Anti-fungal agents

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Anti-fungal agents

  1. 1. Antifungal AgentsCopyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
  2. 2. Antifungal Agents Drugs used to treat infections caused by fungi • Systemic and topicalCopyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
  3. 3. Fungi • Also known as mycoses • Very large and diverse group of microorganisms • Broken down into yeasts and moldsCopyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
  4. 4. Yeasts • Single-cell fungi • Reproduce by budding • Very useful organisms – Baking – Alcoholic beveragesCopyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
  5. 5. Molds • Multicellular • Characterized by long, branching filaments called hyphaeCopyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
  6. 6. Mycotic Infections Four General Types • Cutaneous • Subcutaneous • Superficial • Systemic* *Can be life-threatening *Usually occur in immunocompromised hostCopyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
  7. 7. Mycotic Infections Candida albicans • Due to antibiotic therapy, antineoplastics, or immunosuppressants • May result in overgrowth and systemic infectionsCopyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
  8. 8. Mycotic Infections In the mouth: • Oral candidiasis or thrush • Newborn infants and immunocompromised patientsCopyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
  9. 9. Mycotic Infections Vaginal candidiasis: • “Yeast infection” • Pregnancy, diabetes mellitus, oral contraceptivesCopyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
  10. 10. Antifungal Agents Systemic • Examples: amphotericin B, fluconazole, ketoconazole, itraconazole Topical • Examples: clotrimazole, miconazole, nystatinCopyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
  11. 11. Antifungal Agents Broken down into four major groups based on their chemical structure • Polyenes: amphotericin B and nystatin • Flucytosine • Imidazoles: ketoconazole, miconazole, clotrimazole, fluconazole • GriseofulvinCopyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
  12. 12. Antifungal Agents: Mechanism of Action Polyenes: amphotericin B and nystatin • Bind to sterols in cell membrane lining • Allow K+ & Mg++ to leak out, altering fungal cell metabolism • Result: fungal cell deathCopyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
  13. 13. Antifungal Agents: Mechanism of Action flucytosine • Also known as 5-fluorocytosine (antimetabolite) • Taken up by fungal cells and interferes with DNA synthesis • Result: fungal cell deathCopyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
  14. 14. Antifungal Agents: Mechanism of Action Imidazoles ketoconazole, miconazole, clotrimazole, fluconazole • Inhibit an enzyme, resulting in cell membrane leaking • Lead to altered cell membrane • Result: fungal cell deathCopyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
  15. 15. Antifungal Agents: Mechanism of Action griseofulvin • Disrupts cell division • Result: inhibited fungal mitosis (reproduction)Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
  16. 16. Antifungal Agents: Side Effects amphotericin B “Shake and Bake” fever chills headache anorexia malaise nausea hypotension tachycardia muscle and joint pain lowered potassium and magnesium levels *renal toxicity *neurotoxicity: seizures and paresthesiasCopyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
  17. 17. Antifungal Agents: Side Effects fluconazole • nausea, vomiting, diarrhea, abdominal pain, • increased liver function studies flucytosine • nausea, vomiting, anorexia griseofulvin • rash, urticaria, headache, nausea, vomiting, anorexiaCopyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
  18. 18. Antifungal Agents: Nursing Implications • Before beginning therapy, assess for hypersensitivity, possible contraindications, and conditions that require cautious use. • Obtain baseline VS, CBC, liver function studies, and ECG. • Assess for other medications used (prescribed and OTC) in order to avoid drug interactions.Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
  19. 19. Antifungal Agents: Nursing Implications • Follow manufacturer’s directions carefully for reconstitution and administration. • Monitor VS of patients receiving IV infusions every 15 to 30 minutes. • During IV infusions, monitor I & O and urinalysis findings to identify adverse renal effects.Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
  20. 20. Antifungal Agents: Nursing Implications amphotericin B • To reduce the severity of the infusion-related reactions, pretreatment with an antipyretic (acetaminophen), antihistamines, and antiemetics may be given. • A test dose of 1 mg per 20 mL 5% dextrose in water infused over 30 minutes should be given. • Use IV infusion pumps and the most distal veins possible.Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
  21. 21. Antifungal Agents: Nursing Implications • Tissue extravasation of fluconazole at the IV site may lead to tissue necrosis—monitor IV site carefully. • Oral forms of griseofulvin should be given with meals to decrease GI upset. • Monitor carefully for side/adverse effects.Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
  22. 22. Antifungal Agents: Nursing Implications Monitor for therapeutic effects: • Easing of the symptoms of infection • Improved energy levels • Normal vital signs, including temperatureCopyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

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