Antifungals Flashcards

1
Q

Explain how fungus differs from bacteria.

A

It is composed of a rigid cell wall made up of chitin and various polysaccharides, and a cell membrane containing ergosterol.

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2
Q

What makes the fungus resistant to antibiotics?

A

Protective layers of the fungal cell make the organism resistant to antibiotics

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3
Q

What is the name of a fungal infection?

A

Mycosis

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4
Q

What patients are susceptible to fungal infections?

A

Immunocompromised patients

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5
Q

Give some examples of patients susceptible to fungal infections.

A
  • Patients with AIDS and AIDS-related complex (ARC)
  • Patients taking immunosuppressant drugs
  • Patients who have undergone transplantation surgery or cancer treatment.
  • Members of growing elderly population because their immune system is in decline.
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6
Q

What lifespan considerations are important to keep in mind when considering antifungal medication for children?

A
  • Very sensitive to adverse effects and have more severe reactions occur
  • Most systemic agents do not have proven safety and efficacy in children
  • If needed, fluconazole, ketoconazole, terbinafine, and griseofulvin should be used due to pediatric dosing.
  • Do not use topical agents over open or draining areas
  • Do not use occlusive dressing or tight diapers over affected areas
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7
Q

Why should we not use topical antifungals over open or draining areas?

A

Because it increases systemic absorption which again increases the risk for toxicity.

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8
Q

Why should we not use topical antifungals under occlusive dressing or tight diapers over affected areas?

A

It increases the risk for systemic absorption.

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9
Q

If used in children, what are the names of the antifungal agents that we should prescribe? And why?

A

fluconazole, ketoconazole, terbinafine, and griseofulvin
These agents have pediatric dosing.

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10
Q

What lifespan considerations are important to keep in mind when considering antifungal medication for adults?

A
  • Systemic agents can be very toxic
  • Do not use unless causative organism has been identified
  • OTC preps: follow instructions and call provider if situation does not improve
  • Contraindicated in pregnancy and lactation
  • Do not use topical agents over open or draining areas
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11
Q

What lifespan considerations are important to keep in mind when considering antifungal medication for older adults?

A
  • More susceptible to adverse effects
  • Hepatic dysfunction: may worsen hepatic problems or be toxic
  • Systemic dose may need to be lowered
  • Monitor patient more frequently (esp liver values)
  • Some systemic agents are associated with renal toxicity
  • Use cautiously in renal impairment and monitor closely
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12
Q

At what stage in our lifespan are we more susceptible to get a fungal infection?

A

As older adults.

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13
Q

When giving systemic antifungals, does the culture and sensitivity test need to be completed prior to administering, or can we administer medication and change if needed once results are back?

A

A culture and sensitivity should be completed prior to prescribing or administering systemic antifungal agents.
The only exception is if there is a quickly progressing life-threatening infection.

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14
Q

Considering patients who are prescribed antifungal agents are often already immunocompromised, what considerations should we take when administering these agents?

A

The need to wait for the culture and sensitivity test should be completed before administering these agents because these patients should not be placed at additional risks due to an incorrect agent and
their toxic effects.

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15
Q

What are the suffix(ex), names and potential outliers for the Systemic Azole Antifungals?

A

“-conazole”

  • Fluconazole
  • Itraconazole
  • Ketoconazole
  • Voriconazole
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16
Q

Why would we give Azole’s to patients?

A

fungal infections

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17
Q

How does Azole’s work in the body?

A

Bind to steroids causing cell death and inhibit glucan synthesis

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18
Q

TRUE/FALSE

Azoles are less toxic that some other antifungals, however this also makes them less effective.

A

TRUE

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19
Q

Are there any absolute & relative contraindications to prescribing Azole’s and if so, what are they?

A

Absolute : Allergy
Relative : hepatic and renal dysfunction
pregnancy and lactation

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20
Q

What are some known adverse reactions that patients may experience with Azole’s?

A
  • Liver toxicity
  • Teratogenic effects
21
Q

Are there any DDI’s with Azole’s. and if so, what are they?

A

Many

22
Q

What are the suffix(es), names and potential outlier for the Systemic Echinocandin Antifungals?

A

“-fungin”

  • Anidulafungin
  • Caspofungin
  • Micafungin
23
Q

Who would we give a patient Echinocandin Antifungals?

A

Fungal infection

24
Q

How does Echinocandin Antifungals work in the body?

A

inhibit glucan synthesis

25
Q

What would contraindicate the use of Echinocandin Antifungals?

A
  • hepatic /renal dysfunction
  • pregnancy and lactation
26
Q

What are some known adverse reactions that a patient taking Echinocandin Antifungals may experience?

