Exam 1: Antiviral & Antifungal
Pharmacotherapy
Example of polyene antifungals - Answer -Amphotericin B
-Nystatin
-Micafungin
Example of antifungals ending in -azole - Answer •Fluconazole
•Itraconazole
•Ketaconazole
•Voriconazole
•Miconazole
What is amphotericin B - Answer -antifungal
-used for systemic infections
-comes in 2 forms: conventional and lipid forms
Indication for amphotericin B - Answer -usually reserved for a progressive, potentially
fatal systemic fungal infection
Route of Amphotericin B
-Fungizone
-lipid formulations (Ampho B lipid complex (Abelcet), liposomal ampho B (AmBisome). -
Answer Conventional:
-Fungizone
-IV
-nephrotoxicity is a huge SE
Lipid forms
-less side effects
MOA of Amphotericin B - Answer Binds to sterols in fungal membranes, which causes
pores and channels to form.
This increased permeability leads to cell contents to leak out and subsequent death of
the cell.
Why is Amphotericin B called 'amphoterrible'? - Answer The MOA of amph B involves
the drug binding to sterols and causing the cell to die, due to its contents leaking out
from the pores that form.
Human cells contain sterols as well... So the effects that the drug has on fungus does
the same thing to humans, which makes it hard to tolerate.
, SE of Amphotericin B (fungizone)? - Answer -nephrotoxicity
Infusion-related reactions
-H/A
-chills
-fever
-rigors
-hypotention
NI for Amphotericin B - Answer Pre-Admin
-pre-medicate with diphenhydramine (Benadryl) and acetaminophen (Tylenol) to
prevent fever and allergic reactions.
Infusion
-IV infused over at least 4 hours.
-Abelcet >2 hours
-Ambisome > 2.5 mg/kg/hr
-start with low dose and build up to a daily dose
Rigors
-if develop, give dantrolene and meperidine (Demerol)
What is nystatin (Mycostatin)? - Answer An antifungal belonging to the polyene class.
Indication for Nystatin - Answer fungal infections of the skin, mouth, esophagus, and
vagina.
NI for Nystatin (Mycostatin) - Answer Teach
-swish and swallow
-
SE for Nystatin (Mycostatin) - Answer -this is highly toxic, so should not be used
systemically
-this is poorly absorbed from GI tract, so swish and swallow is ok.
Indication for Mycafungin (Mycamine) - Answer -esophageal candidiasis
-candidemia
-disseminated candidiasis
Route for Mycafungin (Mycamine) - Answer IV
NI for Mycafungin (Mycamine) - Answer -give IV > hour
-must be light protected
MOA of fluconazole (Diflucan) - Answer inhibit ergosterol or cell membrane synthesis of
a fungus.
Pharmacotherapy
Example of polyene antifungals - Answer -Amphotericin B
-Nystatin
-Micafungin
Example of antifungals ending in -azole - Answer •Fluconazole
•Itraconazole
•Ketaconazole
•Voriconazole
•Miconazole
What is amphotericin B - Answer -antifungal
-used for systemic infections
-comes in 2 forms: conventional and lipid forms
Indication for amphotericin B - Answer -usually reserved for a progressive, potentially
fatal systemic fungal infection
Route of Amphotericin B
-Fungizone
-lipid formulations (Ampho B lipid complex (Abelcet), liposomal ampho B (AmBisome). -
Answer Conventional:
-Fungizone
-IV
-nephrotoxicity is a huge SE
Lipid forms
-less side effects
MOA of Amphotericin B - Answer Binds to sterols in fungal membranes, which causes
pores and channels to form.
This increased permeability leads to cell contents to leak out and subsequent death of
the cell.
Why is Amphotericin B called 'amphoterrible'? - Answer The MOA of amph B involves
the drug binding to sterols and causing the cell to die, due to its contents leaking out
from the pores that form.
Human cells contain sterols as well... So the effects that the drug has on fungus does
the same thing to humans, which makes it hard to tolerate.
, SE of Amphotericin B (fungizone)? - Answer -nephrotoxicity
Infusion-related reactions
-H/A
-chills
-fever
-rigors
-hypotention
NI for Amphotericin B - Answer Pre-Admin
-pre-medicate with diphenhydramine (Benadryl) and acetaminophen (Tylenol) to
prevent fever and allergic reactions.
Infusion
-IV infused over at least 4 hours.
-Abelcet >2 hours
-Ambisome > 2.5 mg/kg/hr
-start with low dose and build up to a daily dose
Rigors
-if develop, give dantrolene and meperidine (Demerol)
What is nystatin (Mycostatin)? - Answer An antifungal belonging to the polyene class.
Indication for Nystatin - Answer fungal infections of the skin, mouth, esophagus, and
vagina.
NI for Nystatin (Mycostatin) - Answer Teach
-swish and swallow
-
SE for Nystatin (Mycostatin) - Answer -this is highly toxic, so should not be used
systemically
-this is poorly absorbed from GI tract, so swish and swallow is ok.
Indication for Mycafungin (Mycamine) - Answer -esophageal candidiasis
-candidemia
-disseminated candidiasis
Route for Mycafungin (Mycamine) - Answer IV
NI for Mycafungin (Mycamine) - Answer -give IV > hour
-must be light protected
MOA of fluconazole (Diflucan) - Answer inhibit ergosterol or cell membrane synthesis of
a fungus.
