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

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

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

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