Antifungals Flashcards
Antifungals across the lifespan: CHILDREN
-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)
Antifungals across the lifespan: ADULTS
-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 
Antifungals across the lifespan: OLDER ADULTS
-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
Drug class: Systemic Conazole antifungals
What are the drug names or suffixes in this class?
“-conazole”
-Fluconazole
-Itraconazole
-Ketoconazole
-Voriconazole
Drug class: Systemic Conazole antifungals
What are the actions?
-Bind to sterols causing cell death
-Inhibits Lucan synthesis
Drug class: Systemic Conazole antifungals
What are the indications?
Fungal infections
less toxic than other antifungals… but also less effective
Drug class: Systemic Conazole antifungals
What are the contraindications?
Absolute:
-allergy
Relative:
-hepatic and renal dysfunction
-Pregnancy/lactation
Drug class: Systemic Conazole antifungals
What are the adverse effects?
-liver toxicity
-teratogenic effects
Drug class: Systemic Conazole antifungals
What are the adverse effects?
-liver toxicity
-teratogenic effects
Drug class: Systemic Conazole antifungals
What are the drug drug interactions?
There are many… check the drug guide before administering this medication.
Drug class: Systemic Echinocandin antifungals
What are the suffixes or drugs in this class?
“-fungin”
-anidulafungin
-caspofungin
-icafungin
Drug class: Systemic Echinocandin antifungals
What are the actions?
Inhibits glucan synthesis
Drug class: Systemic Echinocandin antifungals
What are the indications?
Fungal infections
Drug class: Systemic Echinocandin antifungals
What are the contraindications?
-hepatic/renal dysfunction
-pregnancy/lactation
Drug class: Systemic Echinocandin antifungals
What are the adverse effects?
-liver toxicity
-teratogenic effects
-bone marrow suppression
Drug class: Systemic Echinocandin antifungals
What are the drug-drug interactions?
Caspofungin + cyclosporine = liver injury
Drug class: Other systemic antifungals
What are the drugs included in this class?
-Amphotericin B
-Griseofulvin
-Nystatin
Drug class: Other systemic antifungals
What are the adverse effects?
-Amphotericin B = renal toxicity, bone marrow suppression, GI effects
-Griseofulvin = used for scalp and nail infections
-Nystatin = used for oral candida (thrush)
Nursing process of systemic antifungals
Assessment:
-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
Nursing process of systemic antifungals
Nursing conclusions:
-impaired comfort r/t adverse effects
-altered sensory perception (kinesthetic) r/t to CNS effects
Nursing process of systemic antifungals
Implementation:
-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.
Drug class: Topical antifungals
What are the names or suffixes in this class?
“-azole”
-Clotrimazole
-Ketoconazole
-Miconazole
-Tioconazole
Others: Terbinafine, Tolnaftate
Drug class: Topical antifungals
What are the actions?
-Prevents replication causing fungal death
Drug class: Topical antifungals
What are the indications?
-only for local treatment of dermatophytes, including tinea (ring worm) infections
(Athletes foot, jock itch)
Drug class: Topical antifungals
What are the contraindications?
-Absolute: allergy
-Relative: open areas (can cause systemic effects)
Drug class: Topical antifungals
What are the adverse effects?
Irritation, burning, rash, swelling the site of application
Drug class: Topical antifungals
What are the drug-drug interactions?
None are known
Nursing process for topical antifungals
Assessment:
-History: allergy to the drug?
-Phys: area of application; color, temperature, lesions/open areas (skin)
Labs: culture and sensitivity possibly
Nursing process for topical antifungals
Nursing diagnoses:
-Impaired comfort
-Impaired skin integrity risk (from irritation of applying the cream)
Nursing process for topical antifungals
Implementation:
-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
