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Antifungal Drugs. Antifungal Drugs. Drugs used to treat infections caused by fungi Systemic Topical. Antifungal Drugs Fungi. Very large and diverse group of microorganisms Broken down into yeasts and molds Fungal infections also known as mycoses

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antifungal drugs1
Antifungal Drugs

Drugs used to treat infections caused by fungi

  • Systemic
  • Topical
antifungal drugs fungi
Antifungal DrugsFungi
  • Very large and diverse group of microorganisms
    • Broken down into yeasts and molds
  • Fungal infections also known as mycoses
  • Some fungi are part of the normal flora of the skin, mouth, intestines, vagina
  • Reproduce by budding
  • Can be used for
    • Baking
    • Alcoholic beverages
antifungal drugs yeasts
Antifungal DrugsYeasts
  • Multicellular
  • Characterized by long, branching filaments called hyphae
antifungal drugs mycotic infections
Antifungal Drugs Mycotic Infections

Four general types

  • Cutaneous
  • Subcutaneous
  • Superficial
  • Systemic*

*Can be life threatening

*Usually occur in immunocompromised host

antifungal drugs mycotic infections1
Antifungal Drugs Mycotic Infections

Candida albicans

  • Due to antibiotic therapy, antineoplastics, or immunosuppressants (corticosteroids)
  • May result in overgrowth and systemic infections
  • Growth in the mouth is called thrush or oral candidiasis
  • Common in newborn infants and immunocompromised patients

Vaginal candidiasis

  • “Yeast infection”
  • Pregnancy, women with diabetes mellitus, women taking oral contraceptives
antifungal drugs2
Antifungal Drugs

Systemic

  • amphotericin B, caspofungin, fluconazole, ketoconazole, others

Topical

  • Examples: clotrimazole, miconazole, nystatin

Major groups based on their mechanisms of action

  • Polyenes: amphotericin B and nystatin
  • Imidazoles: ketoconazole (Nizoral)
  • Triazoles: fluconazole (Diflucan), itraconazole (Sporanox)
  • Echinocandins: caspofungin (Cancidas), micafungin
  • Listed individually, not by mechanism of action:
    • griseofulvin, flucytosine
antifungal drugs mechanism of action
Antifungal DrugsMechanism of Action

Polyenes: amphotericin B and nystatin

  • Bind to sterols in cell membrane lining
  • Result: fungal cell death
  • Do not bind to human cell membranes or kill human cells
  • Use: Serious systemic fungal infections
  • Administered: IV, PO, topical
antifungal drugs mechanism of action1
Antifungal Drugs Mechanism of Action

Flucytosine (Ancobon)

  • Also known as 5-fluorocytosine (antimetabolite)
  • Taken up by fungal cells and interferes with DNA synthesis
  • Result: fungal cell death
  • Use: Systemic mycoses due to Candida species or Cryptococcus neoformans – administered orally
antifungal drugs mechanism of action2
Antifungal Drugs Mechanism of Action

Imidazoles and triazoles:

Ketoconazole (Nizoral), fluconazole (Diflucan)

  • Inhibit fungal cell cytochrome P-450 enzymes, resulting in cell membrane leaking
  • Lead to altered cell membrane
  • Result: fungal cell death
  • Use: Ketoconazol (Nizoral): (po/topical): candidiasis, histoplasmosis, coccidoidomycosis; cutaneous candidiasis; tinea infections
  • Use: fluconazole (Diflucan): (po/IV): systemic, oral, esophageal or vaginal candidiasis; prevention of candidiasis after bone marrow transplant; cryptococcal meningitis.
antifungal drugs mechanism of action3
Antifungal Drugs Mechanism of Action

griseofulvin

  • Disrupts cell division
  • Result: inhibited fungal mitosis (reproduction)
  • Use: (po) Dermatophytosis (skin, hair, nails)
antifungal drugs mechanism of action4
Antifungal Drugs Mechanism of Action

Echinocandins:capsofungin (Cancidas)

  • Prevent the synthesis of glucans, which are essential components of fungal cell walls
  • Causes fungal cell death
  • Use: (IV) Invasive aspergillosis, Candidiasis
antifungal drugs indications
Antifungal Drugs Indications
  • Systemic and topical fungal infections
  • Drug of choice for the treatment of many severe systemic fungal infections is amphotericin B
  • Choice of drug depends on type and location of infection
antifungal drugs adverse effects amphotericin b
Antifungal Drugs Adverse Effects – Amphotericin B
  • Fever / Headache
  • Malaise
  • Hypotension
  • Muscle and joint pain
  • Lowered potassium and magnesium levels
  • Main concerns:
    • *Renal toxicity
    • *Neurotoxicity: seizures and paresthesias
  • Many other adverse effects
  • Chills
  • Dysrhythmias
  • Nausea
  • Anorexia
antifungal drugs adverse effects
Antifungal Drugs Adverse Effects

Fluconazole (Diflucan)

  • Nausea, vomiting, diarrhea, stomach pain,
  • increased liver function studies

Flucytosine (Ancobon)

  • Nausea, vomiting, anorexia, headache, dizziness, others

griseofulvin

  • Rash, urticaria, headache, nausea, vomiting, anorexia, others
antifungal drugs contraindications
Antifungal Drugs Contraindications
  • Liver failure
  • Renal failure
  • Porphyria: genetic disorder-erythrocyte formation/liver dysfunction (griseofulvin)
antifungal drugs interactions
Antifungal Drugs Interactions
  • Many antifungal drugs are metabolized by the cytochrome P-450 enzyme system
  • Co administration of two drugs that are metabolized by this system may result in competition for these enzymes, and thus higher levels of one of the drugs
antifungal drugs nursing implications
Antifungal Drugs Nursing Implications
  • Before beginning therapy, assess for hypersensitivity, contraindications, and conditions that require cautious use
  • Obtain baseline VS, CBC, liver and renal function studies, and EKG
  • Assess for other medications used (prescribed and OTC) in order to avoid drug interactions
  • Follow manufacturer’s directions reconstitution and administration
  • Monitor VS of patients receiving IV infusions every 15 to 30 minutes
  • During IV infusions, monitor I&O to identify adverse effects
antifungal drugs nursing implications1
Antifungal Drugs Nursing Implications

amphotericin B

  • To reduce the severity of the infusion-related reactions, pretreatment with an antipyretic (acetaminophen), antihistamines, antiemetics, and corticosteroid may be given
  • Use IV infusion pumps and the most distal veins possible
  • Some oral forms should be given with meals to decrease GI upset; others require an empty stomach—be sure to check
antifungal drugs nursing implications2
Antifungal Drugs Nursing Implications
  • Nystatin given as an oral lozenge should be slowly and completely dissolved in the mouth
    • (not chewed or swallowed whole)
  • Nystatin suspension should be swished thoroughly in the mouth as long as possible before swallowing
  • Monitor for therapeutic effects
    • Easing of the symptoms of infection
    • Improved energy levels
    • Normal vital signs, including temperature

Monitor carefully for adverse effects