implications to know): Throughout administration of antibiotics: Patient Education:

General Nursing Responsibilities

Complete assessment and health history Obtain cultures as indicated prior to admin - best get samples before admin antibiotics if can assess/Note s/s of current infection: Antibiotics may increase anticoagulant effect of warfarin; monitor PT/INR and draw it additionally; increases bleeding time

Prior to administration:

Diseases - know why giving antibiotics (kind infection have), pregnancy, reviewing allergies, drugs (all med history so aware d-d interaction), OTC’s, alcohol, major comorbidities - risk for giving antibiotics - CKD

Complete assessment and health history

Should not delay care; nurse may obtain culture before get cultures-then hold for order

Obtain cultures as indicated prior to admin - best get samples before admin antibiotics if can

Fever, fatigue, elevated WBC count, redness, swelling, discomfort, draw with sharpie… - ways to easily track progress; note any signs of infection

assess/Note s/s of current infection:

One most common routes Take on empty stomach with full glass of water 1 hour before meals or 2-3 hours after meals Do not take with/avoid fruit juice, soft drinks, or milk when administering antibiotics

Oral: - When administering antibiotics things to keep in mind depending on route (2 most common listed and most implications to know):

One most common routes Observe IV site closely esp if admin through peripheral IV Some can be vasocostic and cause phlebitis - monitor closely Observe for phlebitis Check rate of infusion or intravenous push (IVP) - get med should directions from pharmacy how long to infuse over and take note; diff for every antibiotics; same for push rates Check compatibility with other meds/IV fluids - in same IV must be compatible so can run together without issues so and if not will precipitate and cause probs in line/pat - sometimes add line to present one and antibiotics may be intermittent - attentive to line present and what line putting it in Some antibiotics central line preferred - Vancomycin - if have central line use it when giving antibiotics; can give through peripheral line - make sure infusing appropriate rate and monitoring site very closely throughout admin to make sure nothing happening at site; but once can go to central line

IV: - When administering antibiotics things to keep in mind depending on route (2 most common listed and most implications to know):

Monitor and report Peak or trough if appropriate - some have these ordered; watch orders Ensure adequate hydration to prevent accumulation of drug and reduce risk of AKI

Throughout administration of antibiotics:

Therapeutic effects - infection better, VS improved Monitor appropriate Lab values Adverse effects

Throughout administration of antibiotics:

CBC (WBC mainly), kidney function (toxicities), LFTs (toxicities), looking at if WBC down, line drew on leg infection drawing away from line

Monitor appropriate Lab values

Take as directed (entire prescription) Females taking birth control pills (use alternative protection) Drink 3 L water per day Report AE that are expected to HCP - what should do if having AE

Patient Education:

The nurse is educating an older adult female regarding antibiotic therapy. Which information is most important to include in the client's education? A.Use alternate protection against pregnancy if taking birth control pills. B.Report nausea to your healthcare provider. C.Take with food if experiencing gastrointestinal upset. D.Drink at least 3 L of water daily.

Answer: D Rationale: Older adult is at increased risk for renal toxicity. An older adult female is at low to no risk for pregnancy. Nausea and GI upset should be included in the education but are not the priority. older adult: means not of child-bearing age, gone through menopause

The nurse is caring for a client taking a penicillin antibiotic. Several days into the course of therapy the client calls the clinic complaining of a diffuse red rash but otherwise feeling well. What is the client most likely experiencing? A.Candida yeast infection B.Anaphylaxis C.Delayed allergic reaction D.Steven's Johnson Syndrome

Answer: C Rationale: The client is experiencing a delayed allergic reaction which usually occurs several hours to several days into therapy. Candida would be a localized rash with itching. Swelling, itching, and difficulty breathing would accompany anaphylaxis. SJS is a rare complication with a blistering rash and other life-threatening systemic manifestations. Diffuse - all over Otherwise feeling well; steer away from Steven’s Johnson - systemic and very serious/critically ill pat Anaphylaxis - more symptomatic; hypotensive, not being able breath Yeast - concentrate fungal; underneath breast/in mouth

