ANTI - FUNGAL

FUNGI PATIENTS SUSCEPTIBLE TO FUNGAL

- known as mycoses INFECTIONS
- large and diverse group of microorganisms - px w/ AIDS and AIDS-related complex (ARC)
-rigid cell wall -taking immunosuppresants drugs
- made up of chitin and a cell membrane -undergone transplantation surgery or cancer
containing ergosterol treatment
- broken down into yeast and molds -members of growing elderly
-protective layers of fungal cell
-make the organism resistant to antibiotics CULTURE
-should obtain prior to prescribing anti-fungal
YEAST agents
- single- cell fungi -px on anti-fungal agents are typically
- reproduce by budding immunosuppressed
-useful organisms -should not be placed at additional risk for incorrect
-baking agent and toxic effects
-alcoholic beverages RESISTANCE TO ANTIBACTERIALS
MOLDS  SENSITIVE BACTERIA
- multicellular - pathogen is destroyed or inhibited
- long, branching filaments called hyphae  RESISTANT BACTERIA
- pathogen continues to grow, despite the
MYCOTIC INFECTIONS administration of the antibacterial drug
- four general types
-cutaneous COMMON SYSTEMIC ANTIFUNGAL
-subcutaneous AGENTS
-superficial  Caspofungin (Cancidas) (IV)
-systemic -treatment of invasive aspergillosis in px
-can be life threatening who are refractory to other treatments
-occur in immunocompromised host  Fluccytosine (Ancobon) (Oral)
 Candida Albicans - less toxic drug
-due to antibiotic therapy, antineoplastics, -treatment of systemic infections caused by
or immunosuppresants Candida or Crypococcus
-result in overgrowth and systemic infections  Nystatin (Mycostatin, Nilstat) (Oral)
 In the mouth - treatment of intestinal candidiasis
- oral candidiasis pr thrush -available in number of topical preparations
-newborn infants and immunocompromised ANTIFUNGALS ACROSS THE LIFE SPAN
patients - CHILDREN
 Vaginal candidiasis -sensitive to effects of antifungal
-yeast infection -more severe reactions
- pregnancy, diabetes mellitus, oral -do not have proven safety and efficacy
contraceptives -extreme caution should be exercised when
using them
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-fluconazole, ketoconazole, terbinafine, and -clotrimazole
griseofulvin established pediatric doses and drugs of -miconazole
choice -nystatin
-topical agents should not be used over open
or draining areas AZOLE ANTIFUNGALS
-occlusive dressings should be avoided over -used to treat systemic and topical fungal infections
affected areas -less toxic
-ADULTS -less effective in very severe and progressive
-can be very toxic to the body infections
-pregnant and nursing women should not  Indications
use -used to treat systemic fungal infections
-women of childbearing should be advised -less toxic than amphotericin B but less
to use barrier effective
-severe fungal infection may threaten the life -bind to sterols and cause cell death , inhibit
of mother and/or fetus glucan synthesis
 Pharmacokinetics
-OLDER ADULTS - absrobed rapidly from GI Tract
-more susceptible to the adverse effects - metabolized in the liver
-px w/ hepatic dysfuction are at increased - excreted in urine and feces
risk of worsening hepatic problems and toxic effects  Contraindication
-if hepatic dysfunction is expected, the dose - hepatic and renal dysfunction
may need to be lowered -pregnancy and lactation and drugs that
-associated w/ renal toxicity, should be used prolong the QTc interval
cautiously in the presence of renal impairment -endocrine or fertility problems
 Adverse effect
ANTIFUNGAL AGENTS -liver toxicity and tetrogenic effects
 Systemic Anti fungal -severe effects on a fetus or a nursing baby.
-annoying (athletes foot) potentialy fatal  Drug to drug Interaction
systemic infection -many
-used to treat systemic fungal infection  Therapeutic Action
-can be toxic to the host and not used -these drugs bind to sterols and can caused
indiscriminately cell death ( a fungicidal effect) or interfere with cell
-important to get a culture to ensure thet replication (a fungistatic effect)
the right drug is being used  Azole include:
Example : -fluconazole (diflucan)
-amphotericin b -treatment of candidiasis, cryptococcal,
-fluconazole meningitis
-ketoconazole -Prophylaxis for reducing the incidence of
-itraconazole candidiasis in bone marrow transplant
 Topical recipients.
example : -itraconazole (sporanox)
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-Blastomycosis, histoplasmosis and -hepatic toxicity
aspergillosis -Hypersensitivity reactions
-ketoconazole (nizoral) -bone marrow suppression
-Treatment of aspergillosis, leishmaniasis, OTHER ANTIFUNGALS AGENTS
cryptococcosis, blastomycosis, moniliasis, POLYENES : AMPHOTERICIN B &
coccidioidomycosis, histoplasmosis, and NYSTATIN
mucormycosis -Bind to sterols in cell membrane lining
-Topical treatment of mycoses, to reduce the -Allow K+ & Mg++ to leak out, altering
scaling of dandruff fungal cell metabolism
-posaconazole (noxofi l) -Result: fungal cell death
-Prophylaxis of invasive Aspergillus and  Indications
Candida infections in adults and children >13 y -Very potent
who are immunosuppressed -reserved for progressive potential fatal
-terbinafi ne (lamisil) fungal infections
-voriconazole (vfend)  Pharmacokinetics
-Treatment of invasive aspergillosis; - IV form only, metabolism not well
ECHINOCANDIN ANTIFUNGALS understood, excreted in the urine
 Therapeutic Actions  Contraindications
- work by inhibiting glucan synthesis. -Pregnancy, lactation and renal impairment
-glucan is an enzyme; present in fungal cell  Adverse Effect
wall but not in human well walls - related to their toxic effects on the liver
-the fungal cell wall cannot form, leading to and kidneys
death of the cell wall -severe renal impairment and bone marrow
-Caspofungin suppression
-Treatment of invasive aspergilllosis  Drug-to-drug Interaction
-px who are refactory or intolerant to other -Nephrotoxic antibiotics or antineoplastics,
therapy cyclosporine, or corticosteroids
-Anidulafungin FLUCYTOSINE
-Treatment of candidemia (infection of the -Also known as 5-fluorocytosine
blood stream) (antimetabolite)
-Candida infection -Taken up by fungal cells and interferes with
-Intraabdominal infections DNA synthesis
-esophageal candidiasis -Result: fungal cell death
-Micafungin  Indications
-esophageal candidiasis; -Prevent the fungal cells from reproducing
prophylaxis of Candida infections in patients with by altering the cell membrane
hematopoietic stem cell transplant
 Contraindications and Cautions:  Pharmacokinetics
-pregnant or lactating women. -IV form only, metabolism not well
-hepatic impairment understood, excreted in the urine
 Adverse Effects:  Contraindications
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-Pregnancy, lactation and renal impairment -Limited to known allergy to any of these
 Adverse Effect drugs
-Toxic effects on the liver and kidneys and  Adverse Reactions
bone marrow suppression -Irritation, burning, rash, and swelling at the
 Drug-to-drug Interaction site
-Nephrotoxic antibiotics or antineoplastics,  Drug-to-drug Interactions
cyclosporine, or corticosteroids -Unknown
Amphotericin B
GRISEOFULVIN -cutaneous and mucocutaneous candida
-Disrupts cell division infections
-Result: inhibited fungal mitosis Gentian violet
(reproduction) -topical mycosis
-Amphotericin Butenafine
-Treatment of aspergillosis, leishmaniasis, -tinea infection
cryptococcosis, blastomycosis, moniliasis, Butoconazole
coccidioidomycosis, histoplasmosis, and -OTC for vaginal candida infections
mucormycosis. Ciclopirox
-Topical treatment of resistant candida. -tinea infection, toenail and fingernail tinea
-Flucytosine infection
-Treatment of candidiasis, cryptococcosis Clotrimazole
-Griseofulvin -oral & vagina candida, tinea infection
-Treatment of tinea corporis, tinea pedis, Econazole
tinea cruris, tinea barbae, tinea capitis, and tinea -tinea infection
unguium. Haloprogin
-Nystatin -athlete’s foot, ring worm
-Treatment of candidiasis Miconazole
TOPICAL ANTIFUNGAL AGENTS -local, topical mycosis, including bladder
-antifungal drugs are available only in a topical for and vagina infection, athlete’s foot
a treating a variety of micosis of the skin and mucus Oxiconazole
membrains. -short-term( up to 4 wks ) topical mycosis
-Fungi cause infection are called dermatophytes. Naftifine
 Indication -short-term( up to 4 wks ) severe topical
-work to alter the cell permeability of the mycosis
fungus, Terbinafine
-causing prevention of replication and -short-term( 1-4 wks ) topical mycosis
fungal death, indicated only for local treatment of Tolnaftate (lamisil)
mycoses, including tinea infections -OTC for athlete's foot
 Pharmacokinetics Undecyclenic acid
-Not systemic -OTC for athlete’s foot, diaper rash,
 Contraindications burning and chafing in the groin area

