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Collab Therapies 2 > Fungal Infections And Antifungal Drugs > Flashcards

Fungal Infections And Antifungal Drugs Flashcards

1
Q

Which fungi microorganisms are included in the fungal infections?

A

Yeast and mould.

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2
Q

How is an infection caused by a fungus called?

What are the four types of those infections?

A

Its called a mycosis.

Four types of mycotic infections:

  • systemic (aspergillosis (effects lungs, transmitted by inhalation) or candidiasis > blood and lungs and transmitted through direct contact )
  • cutaneous (candidiasis > direct contact, affects mucous membranes and skin)
  • subcutaneous
  • superficial
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3
Q

Can mycoses (fungal infections) be dangerous? If so, for who?

A

Yes, they can cause very severe infections in pts with a weak host defense (compromised host immune defence) like :

  • cancer pts
  • pts who have received an organ transplant and are on immunosuppressants
  • pregnant women
  • pts with an immune disease
  • pts with aids
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4
Q

What is the mechanism of action of polyenes class of antifungal drugs ie. Amphotericin B and nystatin?

A

Works by binding to sterols which alters indirectly the cell’s metabolism and leads to death of the cell.

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5
Q

What is the drug of choice for the treatment of many severe systemic fungal infections?
Name some indications for this drug.

A 
Amphotericin B given IV
Indications:
- aspergillosis
- blastomycosis
- candidiasis
- fungal endocarditis 
- fungal septicemia 
And many others systemic fungal infections
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6
Q

What are some indications for Nystatin?

Forms available

A

Most often given to treat:

  • oral and vaginal candida
  • oral prophylaxis against candida infection

Given topically and orally

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7
Q

What are some AE of Amphotericin B (antifungal)?

A
  • cardiac dysthymia
  • kidney toxicity
  • neurotoxicity
  • fever
  • chills
  • GI upset
  • infusion syndrome : shake and bake syndrome
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8
Q

How can you prevent or minimize the shake and bake syndrome caused by Amphotericin B infusion?

A
  • administer premedication: antiemetic, antihistamines, antipyretic, and corticosteroids
  • administer medication through a long infusion time (2 to 6hrs)
  • administer IV saline prior to medication
  • administer in the most distant vein possible
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9
Q

What are some contraindications for Amphotericin B?

A
  • hypersensitivity
  • severe bone marrow suppression
  • kidney impairment (due to kidney toxicity risk)
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10
Q

What are some drug interactions woth Amphotericin B?

A

digitalis: indice hypokalemia, risk dig toxicity
- nephrotoxic drugs: additive nephrotoxicity effect
- thiazide diuretics: hypokalemia

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11
Q

What are some AE of Nystatin?

A
  • Gi: nausea, vomiting, diarrhea, anorexia

- rash, urticaria (local irritation with topical application as well)

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12
Q

What are some indications for Fluconazole (synthetic triazole antifungal)?

A

Passes through CNS so:

  • effective tx of meningitis
  • active against oral and esophageal candida infections
  • serious candida infections
  • used as prophylaxis for pts having bone marrow transplant, organ transplant, chemo or radiation
  • reduce risk of candidiasis
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13
Q

What are some contraindications for fluconazole and voriconazole?
And what is the contraindication tht only applies to voriconazole?

A

Contraindications for both:

  • deug allergies
  • liver and kidney failure

For voricinazole only:
Causes fetal harm so pregnancy

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14
Q

What are some nursing considerations for voriconazole?

A
  • given IV or PO
  • monitor LFTs, potassium
  • take 1hr before or after meals
  • warn about photophobia
  • monitor visual acuity
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15
Q

What are some AE of fluconazole?

A
  • increase liver enzyme
  • GI: nausea, vomiting, diarrhea

Use with caution with pts with kidney or liver dysfunction

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16
Q

Drug interactions with fluconazole?

A
  • cyclosporine: increase drug concentration
  • oral anticoagulants: increased effect of anticoagulant
  • oral antihyperglycemic: reduces metabolism of medication
  • statins: reduce metabolism
17
Q

What are the indications and contraindications for Caspofungin (cancidas)?

A

Indication:
- treatment of aspergillus infection

Contraindications:

  • drug allergies
  • kidney failure
  • liver failure
18
Q

What are some AE of Caspofungin (cancidas) from the Echinocandin antifungal classification?

A
  • fever
  • chills
  • headache
  • hypotension
  • GI: nauseaj, vomiting, diarrhea, hepatotoxicity
  • anemia
  • peripheral edema
19
Q

What are some general assessments before starting an antifungal therapy?

A
  • assess baseline VS
  • baseline weight
  • CBC
  • liver and kidney function tests
  • culture and sensitivity test results
  • ECG
  • assess for any contraindications, cautions and drug interactions
  • avoid taking antifungals and
    subsequent nephrotoxic drugs bc high risk of nephrotoxicity
  • monitor intake and output
20
Q

What are some specific assessments needed to be done prior to starting amphotericin B infusion?

A

all same assessments for all antifungals andddd:

  • assess for any premeds needed (antiemetics, antipyretics, antihistamines, corticosteroids)
  • assess for any sign of bone marrow suppression since it is a contraindication for amphotericin B
21
Q

What are some specific assessments needed to be done prior to caspofungin (antifungal) therapy?

A

All same as all antifungals anddd:

  • careful assessment of BP, pulse rate, liver function, RBC counts, WBC counts (due to potential drug indiced hypotension, tachycardia and hepatotoxicity)
  • assess hemoglobin and hematocrit levels
22
Q

What are some specific assessments to be done prior to starting Fluconazole (antifungal)?

A

All same as all antifungals andddd:

  • closely assess of pre existing GI problems and kidney and liver function
23
Q

What are some specific nursing implementation for the antifungal : Amphotericin B?

A
  • once infusion has begun monitor VS q15min
  • assess for AE q15min while infusion (like cardiac dysrhytmias, visual disturbances, paresthesia (numbing or tingling of hands and feet), resp difficulties, pain, fever, chills and nausea)
  • monitor IV site for signs of phlebitis (ex: heat, pain, redness ober the vein)
  • monitor all lab values during therapy (liver kidney CBC, etc)
  • monitor Weight
24
Q

What are some specific nursing implementation with Caspofungin (antifungal)?

A
  • dilute dose with recommended amount of normal saline
  • monitor liver function tests
  • Monitor for tachycardia, hypotension, fever, chills, or headaches
  • monitor levels of RBC and WBC
25
Q

What are some nursing implementation specific to administration of Fluconazole (antifungal med)?

A
  • can be given PO or IV
  • if IV make sure solution is clear, do not add other meds
  • if IV, if itching or rash occurs stop infusion and rale VS
26
Q

What are some specific implementation to voricobazole administration?

A
  • PO give 1hr before or after meals
  • IV doses may be diluted with 5% dextrose in water or normal saline
  • monitor visual acuity with this medication
27
Q

What is the most common drug used to tx oral candidiasis?

A) oseltamivir (tamiflu)
B) nystatin
C) fluconazole
D) metronidazole

A

B)

28
Q

During an infusion of amphotericin B, the nurse knows that which administration technique may be used to minimize infusion-related AE?

A) encourage fluid during the infusion
B) infuse the medication quickly
C) infusing the medication over an extended period of time
D) stopping the infusion for 2hrs after half of the bag has infused and then resume 1hr later

A

C)

Collab Therapies 2 (28 decks)

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