Chapter 49: Fungal Infections

Question 1

Fungal Infection characteristics

Answer 1

fungal infections not easily transmitted through casual contact
Love dark, moist environments and lots of sugar
serious fungal infections are uncommon in people with healthy immune defenses
treatment may require weeks to months of therapy

Question 2

how do fungal infections affect immunocompromised pts

Answer 2

systemic fungal infections may be rapidly fatal
may experience frequent fungal infections and require aggressive pharmacotherapy

Question 3

Mycoses can be classified as

Answer 3

1. Superficial & subcutaneous - topical agents
   - affect the scalp, skin, nails, and mucous membranes
2. Systemic - oral or parenteral medications
   - affect internal organs (typically lungs, brain, digestive organs)

Question 4

Antifungal drugs MOA

Answer 4

act by disrupting the fungal cell membrane or wall, affecting fungal enzymes or disrupting replication

Question 5

Systemic Fungal Infections prototype

Answer 5

amphotericin B deoxycholate

Question 6

amphotericin B deoxycholate uses

Answer 6

severe systemic mycoses
prophylactic antifungal therapy

Question 7

amphotericin B deoxycholate MOA

Answer 7

binds to ergosterol in fungal cell membrane

Question 8

Amphotericin B deoxycholate ADEs

Answer 8

acute fever
chills
vomiting
anorexia
headahce
phlebitis
potassium deficiency
electrolyte imbalance

Question 9

Amphotericin B deoxycholate

Answer 9

Cardiac arrest
ototoxicity
nephrotoxicity
hepatotoxicity
anaphylaxis
blood abnormalities
dysrhythmias

Question 10

Amphotericin B deoxycholate contraindications/precautions

Answer 10

blood urea nitrogen (BUN) 40mg/dL
serum creatinine above 3mg/dL
hypotension
hypokalemia
shock is medication administered to rapidly

Question 11

Amphotericin B deoxycholate considerations

Answer 11

complete health Hx
perform infection-focused physical examination
premeditate with antipyretics, antihistamines, antiemetics, corticosteroids
perform baseline C&S tests prior to therapy
reduce or discontinue drug if BUN over 40mg/dL or serum creatinine over 3mg/dL
monitor cardio and resp status
check VS Q30 minutes for at least 4 hours after test dose
record I&O and weight
assess for erythema
administer IV over 2-6 hours
observe for injection sit for inflammation or thrombosis
assess for ototoxicity an immediately report any hearing loss or tinnitus, vertigo, or unsteady gait

Question 12

General fungal infection

Answer 12

Azoles

Question 13

Azoles

Answer 13

Largest and most versatile group of antifungals
broad spectrums
can be administered PO and have superior safety profile

Question 14

Two chemical classes of azaleas

Answer 14

Imidazoles
Triazoles

Question 15

Categorization of azoles by utility

Answer 15

systemic agents
topical agents
some agents used for systemic and topical

Question 16

Systemic azoles

Answer 16

spectrum similar to amphotericin B
less toxic
administered PO
ADEs: N/V in 10-20% of pts

Question 17

Azole prototype:

Answer 17

Fluconazole

Question 18

Fluconazole Uses

Answer 18

Candida albicans
cryptococcal meningitis
mycoses resistant to other antifungals

Question 19

Fluconazole MOA

Answer 19

interferences with synthesis of ergosterol

Question 20

Fluconazole ADEs

Answer 20

N/V/D

Question 21

Fluconazole Serious ADEs

Answer 21

SJS in immunosuppressed patients

Question 22

Fluconazole contraindications

Answer 22

hypersensitivity to the drug or another azole
hepatic impairment
hypokalemia
pre existing renal impairment

Question 23

Fluconazole considerations

Answer 23

monitor BUN, serum creatinine, and liver function lab tests
assess for hepatotoxicity

Question 24

fluconazole treatment of OD

Answer 24

no specific therapy
dialysis to lower serum drug level

Question 25

Superficial fungal infections

Answer 25

superficial anti fungal drugs safer than systemic counterparts many are available as over the counter (OTC) creams, gels, and ointments may take weeks to months to treat sometimes used with PO to treat extensive

Question 26

Dematomycoses

Answer 26

1. Tinea corporis (ringworm) 2. Tine curries (jock itch) 3. Tinea pedis (athletes foot) 4. Tinea capitis (head, eyebrows, eyelashes infected)

Question 27

Onychomycosis (tine unguium)

Answer 27

infection of the nail

Question 28

Superficial candidasis

Answer 28

oropharyngeal candidasis (thrush)

Question 29

Superficial prototype drug

Answer 29

Nystatin

Question 30

nystatin uses

Answer 30

candida infections of vagina skin mouth throat and GI

Question 31

nystatin MOA

Answer 31

binds to sterols in the fungal cell membrane allows leakage of intracellular content across the weakened membrane

Question 32

nystatin ADEs

Answer 32

minor skin irritation and burning contact dermatitis D/N/V

Question 33

nystatin contraindications/precautions

Answer 33

hypersensitivity to the drug pregnancy and lactation cream/topicals (Cat B) Oral suspension or tablets (Cat C)

Question 34

Nystatin Drug interactions

Answer 34

unknown

Question 35

Nystatin treatment if OD

Answer 35

symptomatic

Question 36

Nystatin considerations

Answer 36

Hx and assessment avoid occlusive dressing or ointment on moist, dark areas of the body teach pt to avoid sharing towels, shoes, or personal objects

Question 37

Griseofulvin

Answer 37

Drugs similar to nystatin used to treat skin infections such as jock itch athletes foot and ringworm, fungal infections of scalp, fingernails and toenails

Question 38

Griseofulvin SE

Answer 38

phytotoxicity, , urticaria, dizziness, decreased OCP, alcohol = disrulfiram