LO 12 Flashcards
Anti Fungals and Anti Virals
Describe fungal infections
They are more likely to occur in patients who are immunocompromised, and they can become chronic
What are the two common groups of fungal infections and the interventions used?
- Mucocutaneous candidal infections - managed with nystatin, clotrimazole, ketoconazole, or fluconazole
- Tinea - affects the skin and produces athlete’s foot, “jock itch,” and ringworm; managed both with prescription and over-the-counter medications
How long is the treatment course for anti-fungals?
Usually 2 weeks
What common drug do anti-fungals tend to disrupt?
Oral contraceptives
C. Albicans infections typically result in __________ patients as a result of ____________
- immunocompromised
- superinfection/suprainfection
What are the predisposing factors for fungal infections?
- Chronic antibiotic use
- Immune compromised (chemo/radiation, HIV, Chronic corticosteroids)
- Appliances (e.g. dentures)
Antifungal medications can be divided into _________ and __________
- Natural
- Synthetic
Natural antifungals are in the drug group __________
Polyene
Synthetic anti-fungal medications are in the drug group ________ or __________
- Imidazole
- Triazole
What are the trade names for nystatin? (natural antifungal=Polyene)
- Candistatin
- Mycostatin
- Nilstat
- Don’t confuse w/ cholesterol “statin” meds
What is the first choice ant-fungal medication?
nystatin
How does nystatin impact fungi?
Fungicidal and fungistatic
What are the adverse reactions of nystatin?
GI adverse reactions - nausea, vomiting, and diarrhea
What dose form does nystatin come in?
- aqueous suspension containing 50% sucrose
- Swish, swirl, and spit or swallow 5 ml four times daily - The suspension should remain in the mouth for 2 minutes for the best effect
What is the common suffix for synthetic anti-fungals?
azole
What do synthetic antifungals tend to interact with?
inhibitors liver enzymes cytochrome P450
The trade name for ketoconazole is ___________
Nizoral
ketoconazole/ Nizoral requires __________ for optimal absorption
High acidity - take with OJ or cola
What drugs do ketoconazole/ Nizoral interact with?
Antacids will lower absorption - requires highly acidic environment for optimal absorption
What are the adverse affects of ketoconazole/ Nizoral
- GI effects - nausea and vomiting
- Hepatotoxicity
Describe the RX for ketoconazole/ Nizoral
- For treatment of Candida is 200 to 400 mg orally daily
- Used for at least 2 weeks; 6 to 12 months may be required for chronic mucocutaneous candidiasis
What is the trade name for clotrimazole?
Canesten
What are the adverse reactions of clotrimazole/Canesten?
- GI - abdominal pain, diarrhea, and nausea
- Xerostomia
Who should NOT take clotrimazole/Canesten?
- Diabetics
- Children
What is the trade name of fluoconazole?
Diflucan
What is the benefit of fluoconazol/Diflucan?
Improved safety and predictable absorption
What is Dr. I’s #2 choice for an antifungal?
Diflucan
List the drugs in the Polyene group
nystatin =Candistatin =Mycostatin =Nilstat
List the drugs in the Imidazole group
ketoconazole/Nizoral & clotrimazole/ Canesten
List the drugs in the Triazole group
fluoconazol/Diflucan
What are antivirals used for?
- Shown to reduce both the duration of the lesion and the pain of the lesions on the lips and face associated with both primary and recurrent herpes simplex
- MOST EFFECTIVE DURING PRODROMAL STAGE
List 3 common antiviral medications
- acyclovir
- Abreva
- penciclovir
What is the effective spectrum of acyclovir (Zovirax)?
- HSV #1
- HSV #2
- HHV #3
- HHV #5
- EBV (Epstein Barr virus)
What are the routes of administration for acyclovir (Zovirax)?
- Topical: burning, itching
- Oral: nausea, vomiting, diarrhea
- Injection: irritation at injection site, Seizures
What is suggested for patients with Frequent HSV#1 lesions?
- Zovirax (acyclovir ointment) to have on hand and apply during prodromal stage.
- Avoid systemic AV Rx for the severe adverse RXNs
Describe treatment for HIV
- HIV+ is associated with increase opportunistic infections: Tb, HSV, C. albicans, Pneumonia, Flu virus
- ALWAYS check for C. albicans
- AB or AF prophylaxis? NOT REQUIRED
- Higly Affective AntiRetroviral Treatment =“HAART” or AntiRetroviral Treatment=“ART” ( Highly active anti retroviral treatment or anti retroviral treatment)🡺“Cocktail” e.g. Azidothymidine (AZT)
What are the general and oral adverse reactions of AZT?
General
1. bone marrow depression
2. CNS effects include headache, agitation and insomnia
Oral
1. taste perversion
2. edema of the tongue
3. bleeding gums
4. mouth ulcers
5. Pigmentation of oral mucosa
What 4 things should you know about HIV+ patients before treatment?
- CD4 count - should be > 200 cells/mm.
- Platelet count- should be >60,000/mcl (normal is 150,000-450,000)
- Absolute neutrophil count- if <500 cells/mcl., requires prophy AB
- Viral load - should be <3,000/mcl.
- 1 & 4 are the most important
What should you know if HIV patient has comorbidities such as diabetes or if client is on Coumadin?
- Diabetes - A1C- >8% is poorly controlled.
- Coumadin - Able to treat as long as it is in the therapeutic range of 2-3 (if >3, do not treat)
