Antifungal, Antihelmintic, Ectoparasitic Flashcards
2 broad classifications for antifungal treatments
superficial infection and systemic infections
Where do superficial infections occur?
how are they treated?
scalp, nails, mucous membrane (oral vaginal)
-generally treated with topical drugs
which is more common- superficial or systemic fungal infections?
superficial
where do systemic fungal infections occur?
how do you treat systemic fungal infections?
internal organs: lung, brain, GI
-treat with IV or pill
which is more difficult to treat and requires more treatment time: systemic or superficial fungal infections?
systemic fungal infections
who is at risk for systemic fungal infections?
immunocompromised, transplants, HIV
3 systemic antifungal drugs to know
- Fluconazole (diflucan)
- Itraconazole (sporanox)
- Amphotericin B
How many categories of anitfungal drugs out there?
4
Amphotericin B- systemic or superficial antifungal
systemic antifungal
-broad spectrum
amphotericin B fxn
works by binding to ergosteroids in fungal cell membrane
- increase permeability
- cell leaks out cat ions like Potassium
amphotericin route
IV ONLY
Amphotericin Adverse effects
- nephrotoxicity
- electrolyte imbalance (K and Mg need replacing)
- anemia with long term use (monitor CBC)
total infusion time for 1 dose of amphotericin B
18 hours!
- 12 hours electrolyte
- 4 hours ampho
- 2 hours normal saline
Amphotericin Admin issues (3 general)
-phlebitis, fever, chills
Why use central line with amphotericin B?
avoid thrombophlebitis
how to decrease risk of nephrotoxicity with amphotericin B
give 500-1000 mL SALINE 1 hour before infusion of ampho
What do you premedicate with for Amphotericin B?
TYLENOL and BENADRYL to prevent infusion rxn of stimulating pro-inflammatory cytokines causing fever/chills/nause/headache
IV tubing and Amphotericin B
- IV tubing not compatible with normal saline!!
- –> change IV tubing to set up with D5
saline + aphotericin B=
precipitate
Amphotericin infusion rate
4 hours
Amphotericin B and Rigors- treat with….
merperidine (demerol) or dantrolene to stop shaking chills
2 post admin things to be done with Amphotericin B
- 500-1000 ml NORMAL SALINE over 1 hr
- Replace potassium and Magnesium
Amphotericin KCL replacement infusion rate
40 meq over 2 hours X 4 bags = 8 hours
Amphotericin infusion of replacement Mg
infuse over 2-4 hours
how do identify azoles?
end in azole
what do azoles treat?
systemic and superficial fungal infections
Azoles have a drug drug interaction with
CYP450 pathway
Itraconazole Adverse Effects
(sporanox)
- N/V/D
- can’t give to someone with heart failure b/c makes worse
- Liver injury (N/V, RUQ pain, jaundice, fatigue, pale stool)
Itraconazole administration consideration
- give with cola soda b/c need acidic enrivo
- give 1 hr before getting drugs that raise gastric pH
which drugs needs an acidic enviro to be absorbed?
Itraconazole
Fluconazole treats
(Diflucan)
systemic fungal infections
Fluconazole Adverse Effects
GI (N/V/D)
Steven Johnson Syndrome (rare)
superficial mycoses are caused by 2 groups of organisms
- candida
2. dermatophytic infection
candida effects what part of body?
- mucous membrane, moist skin
chronic: nails, hair, scalp
dermatophytic infections effect
-skin, hair nails
dermatophytic infections =
RINGWORM
clotrimazole treats
(mycelex) superficial infections
nystatin treats
(mycostatin)
-superficial infections
what the heck is a helminth?
treats parasitic worms
most common site of parasitic worm infection =
intestines
-caused by poor sanitation
Parasitic worm infections can subside…
on own when adult worm dies
Mebendazole treats
intestinal round worm and mixed parasites
mebendazole fxn
prevents uptake of glucose by susceptible worms causing a slow death
mebendazole absorption
poorly absorbed so results in less side effects
clearance of parasitic worms can take ___ days and cause
up to 3 days
-cause abd pain and diarrhea if large infection
what the heck is an ectoparasite?
parasite that lives on the surface of the host
pediculosis- what is it?
LICE infestation
what part of lice infestation do we see?
nits aka eggs
how is lice transmitted?
head to head contact
What are scabies
mites burrow into the skin to lay eggs
how is scabies transmitted?
direct contact, linen, towels, clothes, furniture
***treat items + person!
common burrows for scabies
wrists, elbows, web oof fingers, gentials
itching with scabies is worse at
bedtime
how do you treat lice?
Nix - 1% permethrin formula
How do you treat scabies?
Elimite - 5% permethrin formula
what does permethrin do?
highly toxic to ADULT MITES and LICE - not so much the ova
-causes paralysis of insect
Permethrin Adverse Effects
- exacerbation of itching
- edema
- erythema
- burning/stinging/numbness
how long can scabies itching last?
1-2 weeks
besides meds, what else do you do to treat lice?
remove nits with a fine tooth comb
