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CH 91:
Antifungals
| Question | Answer |
|---|---|
| what are the 2 classes of systemic antifungals? | Polyene antibiotics and -azoles |
| what class is Amphotericin B in? | Polyene abx |
| Amphotericin B: broad or narrow spectrum? | Broad |
| Amphotericin B: high toxicity/low toxicity? | high |
| when is Amphotericin B used? | only if the pt has a fatal fungal infection |
| administration route of Amphotericin B | IV only! |
| mechanism of action for Amphotericin B | binds to ergosterol (type of cholesterol) in the fungal cell membrane -> increased permeability |
| Amphotericin B: -static/-cidal | can be static or cidal depending on drug concentration |
| treatment length of Amphotericin B | typically 6-8 weeks, but can last 4-6 months |
| Amphotericin B: cross BBB? | no |
| Amphotericin B: absorbed in GI tract? | no |
| a pt on Amphotericin B is in the hospital? or at home | HOSPITAL |
| are infusion rxns common in pts on Amphotericin B? | yes |
| adverse effects of Amphotericin B | infusion rxn, phlebitis, nephrotoxicity, bone marrow suppression, electrolyte imbalance |
| what are the s/s of an Amphotericin B infusion rxn? | fever, chills, nausea, headache |
| when do s/s of infusion rxn appear when a pt is on Amphotericin B? | usually 1 hour after infusion |
| what can you do to prevent an infusion rxn in a pt on Amphotericin B? | pre-medicate with benadryl and tylenol |
| what is the cause of an Amphotericin B infusion rxn? | release of pro-inflammatory cytokines |
| what can you do to prevent phlebitis in a pt on Amphotericin B? | you cna pre-treat with heparin. |
| what do you do after phlebitis occurs in a pt on Amphotericin B? | change IV site |
| what is nephrotoxicity in a pt on Amphotericin B dependent on? | dose and duration of drug |
| is nephrotoxicity in a pt on Amphotericin B reversible? | typically once the med has been DC, the kidneys tend to repair themselves |
| what can you do to minimize the risk for kidney damage in a pt on Amphotericin B? | give a bolus of fluid (1L NS) -> look at co-morbidities (CHF) |
| if all else fails against an infusion rxn in a pt on Amphotericin B, what can be used? | glucocorticoids |
| -azoles: broad/narrow spectrum? | broad |
| what is the mechanism of action for -azoles? | inhibits the synthesis of ergosterol -> increased cell permeability |
| administration route of -azoles: | oral |
| -azoles: lots or few drug interactions? | lots! because they inhibit the hepatic P450 in the liver |
| what are the side effects of Intraconazole [Sporanox]? | cardio-suppression, hepatotoxicity, pale stools, dark urine, n/v/d, hypersensitivity |
| why does Intraconazole [Sporanox] cause cardio-suppression? | Intraconazole [Sporanox] is a negative inotrope which decreases contractility which decreases CO and EF |
| who should NOT receive Intraconazole [Sporanox] | CHF pt (decreases CO/EF) |
| what s/s will you note in a pt with hepatotoxicity? | RUQ pain, jaundice, anorexia, fatigue, bleeding, |
| what drug interactions occur with Intraconazole [Sporanox]? | Intraconazole [Sporanox] can raise levels of many drugs because it inhibits CYP3A4 |
| administration route of Fluconazole [Diflucan] | IV or oral |
| Fluconazole [Diflucan]: static/cidal | static |
| Fluconazole [Diflucan]: systemic/local use? | systemic |
| Voriconazole [Vfend]broad/narrow? | broad |
| what is Voriconazole [Vfend] used for most? | Yeast: candidemia (yeast in blood), esophageal candida |
| what is an advantage of Voriconazole [Vfend]? | lower risk for renal damage |
| adverse effects of Voriconazole [Vfend]? | similar to others, ONE UNIQUE ONE = visual disturbances. (decreased acuity, photophobia, altered color perception.) |
| Ketoconazole: frequent or rare use? | frequent |
| Ketoconazole: used for systemic or superficial fungal infections? | both |
| advantage of Ketoconazole over Amphotericin B? | less toxic |
| disadvantage of Ketoconazole | takes longer to see an effect |
| what is Ketoconazole better for acute or chronic fungal infections? | chronic |
| what is necessary for absorption of Ketoconazole? | acidic environment (stomach) |
| what drugs should you avoid in a pt on Ketoconazole? | any drugs taht decrease acidity in the stomach (separate administration by 2+ hours) |
| side effects of Ketoconazole? | n/v/d/c, hepatotoxicity, rash, dizziness, photophobia, headache |
| how can you decrease GI problems dt Ketoconazole? | administration with food |
| give me the common name for Tinea Pedis: | Ringworm of the foot: Athletes Foot |
| give me the common name for Tinea Corporis: | Ringworm of the BODY |
| give me the common name for Tinea Cruris: | Ringworm of the groin: Jock Itch |
| give me the common name for Tinea Capitis: | ringworm of the scalp |
| what is onychomycosis? | nail infection |
| what is the treatment time for onychomycosis? | oral antifungal therapy 3-6 months |
| how effective is the treatment for onychomycosis? | only about 50% |
| what is the preferred treatment for onychomycosis? | terbinafine [Lamisil] and itraconazole [Sporanox] |
| Tinea Capitis: local or systemic treatment? | Systemic |
| yeast infections: topical/systemic treatment? | either or |
| thrush treatment drug? directions for this? | nystatins. swish and swallow OR swish and spit |
| When a pt has oral thrush, how should you correlate food and medication treatment. | hold off eating/drinking for 30 minutes after treatment (oral thrush can be very painful) |
| what class of drug is nystatin? | polyene abx |
| what are nystatins used for? | ONLY FOR CANDIDA |
| what route of administration is nystatin? | oral or topical |
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