NR566 WEEK 2
Amphotericin B
-polyene macrolide
-broad spectrum antifungal
HIGHLY TOXIC
-only given for infections that are progressive and potentially fatal
- given IV only
Amphotericin B Black Box Warning
should only be used in the setting of a potentially life-threatening infection
Amphotericin B side effects
-infusion reactions (fever, chills,rigors, nausea, headache)
-neprhotoxic
-bone marrow suppression
Drug interactions with Amphotericin B
increased risk for kidney damage when used with other nephrotoxic drugs such
as:
aminoglycosides
cyclsoporine
NSAIDs
Azoles for systemic mycoses
itraconazole
ketoconazole
fluconazole
voriconazole
posaconazole
isavuconazonium
Itraconazole (Sporanox)
, -alternative to amph b for systemic mycoses
- safer; oral dosing
- adverse effects cardiosupporession and liver injury
-causes transient decrease in EF
-administration with cola enhances absorption
Itraconazole Black Box Warning
negative inotropic actions; should not be used for superficial fungal infections,
patients with HF, hx of HF or other indications of ventricular dysfunction
Drug interactios with Itraconazole
-cyclosporine
-warfarin
-sulfonylurea-type oral hypoglycemics
-digoxin
-quinidine
-give antacids 1 hour before or 2 hours after
Prescribing Considerations for Azoles
-use with caution in patients with liver disease
-avoid use with drugs metabolized by cyp3a4:
-warfarin
-cyclosporine
-digoxin
-quinidine
Lifespan considerations for Azoles
ketoconazole has high potential for hepatotoxicity; do not use in breastfeeding
women
Treatment for tines pedis (athlete's foot)
Topical ketaconazole (antifungal)
Terbinafine
Amphotericin B
-polyene macrolide
-broad spectrum antifungal
HIGHLY TOXIC
-only given for infections that are progressive and potentially fatal
- given IV only
Amphotericin B Black Box Warning
should only be used in the setting of a potentially life-threatening infection
Amphotericin B side effects
-infusion reactions (fever, chills,rigors, nausea, headache)
-neprhotoxic
-bone marrow suppression
Drug interactions with Amphotericin B
increased risk for kidney damage when used with other nephrotoxic drugs such
as:
aminoglycosides
cyclsoporine
NSAIDs
Azoles for systemic mycoses
itraconazole
ketoconazole
fluconazole
voriconazole
posaconazole
isavuconazonium
Itraconazole (Sporanox)
, -alternative to amph b for systemic mycoses
- safer; oral dosing
- adverse effects cardiosupporession and liver injury
-causes transient decrease in EF
-administration with cola enhances absorption
Itraconazole Black Box Warning
negative inotropic actions; should not be used for superficial fungal infections,
patients with HF, hx of HF or other indications of ventricular dysfunction
Drug interactios with Itraconazole
-cyclosporine
-warfarin
-sulfonylurea-type oral hypoglycemics
-digoxin
-quinidine
-give antacids 1 hour before or 2 hours after
Prescribing Considerations for Azoles
-use with caution in patients with liver disease
-avoid use with drugs metabolized by cyp3a4:
-warfarin
-cyclosporine
-digoxin
-quinidine
Lifespan considerations for Azoles
ketoconazole has high potential for hepatotoxicity; do not use in breastfeeding
women
Treatment for tines pedis (athlete's foot)
Topical ketaconazole (antifungal)
Terbinafine
