AntiFungal Drugs Flashcards
Amphotericin B
Functional Classification
Antifungal
Amphotericin B (Mechanism of Action)
Increases cell membrane permeability in susceptible fungi by binding sterols; alters cell membrane, thereby causing leakage of cell components, cell death
Amphotericin B
Uses
Histoplasmosis, blastomycosis, aspergillosis, coccidioidmycosis, cryptococcosis, aspergillosis, zygomycosis, candidiasis, sporotrichosis, cryptococcal meningitis; mucomycosis caused by mucormycosis, Rhizopus, Absidia, Entomorphthora, Basidiobolus
Amphotericin B
Contraindications
Hypersensitivity, severe bone marrow depression
Amphotericin B
Side Effects
CNS: Headache, Fever, Chills, peripheral nerve pain, paresthesias, peripheral neuropathy, SEIZURES, dizziness
CV: bradycardia, hypotension, CARDIAC ARREST
EENT: tinnitus, deafness, diplopia, blurred vision
GI: Nausea, Vomiting, Anorexia, diarrhea, cramps, HEMORRHAGIC GASTROENTERITIS, ACUTE LIVER FAILURE
GU: Hypokalemia, azotemia, hyposthenuria, RENAL TUBULAR ACIDOSIS, nephrocalcinosis, PERMANENT RENAL IMPAIRMENT, ANURIA, OLIGURIA
HEMA: normochromic, normocytic anemia, THROMBOCYTOPENIA, AGRANULOCYTOSIS, LEUKOPENIA, EOSINOPHILIA, hypokalemia, hyponatremia, hypomagnesemia
INTEG: Burning, Irritation, pain, necrosis at inj site with extravasation, flushing, dermatitis, skin rash (topical route)
MS: Arthralgia, myalgia, generalized pain, weakness, weight loss
SYST: STEVENS-JOHNSON SYNDROME, TOXIC EPIDERMAL NEUROLYSIS, EXFOLIATIVE DERMATITIS, ANAPHYLAXIS
Amphotericin B
Nursing Considerations
ASSESS:
- VS q15-30min during first inf; note changes in pulse, BP
- I&O ratio; watch for decreasing urinary output, change in specific gravity; discontinue product to prevent permanent damage to renal tubules
- Blood studies: CBC, K, Na, Ca, Mg q2wk, BUN, creatinine 2-3x/wk
- Weigh weekly; if weight increases by more than 2lb/wk, edema is present; renal damage should be considered
- FOR RENAL TOXICITY: increasing BUN, serum creatinine; if BUN is >40mg/dl or if serum creatinine is >3mg/dl, product may be discontinued, dosage reduced
- FOR HEPATOTOXICITY: increasing AST, ALT, alk phos, bilirubin
- FOR ALLERGIC REACTION: DERMATITIS, RASH; PRODUCT SHOULD BE DISCONTINUED, ANTIHISTAMINES (MILD REACTION), or EPINEPHrine (SEVERE REACTIONS) ADMINISTERED
- FOR HYPOKALEMIA: anorexia, drowsiness, weakness, decreased reflexes, dizziness, increased urinary output, increased thirst, paresthesias
- FOR OTOTOXICITY: TINNITUS (RINGING, ROARING IN EARS), VERTIGO, LOSS OF HEARING (RARE)
PERFORM/PROVIDE:
-Acetaminophen and diphenhydrAMINE 30 min before inf to reduce fever, chills, headache
Fluconazole
Functional Classification
Antifungal, systemic; azole
Fluconazole
Chemical Classification
Triazole
Fluconazole
Mechanism of Action
Inhibits ergosterol biosynthesis, causes direct damage to fungal membrane phospholipids
Fluconazole
Uses
Oropharyngeal candidiasis, chronic mucocutaneous candidiasis; systemic, vaginal, urinary candidiasis; cryptococcal meningitis; prevention of candidiasis in bone marrow transplant in those who receive chemotherapy and/or radiation therapy; cystitis, fungal prophylaxis, peritonitis, pneumonia, pyelonephritis
Fluconazole
Contraindications
Hypersensitivity to this product or azoles, pregnancy (D)
Fluconazole
Side Effects
CNS: headache, SEIZURES
CV: QT PROLONGATION, TORSADES DE POINTES
GI: nausea, vomiting, diarrhea, cramping, flatus, increased AST, ALT, HEPATOTOXICITY
HEMA: AGRANULOCYTOSIS, EOSINOPHILIA, LEUKOPENIA, NEUTROPENIA, THROMBOCYTOPENIA
INTEG: STEVENS-JOHNSON SYNDROME, ANGIOEDEMA, ANAPHYLAXIS, EXFOLIATIVE DERMATITIS, TOXIC EPIDERMAL NECROLYSIS
Fluconazole
Nursing Considerations
ASSESS:
- INFECTION: clearing of CSF and other culture during treatment, obtain C&S baseline and throughout treatment, product may be started as soon as culture is taken
- HEPATOTOXICITY: increasing AST, ALT, periodically alk phos, bilirubin; for renal status: BUN, creatinine
Amphotericin B
Chemical Classification
Amphoteric polyene
