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Antifungals 331

Nursing Pharmacology Antifungals

QuestionAnswer
Which patients most often present with systemic fungal infections? Severely immunocompromised chemotherapy patients HIV-AIDS patients Transplant patients Elderly patients
What are topical fungal infections caused by? Dermophytes
What are two common types of topical fungal infections? Tinea infections and candida
What tests should you always do to monitor patient while giving anti-fungals? LIVER function tests, antifungals are very hepatotoxic
Which enzyme system do most antifungals interfere with? the CYP450 enzyme system
Which contraindications are common to all antifungals? Preg. and lact. (except for Terbafine for life threatening infections) RENAL or LIVER disease
What is the prototype drug for the Azole class of antifungals? Fluconazole (Diflucan)
How do Azole class antifungals work? Bind to sterols in cell membrane, can be fungicidal or fungistatic. Itra-, Keto- and Fluc- block activity of sterol in cell wall Posa- and Vori- inhibit ergosterol Terbafine: inhibits p450 2D6 enzyme
What is fluconazole used for? candidiasis (oral, vaginal, esophageal) and other systemic fungal infections
What are the adverse effects that are common to all antifungals? CNS: headache, fever, chills, dizziness, shaking GI: n/v/d, anorexia Hepatic and renal dysfunction Rash and itching (local)
What should you always monitor and consider when using antifungals? LIVER function and liver toxicity
What are five other azole class antifungals aside from fluconazole? Itraconazole Ketaconazole Posaconazole Voriconazole Terbafine
What are the drug-drug interactions when using azole antifungals? Increased serum levels of: Cyclosporin Digoxin Oral Hypoglycemics Warfarin Oral Anticoagulants Phenytoin Voriconazole: any other drugs that prolong QTc interval, ergot alkaloids
What are the contraindications for ketoconazole? hepatic dysfunction endocrine or fertility issues (bc interferes w/sterols)
What are the contraindications for itraconazole? hepatic failure, hepatic impairment
What are the contraindications for posaconazole? Preg. & lact. hepatic impairment
What are the three drugs classed as echinocandin antifungals? anidulafungin caspofungin micafungin
what do echinocandin antifungals do? inhibit glucan sythesis, fungicidal
what are the drug-drug interactions with echnocandin antifungals? caspofungin & cyclosporine should not be used together --> hepatic injury
what are the containdications for echinocandin antifungals? Anidulafungin and Caspofungin: hepatic impairment pg and bf Caspofungin: known embryotoxin
What are 4 other antifungals that are not azole or echinocandin drugs? Amphotericin B Flucytosine Grisofulvin Nystatin
What are the adverse effects of echinocandin antifungals? Liver toxicity Micafungin: serious hypersensative rxns bone marrow suppression
How does amphotericin B work? binds to sterols in fungal cell wall can be fungicidal or fungistatic
how do flucytosine and grisofulvin work? alter cell membrane fungicidal
What are the drug-drug interactions for amphotericin B? do not give other nephrotoxic antibiotics, antineoplastics, cyclosporine or corticosteriods All increase risk of SEVERE renal toxicity
What are the major contraindications for amphotericin B? use CAUTIOUSLY in pg, NOT in lactation
What are the contraindications for flucytosine and nystatin? Renal impairment, pg and lact
What are the adverse effects of amphotericin B? SEVERE renal impairment GI irritation (n/v/d/, anorexia, weight loss) possible phlebitis or thrombophlebitis
What is the prototype drug for the topical azole antifungals? Clotrimazole (Monistat)
How do topical azole antifungals work? alter cell permeability of the fungus
What are the other 10 topical azole antifungals besides clotrimazole? Butoconazole Econazole Ketoconazole* Miconazole Oxiconazole Sertaconazole Sulconazole Terbafine* Terconazole Tioconazole *also systemic
What are the contraindications for topical antifungals? not absorbed systemically so limited to known allergies and open lesions
What are the adverse effects of topical azole antifungals? local effects: rash, burning, stinging, swelling suppository or troche: n/v, hepatic dysfunction, urinary frequency, burning, change in sexual activity
What should one be careful of when using topical antifungals? Not to use them too near open wounds or lesions so as to avoid systemic absorbtion
which antifungal would be most likely prescribed for tinea infections? Griseofulvin
Which antifungal(s) would be most likely prescribed for candidia infections? Nystatin, Diflucan, clotrimoxazole
What is an enzyme found in fungal cell walls but not in human cells? Glucan
Created by: SarahTzipporah