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Pharmacology Exam #3 > Antifungals > Flashcards

Antifungals Flashcards

1
Q

What is mycosis?

A

A fungal infection

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2
Q

Who are susceptible to fungal infections?

A

Immunocompromised patients
* Patients with AIDS or AIDS Related Syndrome (ARS)
* Patients taking immunosuppressants
* Patients who’ve undergone organ transplants or cancer therapy
* Members of elderly population with declining immune system

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3
Q

Considersations for Antifungals
In Children

A
  • Very sensitive to adverse effects
  • More severe reactions occur
  • Most systemic agents DO NOT have proven safety and efficacy in children
  • If needed use: fluconazole, ketoconazole, terbinafine, and griseofulvin –> these have pediatric dosing
  • Do not use topical agents over open or draining areas
  • Do not use occlusive dressings or tight diapers over affected areas
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4
Q

Considerations for Antifungals
In Adults

A
  • Systemic agents can be very toxic (and hard on the liver)
  • Do not use unless causative organism has been identified
  • OTC preparations: follow instructions and call provider if situation does not improve
  • Contraindicated in pregnancy and lactation (Systemic) (Caution in topical agents)
  • Do not use topical agents over open or draining areas
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5
Q

Considerations for Antifungals
In Older Adults

A
  • More susceptible to adverse effects
  • Hepatic dysfunction: may worsen hepatic problems or be toxic (systemic dose should be lowered, monitor more frequently)
  • Some systemic agents are associated with renal toxicity (use cautiously in renal impairment, monitor closely)
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6
Q

When should antifungal treatment be started?

A

NOT until culture and sensitivity are collected AND results are LOOKED AT
(Unless it is a life threatening fungal infection)

Many patients are immunocompromised already and should not be placed at additional risk with an incorrect antifungal.

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7
Q

Systemic Antifungals: Azoles
Drug Names

A

“-conazole”

Fluconazole
Itraconazole
Ketoconazole
Voriconazole

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8
Q

Systemic Antifungals: Azoles
Mechanism of Action

A
  • Binds to sterols causing cell death
  • Inhibits glucan synthesis
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9
Q

Systemic Antifungals: Azoles
Contraindications

A

Absolute:
* Allergy

Relative:
* Hepatic and renal dysfunction
* Pregnancy and lactation

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10
Q

Systemic Antifungals: Azoles
Adverse Effects

A
  • Liver toxicity
  • Teratogenic effects

Less toxic than other antifungals (also less effective)

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11
Q

Systemic Antifungals: Azoles
Drug Interactions

A

Numerous
(Check drug guide)

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12
Q

Systemic Antifungals: Echinocandins
Drug Names

A

“-fungin”

Anidulafungin
Caspofungin
Micafungin

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13
Q

Systemic Antifungals: Echinocandins
Mechanism of Action

A
  • Inhibit glucan synthesis
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14
Q

Systemic Antifungals: Echinocandins
Contraindications

A

Absolute:
* Allergy
* Hepatic and renal dysfunction
* Pregnancy and lactation

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15
Q

Systemic Antifungals: Echinocandins
Adverse Effects

A
  • Liver toxicity
  • Teratogenic effects
  • Bone Marrow Supression
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16
Q

Systemic Antifungals: Echinocandins
Drug Interactions

A

Cyclosporine interacts with Caspofungin
(increased liver injury)

17
Q

Systemic Antifungals: Others
Amphotericin B

A

Very effective & very toxic
* Renal toxicity
* Bone marrow suppression
* GI effects

18
Q

Systemic Antifungals: Others
Griseofulvin

A

Used often for nail and scalp infections

19
Q

Systemic Antifungals: Others
Nystatin

A

Used frequently for oral candida
(thrush)

20
Q

Systemic Antifungals
Assessment

A

History:
* Allergy
* liver or renal dysfunction
* pregnancy or lactation

Physical:
* CNS
* Skin
* GI

Labs:
* C&S
* Liver and kidney function tests
* CBC (because of bone marrow suppression)

21
Q

Systemic Antifungals
Nursing Conclusions/Diagnoses

A
  • Impaired Comfort (r/t GI effects)
  • Altered Sensory Perception (r/t CNS effects)
  • Knowledge Deficit
22
Q

Systemic Antifungals
Implementation/Patient Teaching

A
  • Administer entire course of drug (up to 6 months)
  • Monitor IV sites to assess for phlebitis or infiltration
  • Monitor renal and hepatic function
  • Small, frequent meals for GI upset
  • Report signs of liver impairment: yellowing, itching, bleeding
23
Q

Topical Antifungals
Drug Names

A

“-azole”

Clotrimazole
Ketoconazole
Miconazole
Tioconazole

Terbinafine
Tolnaftate

24
Q

Topical Antifungals
Indication

A

Only for local treatment of dermatophytes
Including tinea infections (ringworm)

25
Q

Topical Antifungals
Mechanism of Action

A
  • Prevents replication causing fungal death
26
Q

Topical Antifungals
Contraindications

A

Absolute:
* Allergy

Relative:
* Open areas (could become systemic)

27
Q

Topical Antifungals
Adverse Effects

A
  • Irritation, burning, rash, swelling at the site
28
Q

Topical Antifungals
Drug Interactions

A

Unknown

29
Q

Topical Antifungals
Assessment

A

History:
* Allergy

Physical:
* Area of application: color, temperature, lesions/open areas

Labs:
* C&S - only if medication is not working

30
Q

Topical Antifungals
Nursing Conclusions/Diagnoses

A
  • Impaired Comfort (r/t irritation at application site)
  • Impaired skin integrity risk
  • Knowledge Deficit
31
Q

Topical Antifungals
Implementation/Patient Teaching

A
  • Clean area with soap and water, pat dry
  • Avoid occlusive dressings & tight diapers
  • Do not apply to open wounds
  • Troches should be dissolved slowly in the mouth
  • Vaginal suppositories, creams, 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
  • Stop the drug if a severe rash occurs or worsens

Pharmacology Exam #3 (6 decks)

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