Nursing Pharmacology Antifungals
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| Which patients most often present with systemic fungal infections? | Severely immunocompromised
chemotherapy patients
HIV-AIDS patients
Transplant patients
Elderly patients
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| What are topical fungal infections caused by? | Dermophytes
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| What are two common types of topical fungal infections? | Tinea infections and candida
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| What tests should you always do to monitor patient while giving anti-fungals? | LIVER function tests, antifungals are very hepatotoxic
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| Which enzyme system do most antifungals interfere with? | the CYP450 enzyme system
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| Which contraindications are common to all antifungals? | Preg. and lact. (except for Terbafine for life threatening infections)
RENAL or LIVER disease
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| What is the prototype drug for the Azole class of antifungals? | Fluconazole (Diflucan)
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| 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
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| What is fluconazole used for? | candidiasis (oral, vaginal, esophageal) and other systemic fungal infections
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| 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)
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| What should you always monitor and consider when using antifungals? | LIVER function and liver toxicity
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| What are five other azole class antifungals aside from fluconazole? | Itraconazole
Ketaconazole
Posaconazole
Voriconazole
Terbafine
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| 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
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| What are the contraindications for ketoconazole? | hepatic dysfunction
endocrine or fertility issues (bc interferes w/sterols)
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| What are the contraindications for itraconazole? | hepatic failure, hepatic impairment
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| What are the contraindications for posaconazole? | Preg. & lact.
hepatic impairment
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| What are the three drugs classed as echinocandin antifungals? | anidulafungin
caspofungin
micafungin
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| what do echinocandin antifungals do? | inhibit glucan sythesis, fungicidal
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| what are the drug-drug interactions with echnocandin antifungals? | caspofungin & cyclosporine should not be used together --> hepatic injury
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| what are the containdications for echinocandin antifungals? | Anidulafungin and Caspofungin: hepatic impairment
pg and bf
Caspofungin: known embryotoxin
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| What are 4 other antifungals that are not azole or echinocandin drugs? | Amphotericin B
Flucytosine
Grisofulvin
Nystatin
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| What are the adverse effects of echinocandin antifungals? | Liver toxicity
Micafungin:
serious hypersensative rxns
bone marrow suppression
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| How does amphotericin B work? | binds to sterols in fungal cell wall
can be fungicidal or fungistatic
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| how do flucytosine and grisofulvin work? | alter cell membrane
fungicidal
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| 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
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| What are the major contraindications for amphotericin B? | use CAUTIOUSLY in pg, NOT in lactation
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| What are the contraindications for flucytosine and nystatin? | Renal impairment, pg and lact
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| What are the adverse effects of amphotericin B? | SEVERE renal impairment
GI irritation (n/v/d/, anorexia, weight loss)
possible phlebitis or thrombophlebitis
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| What is the prototype drug for the topical azole antifungals? | Clotrimazole (Monistat)
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| How do topical azole antifungals work? | alter cell permeability of the fungus
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| What are the other 10 topical azole antifungals besides clotrimazole? | Butoconazole
Econazole
Ketoconazole*
Miconazole
Oxiconazole
Sertaconazole
Sulconazole
Terbafine*
Terconazole
Tioconazole
*also systemic
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| What are the contraindications for topical antifungals? | not absorbed systemically so limited to known allergies and open lesions
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| 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
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| 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
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| which antifungal would be most likely prescribed for tinea infections? | Griseofulvin
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| Which antifungal(s) would be most likely prescribed for candidia infections? | Nystatin, Diflucan, clotrimoxazole
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| What is an enzyme found in fungal cell walls but not in human cells? | Glucan
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