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CH 91:

Antifungals

QuestionAnswer
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
Created by: 1398660434