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Antifungals 331
Nursing Pharmacology Antifungals
| Question | Answer |
|---|---|
| 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
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