Aminoglycosides Carbapenems Cephalosporins Fluoroquinolones Macrolides Penicillins Sulfonamides Tetracyclines Miscellaneous antibiotics

Classifications: antibiotics

toxic to 8th CN (deals with hearing - monitor for tinnitus (ringing of ears), hearing loss); systemic routes higher risk toxicities - IV - more likely have toxicity

AE: - Aminoglycosides: Prototype: Gentamicin

nephrotoxicity, neurotoxicity - potent antibiotic

Black Box (high alerts): - Aminoglycosides: Prototype: Gentamicin

draw peak; see general slides

Nursing: - Aminoglycosides: Prototype: Gentamicin

Broadest spectrum antibiotic have; Given early on in case sepsis to cover for any organism to start treating pat quickly

Carbapenems: prototype: Ertapenem

See general; systemic routes higher risk toxicities

AE: - Carbapenems: prototype: Ertapenem

Used lot in out-pat

Fluoroquinolone: Prototype: Ciprofloxacin

photosensitivity (sensitivity to sunlight, high risk to sunburns, wear sunscreen and avoid lot time in sunlight); D-D interaction with corticosteroids: at risk for tendon rupture possible with corticosteroids: achilles tendon most common - avoid taking at same time; can cause QT prolongation: dysrhythmias more likely occur with IV route so needs be on telemetry - need able monitor rhythm because at risk for dysrhythmias

Adverse effects: - Fluoroquinolone: Prototype: Ciprofloxacin

Telemetry if indicated; educate wear sunscreen; see general

Nursing: - Fluoroquinolone: Prototype: Ciprofloxacin

Not used systemically; more ophthalmic

Macrolides: prototype: Erythromycin

IV route higher risk for toxicities

AE: - Macrolides: prototype: Erythromycin

cross sensitivity to cephalosporin - note allergies and 10% allergic to both; renal disease; Pregnancy category B (safer antibiotics so often prescribed)

Contraindications: - Penicillins: prototype: Amoxicillin

decreases effectiveness of oral contraceptives - esp true with penicillins; increase anticoagulation effect of warfarin

Drug-Drug: - Penicillins: prototype: Amoxicillin

oldest and resistance started develop quickly and more resistance developing and been around long-time - not used as much because not as effective

Prob: - Penicillins: prototype: Amoxicillin

Contraindications: allergy to/cross sensitivity with penicillin; Pregnancy category B *Note: there are 5 generations of cephalosporins - lot antibiotics within gens

Cephalosporins (1st gen): prototype: Cefazolin

Alcohol

Drug-food: - Cephalosporins (1st gen): prototype: Cefazolin

see general; systemic routes higher risk toxicities

Adverse effects: - Cephalosporins (1st gen): prototype: Cefazolin

Admin IM in large muscle; avoid alcohol; see general slides

Nursing: - Cephalosporins (1st gen): prototype: Cefazolin

sulfa allergy: contains sulfa - allergy need know; pregnancy/breast feeding

Contraindication: - Sulfonamides: prototype: sulfamethoxazole/trimethroprim (SMZ-TMP)

precautions: folate deficiency; hyperkalemia

(drug-drug) - Sulfonamides: prototype: sulfamethoxazole/trimethroprim (SMZ-TMP)

more likely to cause GI effects compared to other antibiotics, photosensitivity (wear sunscreen and avoid sunlight because burn easily)

AE: - Sulfonamides: prototype: sulfamethoxazole/trimethroprim (SMZ-TMP)

more resistance because not helpful as much anymore; not work like used to so not used as much anymore