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ANTIFUNGAL AGENTS: SIDE EFFECTS -Amphotericin B
AMPHOTERICIN B: “SHAKE AND -To reduce the severity of the
BAKE” infusion-related reactions, pretreatment with
-fever, chills, headache, anorexia, an antipyretic (acetaminophen),
malaise, nausea, hypotension, tachycardia, antihistamines, and antiemetics may be
muscle and joint pain given.
-lowered potassium and magnesium -A test dose of 1 mg per 20 mL
levels 5% dextrose in water infused over 30
*renal toxicity minutes should be given.
*neurotoxicity: seizures and -Use IV infusion pumps and
paresthesias the most distal veins possible.
FLUCONAZOLE -Tissue extravasation of fluconazole at
-nausea, vomiting, diarrhea, the IV site may lead to tissue necrosis—
abdominal pain, monitor IV site carefully.
-increased liver function studies -Oral forms of griseofulvin should be
FLUCYTOSINE given with meals to decrease GI upset.
-nausea, vomiting, anorexia -Monitor carefully for side/adverse
GRISEOFULVIN effects.
-rash, urticaria, headache, nausea, -Monitor for therapeutic effects:
vomiting, anorexia -Easing of the symptoms of
ANTIFUNGAL AGENTS: NURSING infection
IMPLICATIONS -Improved energy levels
-Before beginning therapy, assess for -Normal vital signs, including
hypersensitivity, possible contraindications, temperature
and conditions that require cautious use. NURSING CONSIDERATIONS FOR
-Obtain baseline VS, CBC, liver SYSTEMIC ANTIFUNGAL AGENTS
function studies, and ECG. -Assess:
-Assess for other medications used -History of allergy to antifungal
(prescribed and OTC) in order to avoid -Physical status
drug interactions. -Culture of the infected area
-Follow manufacturer’s directions -Renal and hepatic function tests and
carefully for reconstitution and CBC
administration. NURSING CONSIDERATIONS FOR
-Monitor VS of patients receiving IV TOPICAL ANTIFUNGAL AGENTS
infusions every 15 to 30 minutes. -Assess:
-During IV infusions, monitor I & O -History of allergy to antifungal
and urinalysis findings to identify adverse -Physical status
renal effects. -Culture of the infected area
-Renal and hepatic function tests and
CBC