E3 Antifungals Flashcards
4 major classes of Antifungals
- Polyenes (nystatin & amphotericin B
- Pyrimidine (flucytosine)
- Azoles (fluconazole)
- Misc. Agent (grisefulvin)
Nystatin indication
Treatment of superficial candida infections of mouth (thrush), oral mucosa, vaginal, & skin
-Never for systemic infection
nystatin route
Creams, powders, TOPICAL, vaginal
TOO TOXIC for parental (IV)
SE of nystatin
Not alot
Mild skin irritation
N/V/D when taken orally
Poor GI absorption
Indication of Amphotericin B
Agent of choice for most systemic mycoses
MOA of Amphotericin B
Binds to ergosterol in fungal cell membranes & causes them to become leaky and destroys cell wall of the fungus
Amphotericin B route
PO
Parental (IV)- must dilute & admin slowly
NOT TOPICAL
Nursing considerations for Amphotericin B
-Monitor BUN/Creatinine
-Pt must be on cardiac monitor with frequent vitals
-Given every other day for several months
Pretreatment of Amphotericin B with ______ to decrease infusion symptoms of _______
diphenhydramine, acetaminophen, or aspirin
fever, pain, nausea, headache
Amphotericin B has synergistic effect when given with _____
flucystosine
MOA of flucytosine
inhibits fungal DNA synthesis
Indications of flucytosine
allows for a lower dose of Amphotericin B to be used (decrease SE)
What are the 5 azoles
- Ketoconazole
- Miconazole
- Clotrimazole
- Itraconazole
- Fluconazole
MOA of the azoles
Interrupts the integrity of the cell wall by interfering with the synthesis of ergosterol
Indications of azoles
Used for both superficial and less serious systemic fungal infections
SE of azoles
-Topical may cause redness, burning, itching
-Systemic- severe GI upset N/V/D & liver toxicity (look for jaundice & abdominal pain
Administration of azoles
-Take with food to minimize SE
-For oral separate at least 2 hours from antacids and drugs that decrease stomach acid
Advantages of fluconazole
-Rapidly and completely absorbed when given orally, able to reach bones, CNS, eyes, respiratory, and urinary tract
-Much less toxic than Amphotericin B with fewer SE
Disadvantages of fluconazole
Narrow spectrum
Many drug interactions (CYP450 path)
Nursing implications of fluconazole
-Do not mix IV fluconazole with other meds
-Monitor coags for pts on warfarin
-Watch for hypoglycemia for pts w/ sulfonylureas
-Increases Haldol and Dilantin levels
MOA of Grisefulvin
-Inhibits fungal mitosis
-Binds to keratin
-Does not effect the cell wall or membrane
SE of Grisefulvin
-Bone marrow suppression
-Rash
-CNS changes
-N/V/D
-Anorexia
Indications of Grisefulvin
Resistant dermatophyte infection of scalp, skin, and nails
What Antifungals can be given topically?
- Nystatin
- Flucytosine?
- Azoles
- Grisefulvin
What Antifungal CAN NOT be given topically?
Amphotericin B