Older class: - Sulfonamides: prototype: sulfamethoxazole/trimethroprim (SMZ-TMP)

wear sunscreen; highly resistant; see general slides

Nursing: - Sulfonamides: prototype: sulfamethoxazole/trimethroprim (SMZ-TMP)

teeth discoloration (pronounced affinity for teeth and bones), photosensitivity (highest risk for most severe photosensitivity - avoid sunlight and wear sunscreen because can get severe sunburn)

AE: - Tetracycline: prototype: Doxycycline

Pregnancy - probs to developing fetus (slow fetal skeletal growth, tooth enamel hypoplasia), children under 8 y/o - probs to adequate tooth enamel (tooth enamel hypoplasia); Not in younger kids; avoided in pregnancy than other because of risk to developing fetus and in kids

Contraindication: - Tetracycline: prototype: Doxycycline

decreases effectiveness of oral contraceptives

Drug-Drug: - Tetracycline: prototype: Doxycycline

use sunscreen; see general

Nursing: - Tetracycline: prototype: Doxycycline

Given orally/IV - IV route higher risk for toxicity and superinfection Superinfection and vanco: higher risk development of superinfections: one is C.diff; treatment for it is oral vanco; IV vanco causes C.diff and oral vanco treats it at same time - use oral: gets directly into GI tract and more effective that way

Miscellaneous Antibiotics: Glycopeptide: prototype: Vancomycin

superinfection; nephrotoxicity; ototoxicity; Red Man Syndrome (allergic response to vanco) – histamine release/anaphylactic response - severe hypotension, fever, chills, paresthesia, and erythema/redness starts on neck and back - distinct rxn for vanco

AE: - Miscellaneous Antibiotics: Glycopeptide: prototype: Vancomycin

Administer over at least 1 hour - incidence red man syndrome likelihood and renal toxicity reduced if given slower - make sure not given too fast; central line preferred: vasocostic - if given through a peripheral - monitor site closely and get to central line ASAP; draw trough levels – dose adjusted by HCP - make sure looked at if enough med (if not contributes to resistance and vanco good against lot organisms) and not nearing toxicity - make sure pats in therapeutic window; liver enzymes, renal function; see general

Nursing: - Miscellaneous Antibiotics: Glycopeptide: prototype: Vancomycin

Can use for C.diff but C.diff becoming resistant - not used as much esp in hospital - rarely used for C.diff; if healthy and develops uses because not at high risk for re-occurrence or comps and C. diff is deadly in some pats Used for lot diff organisms

Misc. Antibiotics/Antiprotozoal: prototype: Metronidazole

renal/liver dysfunction; preg/lactation

Contraindication: - Misc. Antibiotics/Antiprotozoal: prototype: Metronidazole

anticoagulants (warfarin)

Drug-Drug: - Misc. Antibiotics/Antiprotozoal: prototype: Metronidazole

CNS effects, metallic taste - when take PO but is norm, severe n/v with alcohol intake (chemical rxn with this and alcohol - drink alcohol with it then have severe N&V - imp to know) - educate to avoid while on medication

Adverse effects: - Misc. Antibiotics/Antiprotozoal: prototype: Metronidazole

Teach – no alcohol; see general

Nursing: - Misc. Antibiotics/Antiprotozoal: prototype: Metronidazole

For TB pats Prescribed in combination (two or more agents) to increase effectiveness and decrease emergence of resistant strains by undertreating infection - adequately treat infection

Misc. Antibiotics/Antimycrobial Agents: TB Treatment meds

GI effects (n/v/d); orange tint to body fluids; neuropathy; bone marrow suppression; liver toxicity (be on meds 6 months-2yrs depending on scenario)

Major AE: - Misc. Antibiotics/Antimycrobial Agents: TB Treatment meds

many

Drug-Drug: - Misc. Antibiotics/Antimycrobial Agents: TB Treatment meds

Monitor AE, labs (LFT's monitored occasionally to make sure liver toxicity not occuring since on prolonged med); educate-take as directed, skip doses, do not stop med could contribute to resistance and not have unlimited amount antibiotics to treat TB; treatment 6 months to 2 years

