Chapter 35 - Fungal, Protozoal, Helminthic Infection Med Cards

Question 1

Amphotericin B - Anti-fungal

Answer 1

Action - bind to ergosterol in fungal cell membranes, causing them to become permeable or leaky.

Use - it has wide spectrum of activity that includes most of the fungi pathogenic to humans

Contraindications - allergy

Adverse Effects - Fever and chills, vomiting, and headache at the beginning of therapy, which subside as treatment continues. Phlebitis is common during IV therapy. Some degree of nephrotoxicity is observed in most patients. Electrolyte imbalances frequently occur. Cardiac arrest, hypotension, and dysrhythmias are possible. Hyperthermia and ototoxicity

Patient teaching - Long term therapy may be needed to clear infection

• • infuse slowly, cardiovascular collapse if pushed too fast
• Risk: 80% of people experience kidney damage, renal impairment, if pregnant monitor fluid & electrolyte balance, edema, dark urine, hearing loss, increased creatinine, increased BUN

Question 2

Fluconazole - Systemic azole, Anti-Fungal

Answer 2

Action - interfere with the synthesis of ergosterol

Use - Primary use is to penetrate most body membranes to reach fungal infections in the CNS, bone, eyes, urinary tract, and respiratory tract. It may not be effective against non-albicans, Candida species (although it is very effective against Candida albicans).

Contraindications - pregnancy
- allergy to this product or azoles

Adverse Effects - It is well tolerated by most patients. Nausea, vomiting, and diarrhea (most common) are possible with high doses. Stevens-Johnson syndrome has been reported in patients with immunosuppression.

Patient teaching - Take with food to avoid GI upset

• Use alternative method of contraceptive
• Notify prescriber of nausea, vomiting, diarrhea, jaundice, anorexia, clay-colored stool, dark urine, skin rash

Question 3

Nystatin - Anti-fungal, Superficial

Answer 3

Action - bind to sterols in the fungal cell membrane, allowing leakage of intercellular contents

Use - Use it topically for Candida infections of the vagina, skin, and mouth. It may also be used orally to treat candidiasis of the intestine. Some formulations of nystatin with triamcinolone are used for treating inflamed subcutaneous lesions

Contraindications - allergy

Adverse Effects - adverse effects are few, other than minor skin irritation; when given orally, it may cause nausea, vomiting, and diarrhea

Patient teaching - Complete the entire course of medication

• Avoid commercial mouthwashes for mouth infections
• Notify PCP of irritation
• • 2 mins to dissolve in mouth
• • swish and spit for oral suspension

Question 4

Chloroquine - Antimalarial

Answer 4

Action - Concentrate in the food vacuoles of Plasmodium residing in red blood cells. Once in the vacuole, it is believed to prevent the metabolism of heme, which then builds to toxic levels within the parasite

Use - Effective in treating the erythrocyctic stage, but has no activity against latent Plasmodium. It has been the prototype medication for treating malaria for over 60 years. It is also used to prevent malaria.

Contraindications - allergy, retinal field changes

Adverse Effects - Nausea and diarrhea. At higher doses, CNS, cardiovascular, and retinal toxicity may be observed.

Patient Teaching - Take with meals or immediately after meals

• Use sunglasses in bright sunlight to avoid photophobia
• Urine may turn rust or brown color
• Report hearing or visual problems, fever, fatigue, bruising, bleeding; may indicate blood dycrasias

Question 5

Metronidazole - Non-malarial antiprotozoal

Answer 5

Action - Act as an antiprotozoal drug that is effective against both the intestinal and hepatic stages of the disease. It also has antibiotic activity against anaerobic bacteria

Use - Treat most forms of amebiasis, and to treat a number of respiratory, bone, skin, and CNS infections

Contraindications - Pregnancy (1st trimester), breastfeeding, allergy to this product

Adverse Effects - Relatively frequent cases of anorexia, nausea, diarrhea, dizziness, and headache. Dryness of the mouth and an unpleasant metallic taste maybe experienced. Bone-marrow suppression is possible, although rare.

Patient teaching - Urine may turn dark reddish brown; that product may cause metallic taste

• Proper hygiene after bowel movement
• Notify PCP of numbering or tingling in extremities
• Avoid hazardous activities because dizziness may occur
• Use condoms during treatment
• Use gum or water for dry mouth
• Do not use alcohol or products that contain alcohol; disulfiram like reaction may occur
• • No alcohol 10 days after therapy

Question 6

Mebendazole - Antihelminthic

Answer 6

Action - to act as a broad spectrum antihelminthic drug. It retains high concentrations in the intestine, where it kills both the adult and larval parasites

Use - treatment of a wide range of helminth infections

Contraindications - Allergy to this product

Adverse Effects - adverse effects are few, but as the worms die, some abdominal pain, distention, and diarrhea may be experienced.

Patient teaching - Proper hygiene after BM

• Infected person should sleep alone
• Clean toliet daily with disinfectant
• All members of the family should be treated
• Report jaundice or liver pain
• • children 3 to 8 years old in U.S.