A
  • liver toxicity
  • teratogenic effects
  • bone marrow suppression
27
Q

Are there any DDI’s to Echinocandin Antifungals, and if so, what are they?

A

Cyclosporine when given with caspofungin because this combination may cause liver injury.

28
Q

What are the names of the “other” systemic Antifungal Agents that we need to know?

A
  • Amphotericin B - Very effective, but very toxic.
    May cause : Renal toxicity, Bone marrow suppression and GI effects
  • Griseofulvin - Used frequently for nail and scalp infections
  • Nystatin - Frequently used for oral candida (thrush in the mouth)
29
Q

Before giving a patient a systemic antifungal agent, what are some of the things that we should be assessing for?

A
  • History: Allergy; liver or renal dysfunction; pregnancy or lactation
  • Physical Exam: CNS, Skin & GI
  • Labs:
    Culture & Sensitivity, liver and kidney function & CBC
30
Q

What are some nursing diagnoses that we should anticipate prior to giving patients systemic antifungal agents?

A
  • Impaired comfort r/t adverse effects
  • Altered sensory perception (kinesthetic) r/t CNS
  • Knowledge deficit r/t drug regimen
31
Q

What are some implementations that we should do/put in place when/after we’ve given systemic antifungal agents?

A
  • Administer the entire course of the drug (may take 6 months)
  • Monitor IV sites to ensure that phlebitis or infiltration
    does not occur (inflammation & infection)
  • Monitor renal and hepatic function
  • Provide comfort and safety measures
  • Provide small, frequent, nutritious meals (GI effect)
  • Provide patient teaching
32
Q

What are some symptoms of liver impairment?

A

Jaundice (yellowing of skin and eyes), easy bruising, itchiness of skin, or bleeding.

33
Q

What are the suffix(ex), names and potential outliers for Topical Antifungals?

A
  • “-azole”
  • Clotrimazole
  • Ketoconazole
  • Miconazole
  • Tioconazole
  • Terbinafine - OTC (athletes foot & jock itch)
  • Tolnaftate - skin infection and toe nail fungus.
34
Q

What is the indication for using Topical Antifungals?

A

Only for local treatment of dermatophytes (fungal skin infection), including tinea infections (ring worm).

35
Q

How does Topical Antifungals work?

A

Prevents replication causing fungal death

36
Q

Would topical antifungals have a systemic effect?

A

No, not unless they were applied to open wounds/areas.

37
Q

What are the absolute and relative contraindications to topical antifungals?

A

Absolute : Allergy.
Relative : Open wounds/areas.

38
Q

What are some known adverse reactions that a patient may experience when applying topical antifungals?

A

Irritation, burning, rash, swelling at the site of application.

39
Q

Are there any DDI’s to topical antifungals, and if so, what are they?

A

None known.

40
Q

Before giving a patient topical antifungals, what are some things that we should be assessing?

A
  • History: allergy
  • Physical exam: Area of application for color, temperature, lesions/open areas
  • Lab: C&S possibly
41
Q

What are some nursing diagnoses that we can anticipate prior to administering topical antifungals?

A
  • Impaired comfort
  • Impaired skin integrity risk (from applying the cream)
  • Knowledge deficit
42
Q

When/After administering topical antifungals to a patient, what implementations should we do/ be prepared to do?

A
  • Instruct patient in the correct method of administration (topical cream & lotion, trochees, vaginal suppositories)
  • 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 to 15 minutes
    after insertion
  • Topical creams and lotions should be gently rubbed
    into the affected area
  • Advise the patient to stop the drug if a severe rash occurs or worsens
  • Provide patient teaching
43
Q

An eight month old infant is receiving antifungals. Which should be included in the nurse’s health teaching to the mother?

A

Make sure area is free form occlusive dressing or diaper to minimize the risk of systemic absorption.

44
Q

Echinocandin and Azole antifungals have the same adverse reactions apart from one specific one, which reaction is this?

A

Echinocandin antifungals amy also cause bone marrow suppression.

45
Q

For systemic antifungals, how long may treatment be?

A

Up to 6 months.

46
Q

The nurse is assessing the patient who is about to receive antifungal drug therapy. Which problem in the patient’s history would be of most concern?

A

Hepatic Disease.

47
Q

What is the term for fungal skin infection?

A

Dermatophytes.

48
Q

What are some other names for Tinea infections?

A

Ring worm, athletes foot

49
Q

When teaching a patient who has been prescribed nystatin troche for oral candidiasis, which instruction by the nurse is correct?

A

Troches should be dissolved slowly in the mouth.