Nursing: - Misc. Antibiotics/Antimycrobial Agents: TB Treatment meds

The nurse is preparing to administer medications to a client allergic to penicillin. When reviewing the client’s medication list, which medication causes concern for the nurse? A.Doxycycline B.Cefazolin C.Ciprofloxacin D.Erythromycin

Answer: B Cross-sensitivities between cephalosporin (Cefazolin) and penicillins Ciprofloxacin - fluoroquinolones Rationale: Cross-sensitivity exists between penicillin and cephalosporin drugs in 5-10% of patients. The nurse should monitor the client closely for signs of allergic reaction.

The nurse is preparing to administer vancomycin to a client. Which assessment should the nurse prioritize? A.Gastrointestinal system B.Urine output C.Integumentary system D.Liver function tests

Answer: B Rationale: Vancomycin poses the greatest risk for nephrotoxicity. Urine output and renal labs should be monitored closely. Although GI and skin effects may occur, they are lower priority than acute kidney injury. The risk of liver toxicity is lower than renal toxicity. Vanco Potent IV antibiotic; given via central line IV antibiotics more potential for toxicities and order: kidneys, neuro, liver All potential correct answers; monitor LFTs and renal func - monitor both: pick most imp - renal toxicity more likely occur than liver and most likely occur with antibiotics GI imp but as immediately threatening to pat

A client is receiving intravenous vancomycin and complains of chills and sweating. The nurse assesses the client and observes redden skin over the back and neck; vital signs: temperature 102 F, heart rate 118, respiratory rate 18, and blood pressure 88/58. What does the nurse recognize as the problem the client is experiencing? A.Red man syndrome B.Sepsis C.Nephrotoxicity D.Drug rash

Answer: A Is rare but be aware of when admin vanco

Treatment or prophylaxis to decrease influenza symptoms

Indications: - Antiviral: Neuroaminidase inhibitors: prototype: Osteltamivir

pregnancy/breastfeeding

Contraindications: - Antiviral: Neuroaminidase inhibitors: prototype: Osteltamivir

GI effects (n/v/d) - pretty well tolerated

Adverse effects: - Antiviral: Neuroaminidase inhibitors: prototype: Osteltamivir

Tx for influenza with this should be initiated/occur within 48 hours of symptoms onset Cognisent of influenza vaccine: Do not administer 48 h before influenza vaccine or 2 wks after; not want have vaccine and antivirals against it; may take with food to decrease GI intolerance

Nursing implications: - Antiviral: Neuroaminidase inhibitors: prototype: Osteltamivir

diff types of Herpes, varicella zoster (shingles)

Indications: - Antivirals: Purine Nucleoside Analog: prototype: Acyclovir

determines severity of AE

Routes: - Antivirals: Purine Nucleoside Analog: prototype: Acyclovir

oral: malaise, headache, more GI effects: n/v/d; IV: nephrotoxicity/neurotoxicity possible - higher risk for toxicities

AE: - Antivirals: Purine Nucleoside Analog: prototype: Acyclovir

admin frequently: 4-5 doses/day; need maintain compliance and dosing circ

Has Short duration - Antivirals: Purine Nucleoside Analog: prototype: Acyclovir

Oral: adm. ATC (around the clock) with food; topical: use gloves when applying; IV: infuse over at least 1 h to decrease possibility of renal damage/toxicity; ensure patient hydrated

Nursing: - Antivirals: Purine Nucleoside Analog: prototype: Acyclovir

take when have flare - still at risk for re-occurance of symp

Not a cure: - Antivirals: Purine Nucleoside Analog: prototype: Acyclovir

targets helper T cells; results in major immunodeficiency when progresses into AIDS; HIV have window period initially then infection goes dormant and asymptomatic for 10 yrs then symptomatic later in disease process; timing disease makes treatment diff

HIV:

Antivirals - Sig increased lifespan Treatment of HIV difficult Combination of at least three different antiviral drugs is used at once to control virus so not replicate and help pat not progress into AIDS where high risk of infection and death General AE: GI effects, CNS effects, flu-like syndrome, risk for toxicity

HIV/AIDS: Antiretroviral Drugs

HIV mutates over time - treatment diff - hard control and treat, drug resistance Length of time the virus can remain dormant within the T cells Adverse effects of many potent drugs

Treatment of HIV difficult

Further depress immune system

Adverse effects of many potent drugs

Achieve maximum effectiveness with the least amount of toxicity Highly active antiretroviral therapy (HAART)

Combination of at least three different antiviral drugs is used at once to control virus so not replicate and help pat not progress into AIDS where high risk of infection and death

Goal: reduce the plasma HIV RNA to lowest possible level

Highly active antiretroviral therapy (HAART)

Specific group pats to treat and pats managed in HIV clinics Take medications exactly as directed/prescribed Do not to skip a dose - aiding into more HIV resistant strains - want prevent that because then need new drugs or HIV could be more deadly Take at same times every day Refill medications before they run out; DO NOT RUN OUT of meds - aiding into more HIV resistant strains - want prevent that because then need new drugs or HIV could be more deadly AE Report immediately: serious rashes, severed diarrhea/vomiting, extreme drowsiness/dizziness, difficulty breathing - signs of toxicity and need report so adequately address Keep scheduled labs and HCP appts - monitored appropriately and therapy appropriate so virus is low

Antiretroviral Drugs: Nursing Edu - drugs for HIV

Fungal infections - require more prolonged treatment; fungi hard to treat OTC

Topical antifungal agents: prototype: Nystatin (Mycostatin)

increases cell wall permeability - cell death

MoA: - Topical antifungal agents: prototype: Nystatin (Mycostatin)

PO, topical

Route: - Topical antifungal agents: prototype: Nystatin (Mycostatin)

Candida infections of vagina, skin (skin folds/breast/groin), mouth

Indications: - Topical antifungal agents: prototype: Nystatin (Mycostatin)

topical: contact dermatitis - skin gets more irritated - rash more red and burn more and worse essentially and need report: rxn to med; oral: n/v/d - GI effects

Adverse effects: - Topical antifungal agents: prototype: Nystatin (Mycostatin)

Oral candida: Direct patients to swish 2 min. and swallow med so coat any candidias in back mouth/throat - not taste great - more med in contact better treatment: needs be recoated: done often; children - swab to try get med coated around mouth Topical: apply to affected area-always use gloves; how often admin and how much and follow directions

Nursing:- Topical antifungal agents: prototype: Nystatin (Mycostatin)

Can be given for 6 months+; pat on for long-term treatment need have LFTs monitored; most common toxicities for antifungal is liver

Systemic antifungal agents: Azoles: prototype: Fluconazole (Diflucan)

increases cell wall permeability - cell death

MoA: - Systemic antifungal agents: Azoles: prototype: Fluconazole (Diflucan)

systemic or superficial fungal infections

Indications: - Systemic antifungal agents: Azoles: prototype: Fluconazole (Diflucan)

Oral, IV

Route: - Systemic antifungal agents: Azoles: prototype: Fluconazole (Diflucan)

n/v/d; long duration: liver toxicity

Adverse effects: - Systemic antifungal agents: Azoles: prototype: Fluconazole (Diflucan)

pregnancy; liver disease

Contraindications: - Systemic antifungal agents: Azoles: prototype: Fluconazole (Diflucan)

Many! Warfarin (bleeding), anti-diabetics (hypolgycemia)

Drug-Drug: - Systemic antifungal agents: Azoles: prototype: Fluconazole (Diflucan)

Monitor labs (LFTs) - not suffering liver toxicity and monitor for s/s of liver toxicity; long duration common (3-6 months)

Nursing: - Systemic antifungal agents: Azoles: prototype: Fluconazole (Diflucan)