Chapter 11:
Antifungal Agents
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How Fungus Differs from Bacteria
Fungus
o Composed of a rigid cell wall made up of chitin and
various polysaccharides, and a cell membrane
containing ergosterol.
o Protective layers of the fungal cell make the
organism resistant to antibiotics.
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Patients Susceptible to Fungal Infections
Patients with AIDS and AIDS-related complex (ARC)
Patients taking immunosuppressant drugs
Patients who have undergone transplantation surgery or
cancer treatment
Members of growing elderly population no longer
protected from environmental fungi
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Culture
A culture should be obtained prior to prescribing anti-
fungal agents.
Patients on antifungal agents are typically
immunosuppressed and should not be placed at
additional risks for incorrect agent and toxic effects.
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Most Common Systemic Antifungal Agents
Caspofungin (Cancidas) (IV)
o Approved for the treatment of invasive aspergillosis
in patients who are refractory to other treatments
Flucytosine (Ancobon) (Oral)
o Less toxic drug used for the treatment of systemic
infections caused by Candida or Cryptococcus
Nystatin (Mycostatin, Nilstat) (Oral)
o Used for the treatment of intestinal candidiasis; also
available in a number of topical preparations
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Use of Antifungals Across the Life Span
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Site of Action of Antifungals
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Azoles
Indications - Newer class of drugs used to treat
systemic fungal infections, less toxic than amphotericin
B but also less effective, bind to sterols and can cause
cell death, inhibit glucan synthesis
Pharmacokinetics – Absorbed rapidly from the GI
tract, metabolized in the liver and excreted in urine and
feces
Contraindications – Hepatic and renal dysfunction,
pregnancy and lactation and drugs that prolong the QTc
interval
Adverse effect- Liver toxicity and tetrogenic effects
Drug-to–Drug Interaction- Many
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Echinocandin Antifungals
Indications – Another group of antifungals, inhibit
glucan synthesis leading to death of the cell wall
Pharmacokinetics – Given IV, rapid onset, metabolized
degradation and excreted in feces
Contraindications – Hepatic /renal dysfunction,
pregnancy and lactation
Adverse effect- Liver toxicity, tetrogenic effects and
bone marrow supression
Drug-to–Drug Interaction- Cyclosporine
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Question #1
Please answer the following statement as true or false.
Nystatin, taken orally, is used for the treatment of
intestinal candidiasis.
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Answer to Question #1
True
Rationale: Nystatin (Mycostatin, Nilstat) (Oral)
o Used for the treatment of intestinal candidiasis; also
available as a topical preparation.
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Other Antifungal Agents : Amphotericin B
Indications – Very potent – reserved for progressive
potential fatal fungal infections
Pharmacokinetics - IV form only, metabolism not well
understood, excreted in the urine
Contraindications – Pregnancy, lactation and renal
impairment
Adverse Effect - related to their toxic effects on the
liver and kidneys, severe renal impairment and bone
marrow suppression
Drug-to-drug Interaction- Nephrotoxic antibiotics or
antineoplastics, cyclosporine, or corticosteroids
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Other Antifungal Agents : Flucytosine
Indications – Prevent the fungal cells from reproducing
by altering the cell membrane
Pharmacokinetics – IV form only, metabolism not well
understood, excreted in the urine
Contraindications – Pregnancy, lactation and renal
impairment
Adverse Effect – Toxic effects on the liver and kidneys
and bone marrow suppression
Drug-to-drug Interaction- Nephrotoxic antibiotics or
antineoplastics, cyclosporine, or corticosteroids
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Topical Antifungal Agents
Indication- Work to alter the cell permeability of the
fungus, causing prevention of replication and fungal
death, indicated only for local treatment of mycoses,
including tinea infections
Pharmacokinetics- Not systemic
Contraindications- Limited to known allergy to any of
these drugs
Adverse Reactions- Irritation, burning, rash, and
swelling at the site
Drug-to-drug Interactions: Unknown
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Question #2
Which of the following is considered a contraindication
of Ketoconazole ?
A. Patients with renal problems
B. Patients with fertility problems
C. Patients with hepatic problems
D. Patients with GI problems
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Answer to Question #2
B. Patients with fertility problems
Rationale: Contraindications – not drug of choice for
patients with endocrine or fertility problems.
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Nursing Considerations for Systemic
Antifungal Agents
Assess:
– History of allergy to antifungal
– Physical status
– Culture of the infected area
– Renal and hepatic function tests and CBC
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Nursing Considerations for Topical
Antifungal Agents
Assess:
– Known allergy to any topical antifungal agent
– Physical status
– Culture and sensitivity testing
– Area of application for color, temperature, and
evidence of lesions
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Prototype Antifungal Agent #1
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Prototype Antifungal Agent #2
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Prototype Antifungal Agent #3
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Question #3
The nurse is caring for a patient with a fungal infection.
Which of the following would be considered an adverse
effect of an antifungal medication?
A. Burning or irritation in the sexual partner
B. Abnormal kidney function tests
C. Upper abdominal pain
D. Urinary retention
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Answer to Question #3
A. Burning or irritation in the sexual partner
Rationale: Adverse effects: Troche: nausea, vomiting,
abnormal liver function tests; topical: stinging, redness,
urticaria, edema; vaginal: lower abdominal pain, urinary
frequency, burning or irritation in the sexual partner
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