Antifungals

Question 1

Antifungals across the lifespan: CHILDREN

Answer 1

-very sensitive to adverse effects
-more severe reactions occur
-most systemic agents do not have proven safety in children
-if needed fluconazole, ketoconazole, terbinafine, and griseofulvin should be used (they have pediatric dosing)
-do not use topical agents over open or draining areas
(increases the risk for systemic absorption, which increases the risk for toxicity)
-do not use inclusive dressing or tight diapers over affected areas
(increases the risk for systemic absorption, which increases the risk for toxicity)

Question 2

Antifungals across the lifespan: ADULTS

Answer 2

-systemic agents can be very toxic
-do not use unless causative organism has been identified
-OTC preps: follow instructions and call providers if situations does not improve
-contraindicated in pregnancy and lactation
-do not use topical agents over open or draining areas 

Question 3

Antifungals across the lifespan: OLDER ADULTS

Answer 3

-more susceptible to getting a fungal infection and more susceptible to the adverse effects of treatment.
-hepatic dysfunction: may worsen hepatic problems or be toxic
^ systemic may need to be lowered
^ monitor patient more frequently

-Some systemic agents are associated with renal toxicity
^ use cautiously in renal impaired patients
^ monitor closely

Question 4

Drug class: Systemic Conazole antifungals
What are the drug names or suffixes in this class?

Answer 4

“-conazole”
-Fluconazole
-Itraconazole
-Ketoconazole
-Voriconazole

Question 5

Drug class: Systemic Conazole antifungals
What are the actions?

Answer 5

-Bind to sterols causing cell death
-Inhibitors Lucan synthesis

Question 6

Drug class: Systemic Conazole antifungals
What are the indications?

Answer 6

Fungal infections

less toxic than other antifungals… but also less effective

Question 7

Drug class: Systemic Conazole antifungals
What are the contraindications?

Answer 7

Absolute:
-allergy

Relative:
-hepatic and renal dysfunction
-Pregnancy/lactation

Question 8

Drug class: Systemic Conazole antifungals
What are the adverse effects?

Answer 8

-liver toxicity
-teratogenic effects

Question 9

Drug class: Systemic Conazole antifungals
What are the adverse effects?

Answer 9

-liver toxicity
-teratogenic effects

Question 10

Drug class: Systemic Conazole antifungals
What are the drug drug interactions?

Answer 10

There are many… check the drug guide before administering this medication.

Question 11

Drug class: Systemic Echinocandin antifungals
What are the suffixes or drugs in this class?

Answer 11

“-fungin”
-anidulafungin
-caspofungin
-icafungin

Question 12

Drug class: Systemic Echinocandin antifungals
What are the actions?

Answer 12

Inhibits glucan synthesis

Question 13

Drug class: Systemic Echinocandin antifungals
What are the indications?

Answer 13

Fungal infections

Question 14

Drug class: Systemic Echinocandin antifungals
What are the contraindications?

Answer 14

-hepatic/renal dysfunction
-pregnancy/lactation

Question 15

Drug class: Systemic Echinocandin antifungals
What are the adverse effects?

Answer 15

-liver toxicity
-teratogenic effects
-bone marrow suppression

Question 16

Drug class: Systemic Echinocandin antifungals
What are the drug-drug interactions?

Answer 16

Caspofungin + cyclosporine = liver injury

Question 17

Drug class: Other systemic antifungals
What are the drugs included in this class?

Answer 17

-Amphotericin B

-Griseofulvin

-Nystatin

Question 18

Drug class: Other systemic antifungals
What are the adverse effects?

Answer 18

-Amphotericin B = renal toxicity, bone marrow suppression, GI effects

-Griseofulvin = used for scalp and nail infections

-Nystatin = used for oral candida (thrush)

Question 19

Nursing process of systemic antifungals
Assessment:

Answer 19

-history of allergy, liver or renal dysfunction and pregnancy or lactation
-Physical exam to assess the skin G.I. and CNS
-labs: C&S, liver and kidney function CBC

before beginning treatment of systemic antifungals, a culture and sensitivity test and it results are required

Question 20

Nursing process of systemic antifungals
Nursing conclusions:

Answer 20

-impaired comfort r/t adverse effects
-altered sensory perception (kinesthetic) r/t to CNS effects

Question 21

Nursing process of systemic antifungals
Implementation:

Answer 21

-administer the entire course of the drug (may take up to 6 months of treatment)
-monitor IV sides to ensure that phlebitis or infiltration does not occur
(no signs of inflammation or infection)
-monitor, renal and hepatic function
-provides small, frequent nutritious meals
-patient teaching: be aware for signs of liver impairment; yellowing of the skin or eyes (jaundice), easily bruising, itchiness of the skin or bleeding.

Question 22

Drug class: Topical antifungals
What are the names or suffixes in this class?

Answer 22

“-azole”
-Clotrimazole
-Ketoconazole
-Miconazole
-Tioconazole

Others: Terbinafine, Tolnaftate

Question 23

Drug class: Topical antifungals
What are the actions?

Answer 23

-Prevents replication causing fungal death

Question 24

Drug class: Topical antifungals
What are the indications?

Answer 24

-only for local treatment of dermatophytes, including tinea (ring worm) infections
(Athletes foot, jock itch)

Question 25

Drug class: Topical antifungals
What are the contraindications?

Answer 25

-Absolute: allergy
-Relative: open areas (can cause systemic effects)

Question 26

Drug class: Topical antifungals
What are the adverse effects?

Answer 26

Irritation, burning, rash, swelling the site of application

Question 27

Drug class: Topical antifungals
What are the drug-drug interactions?

Answer 27

None are known

Question 28

Nursing process for topical antifungals
Assessment:

Answer 28

-History: allergy to the drug?
-Phys: area of application; color, temperature, lesions/open areas (skin)

Labs: culture and sensitivity possibly

Question 29

Nursing process for topical antifungals
Nursing diagnoses:

Answer 29

-Impaired comfort
-Impaired skin integrity risk (from irritation of applying the cream)

Question 30

Nursing process for topical antifungals
Implementation:

Answer 30

-Instruct patient how to correctly administer/apply the medication
^ Troches: should be dissolved slowly in the mouth
^ Vaginal suppositories, creams, and tablets should be inserted high into the vagina with the patient remaining recumbent for at least 10-15 minutes after insertion.
^ Topical creams and lotions should be gently rubbed into the affected area

Patient teaching: clean the area with soap and water and pat it dry, timing of treatment, avoid scratching and occlusive coverings/dressings

advise patient to stop the drug if a severe rash occurs or worsens