NurseReview.Org - Antifungals Updates (pharmacology text on-line)

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  • 1. Antifungal Agents
  • 2. Antifungal Agents
    • Drugs used to treat infections caused by fungi
    • Systemic and topical
  • 3. Fungi
    • Also known as mycoses
    • Very large and diverse group of microorganisms
    • Broken down into yeasts and molds
  • 4. Yeasts
    • Single-cell fungi
    • Reproduce by budding
    • Very useful organisms
      • Baking
      • Alcoholic beverages
  • 5. Molds
    • Multicellular
    • Characterized by long, branching filaments called hyphae
  • 6. Mycotic Infections
    • Four General Types
    • Cutaneous
    • Subcutaneous
    • Superficial
    • Systemic*
      • *Can be life-threatening
      • *Usually occur in immunocompromised host
  • 7. Mycotic Infections
    • Candida albicans
    • Due to antibiotic therapy, antineoplastics, or immunosuppressants
    • May result in overgrowth and systemic infections
  • 8. Mycotic Infections
    • In the mouth:
    • Oral candidiasis or thrush
    • Newborn infants and immunocompromised patients
  • 9. Mycotic Infections
    • Vaginal candidiasis:
    • “ Yeast infection”
    • Pregnancy, diabetes mellitus, oral contraceptives
  • 10. Antifungal Agents
    • Systemic
    • Examples: amphotericin B, fluconazole, ketoconazole, itraconazole
    • Topical
    • Examples: clotrimazole, miconazole, nystatin
  • 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
    • Griseofulvin
  • 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 death
  • 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 death
  • 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 death
  • 15. Antifungal Agents: Mechanism of Action
    • griseofulvin
    • Disrupts cell division
    • Result: inhibited fungal mitosis (reproduction)
  • 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 paresthesias
  • 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, anorexia
  • 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.
  • 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.
  • 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.
  • 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.
  • 22. Antifungal Agents: Nursing Implications
    • Monitor for therapeutic effects:
    • Easing of the symptoms of infection
    • Improved energy levels
    • Normal vital signs, including temperature