This document discusses antifungal agents, which are drugs used to treat infections caused by fungi. It describes the types of fungi that cause infections, including yeasts and molds, and the different types of fungal infections. It also outlines the major classes of antifungal drugs, including polyenes, imidazoles, and others, and explains their mechanisms of action and side effects. Finally, it reviews nursing implications for administering antifungal drugs safely and monitoring patients for therapeutic effects and adverse reactions.

1. Antifungal Agents
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2. Antifungal Agents
Drugs used to treat infections caused by fungi
• Systemic and topical
Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

3. Fungi
• Also known as mycoses
• Very large and diverse group of
microorganisms
• Broken down into yeasts and molds
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4. Yeasts
• Single-cell fungi
• Reproduce by budding
• Very useful organisms
– Baking
– Alcoholic beverages
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5. Molds
• Multicellular
• Characterized by long, branching filaments
called hyphae
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6. Mycotic Infections
Four General Types
• Cutaneous
• Subcutaneous
• Superficial
• Systemic*
*Can be life-threatening
*Usually occur in immunocompromised host
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7. Mycotic Infections
Candida albicans
• Due to antibiotic therapy, antineoplastics,
or immunosuppressants
• May result in overgrowth and systemic infections
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8. Mycotic Infections
In the mouth:
• Oral candidiasis or thrush
• Newborn infants and immunocompromised patients
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9. Mycotic Infections
Vaginal candidiasis:
• “Yeast infection”
• Pregnancy, diabetes mellitus, oral contraceptives
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10. Antifungal Agents
Systemic
• Examples: amphotericin B, fluconazole,
ketoconazole, itraconazole
Topical
• Examples: clotrimazole, miconazole, nystatin
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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
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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
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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
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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
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15. Antifungal Agents:
Mechanism of Action
griseofulvin
• Disrupts cell division
• Result: inhibited fungal mitosis (reproduction)
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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
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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
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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. 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. 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.
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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.
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22. Antifungal Agents:
Nursing Implications
Monitor for therapeutic effects:
• Easing of the symptoms of infection
• Improved energy levels
• Normal vital signs, including temperature
Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.