20 anti fun gals upd

8/14/2019 20 Anti Fun Gals Upd

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Copyright 2002, 1998, Elsevier Science (USA). All rights reserved.

Antifungal AgentsAntifungal Agents

Drugs used to treat infections caused by fungiDrugs used to treat infections caused by fungi

Systemic and topicalSystemic and topical


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FungiFungi

Also known as mycosesAlso known as mycoses

Very large and diverse group ofVery large and diverse group of

microorganismsmicroorganisms

Broken down into yeasts and moldsBroken down into yeasts and molds


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MoldsMolds

MulticellularMulticellular

Characterized by long, branching filamentsCharacterized by long, branching filaments

called hyphaecalled hyphae


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Mycotic InfectionsMycotic Infections

Four General TypesFour General Types

CutaneousCutaneous

SubcutaneousSubcutaneous

SuperficialSuperficial

Systemic*Systemic*

*Can be life-threatening*Can be life-threatening

*Usually occur in immunocompromised host*Usually occur in immunocompromised host


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Candida albicansCandida albicans

Due to antibiotic therapy, antineoplastics,Due to antibiotic therapy, antineoplastics,

or immunosuppressantsor immunosuppressants May result in overgrowth and systemic infectionsMay result in overgrowth and systemic infections


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In the mouth:In the mouth:

Oral candidiasis or thrushOral candidiasis or thrush

Newborn infants and immunocompromised patientsNewborn infants and immunocompromised patients


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Vaginal candidiasis:Vaginal candidiasis:

Yeast infectionYeast infection

Pregnancy, diabetes mellitus, oral contraceptivesPregnancy, diabetes mellitus, oral contraceptives


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SystemicSystemic

Examples: amphotericin B, fluconazole,Examples: amphotericin B, fluconazole,

ketoconazole, itraconazoleketoconazole, itraconazole

TopicalTopical

Examples: clotrimazole, miconazole, nystatinExamples: clotrimazole, miconazole, nystatin


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Broken down into four major groups basedBroken down into four major groups basedon their chemical structureon their chemical structure

Polyenes: amphotericin B and nystatinPolyenes: amphotericin B and nystatin

FlucytosineFlucytosine

Imidazoles: ketoconazole, miconazole, clotrimazole,Imidazoles: ketoconazole, miconazole, clotrimazole,fluconazolefluconazole

GriseofulvinGriseofulvin


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Antifungal Agents:Antifungal Agents:

Mechanism of ActionMechanism of Actionflucytosineflucytosine

Also known as 5-fluorocytosine (antimetabolite)Also known as 5-fluorocytosine (antimetabolite)

Taken up by fungal cells and interferes with DNATaken up by fungal cells and interferes with DNAsynthesissynthesis

Result: fungal cell deathResult: fungal cell death


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Mechanism of ActionMechanism of ActionImidazolesImidazoles

ketoconazole, miconazole, clotrimazole, fluconazoleketoconazole, miconazole, clotrimazole, fluconazole

Inhibit an enzyme, resulting in cell membraneInhibit an enzyme, resulting in cell membraneleakingleaking

Lead to altered cell membraneLead to altered cell membrane Result: fungal cell deathResult: fungal cell death


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Mechanism of ActionMechanism of Actiongriseofulvingriseofulvin

Disrupts cell divisionDisrupts cell division

Result: inhibited fungal mitosis (reproduction)Result: inhibited fungal mitosis (reproduction)


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Antifungal Agents: Side EffectsAntifungal Agents: Side Effects

amphotericin Bamphotericin BShake and BakeShake and Bake

feverfever chillschills headacheheadache anorexiaanorexia

malaisemalaise nauseanausea hypotensionhypotension tachycardiatachycardia

muscle and joint painmuscle and joint pain

lowered potassium and magnesium levelslowered potassium and magnesium levels

*renal toxicity*renal toxicity

*neurotoxicity: seizures and paresthesias*neurotoxicity: seizures and paresthesias


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Antifungal Agents: Side EffectsAntifungal Agents: Side Effects

fluconazolefluconazole

nausea, vomiting, diarrhea, abdominal pain,nausea, vomiting, diarrhea, abdominal pain,

increased liver function studiesincreased liver function studies

flucytosineflucytosine

nausea, vomiting, anorexianausea, vomiting, anorexia

griseofulvingriseofulvin

rash, urticaria, headache, nausea, vomiting, anorexiarash, urticaria, headache, nausea, vomiting, anorexia


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Nursing ImplicationsNursing Implications Follow manufacturers directions carefullyFollow manufacturers directions carefully

for reconstitution and administration.for reconstitution and administration.

Monitor VS of patients receiving IV infusionsMonitor VS of patients receiving IV infusionsevery 15 to 30 minutes.every 15 to 30 minutes.

During IV infusions, monitor I & O andDuring IV infusions, monitor I & O and

urinalysis findings to identify adverseurinalysis findings to identify adverserenal effects.renal effects.


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Nursing ImplicationsNursing Implicationsamphotericin Bamphotericin B

To reduce the severity of the infusion-relatedTo reduce the severity of the infusion-relatedreactions, pretreatment with an antipyreticreactions, pretreatment with an antipyretic

(acetaminophen), antihistamines, and antiemetics(acetaminophen), antihistamines, and antiemeticsmay be given.may be given.

A test dose of 1 mg per 20 mL 5% dextrose inA test dose of 1 mg per 20 mL 5% dextrose inwater infused over 30 minutes should be given.water infused over 30 minutes should be given.

Use IV infusion pumps and the most distalUse IV infusion pumps and the most distalveins possible.veins possible.


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Nursing ImplicationsNursing Implications Tissue extravasation of fluconazole at the IVTissue extravasation of fluconazole at the IV

site may lead to tissue necrosismonitor IVsite may lead to tissue necrosismonitor IVsite carefully.site carefully.

Oral forms of griseofulvin should be givenOral forms of griseofulvin should be givenwith meals to decrease GI upset.with meals to decrease GI upset.

Monitor carefully for side/adverse effects.Monitor carefully for side/adverse effects.


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Nursing ImplicationsNursing ImplicationsMonitor for therapeutic effects:Monitor for therapeutic effects:

Easing of the symptoms of infectionEasing of the symptoms of infection

Improved energy levelsImproved energy levels

Normal vital signs, including temperatureNormal vital signs, including temperature

20 anti fun gals upd

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