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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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Copyright 2002, 1998, Elsevier Science (USA). All rights reserved.
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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Copyright 2002, 1998, Elsevier Science (USA). All rights reserved.
MoldsMolds
MulticellularMulticellular
Characterized by long, branching filamentsCharacterized by long, branching filaments
called hyphaecalled hyphae
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Copyright 2002, 1998, Elsevier Science (USA). All rights reserved.
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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Copyright 2002, 1998, Elsevier Science (USA). All rights reserved.
Mycotic InfectionsMycotic Infections
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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Copyright 2002, 1998, Elsevier Science (USA). All rights reserved.
Mycotic InfectionsMycotic Infections
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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Copyright 2002, 1998, Elsevier Science (USA). All rights reserved.
Mycotic InfectionsMycotic Infections
Vaginal candidiasis:Vaginal candidiasis:
Yeast infectionYeast infection
Pregnancy, diabetes mellitus, oral contraceptivesPregnancy, diabetes mellitus, oral contraceptives
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Copyright 2002, 1998, Elsevier Science (USA). All rights reserved.
Antifungal AgentsAntifungal Agents
SystemicSystemic
Examples: amphotericin B, fluconazole,Examples: amphotericin B, fluconazole,
ketoconazole, itraconazoleketoconazole, itraconazole
TopicalTopical
Examples: clotrimazole, miconazole, nystatinExamples: clotrimazole, miconazole, nystatin
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Copyright 2002, 1998, Elsevier Science (USA). All rights reserved.
Antifungal AgentsAntifungal Agents
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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Copyright 2002, 1998, Elsevier Science (USA). All rights reserved.
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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Copyright 2002, 1998, Elsevier Science (USA). All rights reserved.
Antifungal Agents:Antifungal Agents:
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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Copyright 2002, 1998, Elsevier Science (USA). All rights reserved.
Antifungal Agents:Antifungal Agents:
Mechanism of ActionMechanism of Actiongriseofulvingriseofulvin
Disrupts cell divisionDisrupts cell division
Result: inhibited fungal mitosis (reproduction)Result: inhibited fungal mitosis (reproduction)
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Copyright 2002, 1998, Elsevier Science (USA). All rights reserved.
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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Copyright 2002, 1998, Elsevier Science (USA). All rights reserved.
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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Copyright 2002, 1998, Elsevier Science (USA). All rights reserved.
Antifungal Agents:Antifungal Agents:
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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Copyright 2002, 1998, Elsevier Science (USA). All rights reserved.
Antifungal Agents:Antifungal Agents:
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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Copyright 2002, 1998, Elsevier Science (USA). All rights reserved.
Antifungal Agents:Antifungal Agents:
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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Copyright 2002, 1998, Elsevier Science (USA). All rights reserved.
Antifungal Agents:Antifungal Agents:
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